Echocardiographic predictors of athlete performance: a comparative analysis across different training profiles

Abstract Background Exercise impacts cardiac structure and function, leading to adaptive remodeling known as "athlete's heart." Assessing myocardial function can be challenging, as ejection fraction (EF) and global longitudinal strain (GLS) often fall at the lower end of normal. Purpose This study investigated standard and advanced echocardiographic parameters in endurance athletes with different training profiles, assessing their association with performance. Methods Consecutive endurance athletes undergoing cardiological screening or orthopedic evaluation for knee injuries were evaluated using echocardiography and cardiopulmonary exercise testing. Athletes were categorized into three groups: (1) Long-Distance (n=30), competing in marathons and ultramarathons; (2) Mid-Distance (n=27), competing in middle-distance races; and (3) Detrained (n=31), with ≥6 months of forced training interruption. Results Left ventricular ejection fraction did not differ among groups. The Long-Distance group had the highest stroke volume index (SVi), followed by the Mid-Distance and Detrained groups (p