Effect of intensive exercise training on cardiac mechanics in athletes: A noninvasive evaluation of intra-ventricular pressure gradients.

​Grant funding 2022-2024
Ministry of Education and Sciences

Analyze the hemodynamic forces calculated according to MRI data of the hearts of athletes. In particular, we aim to:
1. evaluate the impact of different types of LV hypertrophy (pathological or physiological); 2. analyze the effect of intensive physical training; and
3. compare cardiac adaptation in endurance and strength athletes

This novel method was recently tested on a large group of healthy volunteers, and it has been proposed as a useful new tool for assessing diastolic function. Furthermore, a hemodynamic force model using B-mode imaging has been proposed as a novel marker of heart failure due to its ability to significantly improve the detection of early systolic myocardial dysfunction when heart volume and strain measurements remain unchanged.
Finally, biventricular pacing-induced changes in left ventricular hemodynamic forces have been shown to correlate with reverse LV remodeling. However, no hemodynamic studies have been published to date on the effects of intense physical training on hemodynamic forces in different models of left ventricular hypertrophy (athletes and hypertensive patients) using conventional cine-MRI image tracking analysis.
Hemodynamic forces, which are the end result of the LV contraction-relaxation rhythm, are crucial in describing cardiac function. Hemodynamic forces can now be incorporated into volume and strain calculations to provide a deeper understanding of cardiac mechanics and possibly an indication of therapeutic outcome. Understanding the intrinsic differences in LV filling and absorption in athletes and hypertensive patients will aid in distinguishing between physiological and pathological LV hypertrophy. Ideally, this new method could be used to optimize athlete training.
This new calculation model allows every MRI center to incorporate flow-mediated hemodynamic forces into the clinical assessment of cardiac mechanics.

Expected and achieved results in 2022_x000D_
1. A comparison of hemodynamic forces in various left ventricular hypertrophy models (hypertension and athletes).

Data analysis and interpretation training was provided to the research team. The research method includes the use of MRI equipment, which is non-invasive, to determine the relative difference in hemodynamic strength between different models of LV hypertrophy. Following that, the video-MRI of the heart and images will be analyzed using software (MEDIS img), which requires analytical and interpretation skills. MEDIS provided two online trainings for the entire research group, which were led by a product support specialist. As a result, the entire research team received training in interpreting, analyzing, and presenting cardiac video MRI results for subsequent statistical analysis.
2. The effect of intense physical training on hemodynamic forces in athletes.
A review of the literature was conducted in order to better understand physiological patterns and different cardiac adaptations to exercise training. A subsequent review of the literature revealed the need for more longitudinal data, particularly when combined with the most recent assessment methods, such as cardiac MRI. Because, even when using MRI of the heart to compare diastolic filling in athletes and the control group, statistically significant results were obtained. Finally, physical endurance exercises cause biventricular dilatation, which is accompanied by an increase in diastolic relaxation. Previous methods were based on blood flow assessment, which required the use of contrast agents and cumbersome procedures that interfered with the routine use of these methods. The new approach is based on the assessment of endocardial motion using B-mode imaging and tissue tracking technology. Using a new mathematical approach, it is possible to perform a calculation of hemodynamic forces, which has shown a high correlation with 4D cardiac MRI flow, which is considered the gold standard._x000D_
3. Differences between endurance and strength athletes._x000D_
Previous studies have relied on 2D echocardiography and Doppler testing. From the available literature, it was found that the effect of intense physical exercise on hemodynamic forces in the left ventricle of the heart in elite athletes shows an improvement in the E' values of the left ventricle and right ventricle within 3 months, while athletes engaged in strength training, there was a significant improvement in compared with the same indicators during the period of decrease in diastolic velocity in the tissues. Also, after a statistical analysis of the results of adaptation of the left ventricle of the heart to physical activity in athletes of different categories (strength and endurance), conflicting results were revealed. Since the adaptation of the left ventricle to physical activity was revealed in the endurance group, in comparison with the strength group, in which the left ventricle of the heart did not always demonstrate adaptation to physical activity. This means that our study is relevant, since data on the value of the analysis of hemodynamic forces are urgently needed, which will allow us to take a fresh look at cardiac hemodynamics in athletes._x000D_

Expected results 2023 1st quarter._x000D_
Collection of data from CardioMRI from patients with hypertension and from athletes (endurance and strength) and analysis of hemodynamic forces._x000D_
For the period December 2022 to January 2023, data were collected and an MRI of the heart was performed for 34 out of 50 athletes at the NSCC for subsequent interpretation of the data. The entire research group underwent two additional online training sessions on interpreting cardiac MRI video through the MEDIS software._x000D_
For the recruitment of patients with hypertension, informational brochures and posters were printed out at the NSCCC and informational letters were sent to medical centers belonging to the UMC