Abstract
By assessing left ventricular hemodynamic forces (HDF) during different phases of the cardiac cycle, we aimed to provide insights into the cardiac adaptations in athletes as compared to patients with hypertension. Sixty athletes and 48 hypertensive patients were studied using cardiac magnetic resonance. HDF were measured during the entire cardiac cycle, the systolic phase (including systolic impulse and elastic rebound), suction, early LV filling, and atrial thrust. Statistical comparisons of HDF parameters were made between athletes and hypertensive patients, and between endurance and strength athletes. The slope of the systolic ejection was significantly higher in athletes compared to hypertensive patients (541.5 vs 435 1/sec; p = 0.033). Athletes showed higher HDF during the first phase of systole (4.53 vs 3.86; p = 0.047) and the systolic impulse (11.2 vs 8.7; p = 0.045), and a higher peak value (62.9 vs 46.8; p = 0.001). Compared to hypertensive patients, the elastic rebound in athletes was shorter (51.6 vs 70.1 ms; p < 0.001) and the hemodynamic work during this phase was lower (-0.31 vs -0.44; p = 0.011). Moreover, hypertensive patients had an abnormal suction phase as revealed by a divergent direction (apex-to-base) of the HDF (0.09). The atrial thrust component was significantly higher in hypertensive patients than in athletes (-0.31 vs -0.05; p < 0.001). Compared to endurance athletes, strength athletes had a shorter duration of the systolic impulse (250 vs 280 ms; p = 0.019) and higher hemodynamic work during the early left ventricular filling (1.65 vs 0.97; p = 0.016). The assessment of HDF allows distinction between the hemodynamic patterns of athletes and patients with hypertension. Athletes were able to generate higher pressure gradients in a shorter period of time, and had a shorter and softer elastic rebound. In hypertensive patients, the suction mechanism is lost. Higher atrial thrust indicates the importance of the active LV filling during diastole in hypertensive patients. This study was funded by a grant of the Ministry of Education and Science of the Republic of Kazakhstan, № AP14869730.