Background: Assessment of the athlete's heart remains challenging due to a phenotypic overlap between reactive physiological adaptation and pathological remodelling. The potential value of myocardial deformation remains controversial in identifying early cardiomyopathy.

Objective: This study sought to identify the echocardiographic phenotype of athletes using advanced 2D speckle tracking imaging and to define predictive factors of subtle left ventricular (LV) systolic dysfunction.

Methods and results: 191 healthy male athletes who underwent a pre-participation medical evaluation at Nancy University Hospital between 2013 and 2020 were included. Clinical and echocardiographic data were compared with 161 healthy male subjects from the STANISLAS cohort. Borderline GLS value was defined as a GLS <17.5%. Athletes demonstrated lower LVEF (57.9 ± 5.3 vs 62.6 ± 6.4%; p<0.01) and lower GLS (17.5 ± 2.2 vs 21.1 ± 2.1%; p<0.01). No significant differences were found between athletes with and without borderline GLS value regarding clinical characteristics, structural echocardiographic features, and exercise capacity. Borderline GLS value was associated with both decreased endocardial GLS (18.8% vs 22.7%; p<0.02) and epicardial GLS (14.0% vs 16.6%; p<0.01) with a greater endocardial/epicardial GLS ratio (1.36 ± 0.07 vs 1.32 ± 0.06; p<0.01). No significant difference was found regarding mechanical dispersion (p=0.46).

Borderline GLS value in athletes does not appear to be related to structural remodelling, mechanical dispersion or exercise capacity. The athlete's heart is characterized by a specific myocardial deformation pattern with a more pronounced epicardial layer strain impairment.

ClinicalTrials.