Exercise-induced cardiac remodeling, known as the "athlete's heart," corresponds to morphological and functional adaptations of the left ventricle in response to prolonged physical training. It is characterized in particular by physiological hypertrophy and improved myocardial function.
Intraventricular blood flow interacts with cardiac mechanics. Regional shape (e.g., sphericity, wall curvature) and myocardial deformations guide flow patterns to create an optimal hemodynamic environment. The interaction between these different parameters in the athlete's heart remains insufficiently explored. In this context, 3D echocardiography makes it possible to combine indices derived from fluid dynamics, regional myocardial function, and cardiac geometry, enabling a comprehensive assessment of cardiac performance.
Primary and secondary objectives:
In this context, the aim of this project is to investigate the relationship between intraventricular flow and cardiac mechanics based on combined measurements of intraventricular flow (e.g., vorticity, pressure gradients), regional myocardial function (e.g., myocardial strain), and global/regional LV geometry (e.g., sphericity, wall curvature) in the athlete's heart. Since these parameters are interdependent, analyzing their interaction through the development of new echocardiographic tools based on 4D assessments will enable a comprehensive evaluation of functional improvements in the athlete's heart.
The secondary objectives are to analyze the impact of dyssynchrony on intraventricular flow, to evaluate the influence of primary and secondary deformations on intraventricular flow, and to study cardiac function from an energetic perspective using non-invasive reconstruction of pressure-volume loops for cardiac work estimation.
Methodology:
The study will include 80 endurance athletes (ENT group) and 80 control subjects (CONT group). The main inclusion criteria common to both groups are: men and women aged 18-45 years, with no known heart disease and no cardiovascular risk factors (e.g., body mass index \> 30 kg/m², arterial hypertension). Athletes must train at least 10 hours per week for the past 5 years. Control subjects must not engage in more than 3 hours of physical activity per week.
Athletes will be recruited from elite groups of various federations, during local long-distance races, or during clinical evaluations at Montpellier University Hospital (Dr. C. Hédon's department). Control subjects will be recruited in the Avignon area and in the cardiology department of Montpellier University Hospital during routine visits.
Echocardiographic examinations will be performed in the left lateral decubitus position using Vivid systems with 4D probes. 4D and tri-plane acquisitions with color Doppler will allow assessment of cardiac structure and intraventricular flow. Data analysis will be performed using TOMTEC software, and scripts developed in Matlab and RStudio will process information related to shape, mechanical dispersion, and dyssynchrony. Intraventricular hemodynamics will be analyzed in collaboration with the CREATIS laboratory (D. Garcia), particularly through measurements of intraventricular pressure gradients and vorticity indices.
None
History of known heart disease;
Current cardiac rhythm disorder;
Individual with one or more cardiovascular risk factors (smoking, diabetes, hypertension, body mass index > 30 kg/m²);
Individual in a period of relative exclusion in relation to another protocol, or for whom the annual maximum compensation amount of €4,500 has been reached;
Participants in the ENT group will be recruited: * At Montpellier University Hospital, in the cardiology department of Dr Hédon, during a follow-up visit. * At various national training centers of the French Triathlon Federation and the French Athletics Federation; * During local long-distance events (e.g., long-distance triathlons, ultramarathons), with assessments carried out at the time of race bib collection. Healthy participants will be recruited in parallel In Avignon and the surrounding area. Some participants from the CONT or ENT groups will also be recruited in the cardiology department of Dr Hédon at Montpellier University Hospital during a follow-up visit, for example as part of systematic cardiovascular screening. These participants will have undergone a preventive cardiology consultation that revealed no abnormalities or pathology. If these participants meet all inclusion criteria, they may then be included in the study.
Cohort
Cross-sectional
Not listed
Left ventricular principal strains
The investigators will assess left ventricular principal strains in resting conditions using 3D echocardiography in the two groups.
Left ventricular secondary strains
The investigators will assess left ventricular secondary strains in resting conditions using 3D echocardiography in the two groups.
Left ventricular principal and secondary strain rates
The investigators will assess left ventricular principal and secondary strain rates in resting conditions using 3D echocardiography in the two groups.
Left ventricular global longitudinal strains
The investigators will assess left ventricular global longitudinal strains in resting conditions using 3D echocardiography in the two groups.
Left ventricular global longitudinal strain rates
The investigators will assess left ventricular global longitudinal strain rates in resting conditions using 3D echocardiography in the two groups.
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University of Avignon
Lead sponsor
CHU Arnaud de Villeneuve MONTPELLIER
Collaborator
