Background: Besides LV ejection fraction (LVEF), global longitudinal strain (GLS) and global myocardial work index (GWI) are increasingly important for the echocardiographic assessment of left ventricular (LV) function in athletes. Since exercise testing is frequently performed on a treadmill, we investigated the impact of upright posture on GLS and GWI.

Methods and results: In 50 male athletes (mean age 26 ± 7 years) transthoracic echocardiography (TTE) and simultaneous blood pressure measurements were performed in upright and left lateral position. LVEF (60 ± 5% vs. 61 ± 5%; P = 0.197) was not affected by athletes’ position, whereas GLS (-11.9 ± 2.3% vs. -18.1 ± 2.1%; P <0.001) and GWI (1284 ± 283mmHg% vs. 1882 ± 247mmHg%; P <0.001) were lower in upright posture. Longitudinal strain was most frequently reduced in upright posture in the mid-basal inferior, and/or posterolateral segments (Figure 1).

Conclusion: Upright posture has a significant impact on LV deformation with lower GLS, GWI and regional LV strain in upright position. These findings need to be considered when performing echocardiography in athletes.