Key result
Global longitudinal strain shows heterogeneous patterns across athletic disciplines and transient post-exercise changes, with a ≥-18% cut-off offering 79% specificity for pathological hypertrophy.
Why the study?
Global longitudinal strain may detect subtle systolic function changes across distinct patterns of exercise adaptation, prompting an evaluation of its alterations across athletic disciplines and its clinical interpretation in physiological versus pathological cardiac remodelling.
Does global longitudinal strain (GLS) assessed by speckle-tracking echocardiography vary across different athletic disciplines and exercise regimens, and can it help differentiate physiological from pathological cardiac remodelling in athletes?
Does global longitudinal strain (GLS) assessed by speckle-tracking echocardiography vary across different athletic disciplines and exercise regimens, and can it help differentiate physiological from pathological cardiac remodelling in athletes?
Global longitudinal strain (GLS) exhibits heterogeneous adaptations across different sports and acute versus chronic exercise, requiring clinicians to interpret GLS in the context of athletic discipline, loading conditions, and ventricular geometry rather than relying on a single universal cut-off to distinguish athlete's heart from pathological hypertrophy.
Background: Cardiac structure and haemodynamic parameters reflect distinct patterns of adaptation to exercise. Global longitudinal strain (GLS) is an echocardiographic measure of myocardial deformation that may detect subtle changes in systolic function. Aim: This paper aims to analyze changes in GLS associated with different athletic disciplines, training characteristics and acute exercise, and to discuss the clinical interpretation of GLS in physiological versus pathological cardiac remodelling. Material and methods: Literature data on the use of GLS in athletes and in the assessment of exercise-related cardiac remodelling were analyzed. This narrative review included studies published between 2010 and 2025 retrieved from PubMed, Scopus, and Web of Science using combinations of the terms GLS, speckle-tracking echocardiography, strain analysis and athlete’s heart. Results: The reviewed studies demonstrate heterogeneous GLS patterns among athletes and across athletic disciplines. Acute prolonged exercise may produce transient changes in myocardial strain, whereas chronic training is associated with variable adaptations depending on exercise modality and cardiac remodelling. Conclusions: GLS should not be interpreted using a single athlete-specific threshold. Its interpretation should consider athletic discipline, training status, ventricular geometry, loading conditions and the timing of measurement relative to exercise.
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Kosiorek et al. (2026) conducted a review in Exercise-related cardiac remodelling (athlete's heart) vs. pathological cardiac remodelling. Global longitudinal strain (GLS) via speckle-tracking echocardiography across acute and chronic exercise vs. Healthy non-athletic controls and patients with pathological left ventricular hypertrophy was evaluated on Changes in global longitudinal strain (GLS) and differentiation of physiological from pathological cardiac remodelling. Global longitudinal strain shows heterogeneous patterns across athletic disciplines and transient post-exercise changes, with a ≥-18% cut-off offering 79% specificity for pathological hypertrophy.
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