Interaction Between Intraventricular Flow and Cardiac Mechanics Using 3D Echocardiography in Athletes and Sedentary Subjects (CARDIO-3D)

Exercise-induced cardiac remodeling, known as the "athlete's heart," corresponds to morphological and functional adaptations of the left ventricle in response to prolonged physical training. It is characterized in particular by physiological hypertrophy and improved myocardial function.

Intraventricular blood flow interacts with cardiac mechanics. Regional shape (e.g., sphericity, wall curvature) and myocardial deformations guide flow patterns to create an optimal hemodynamic environment. The interaction between these different parameters in the athlete's heart remains insufficiently explored. In this context, 3D echocardiography makes it possible to combine indices derived from fluid dynamics, regional myocardial function, and cardiac geometry, enabling a comprehensive assessment of cardiac performance.

Primary and secondary objectives:

In this context, the aim of this project is to investigate the relationship between intraventricular flow and cardiac mechanics based on combined measurements of intraventricular flow (e.g., vorticity, pressure gradients), regional myocardial function (e.g., myocardial strain), and global/regional LV geometry (e.g., sphericity, wall curvature) in the athlete's heart. Since these parameters are interdependent, analyzing their interaction through the development of new echocardiographic tools based on 4D assessments will enable a comprehensive evaluation of functional improvements in the athlete's heart.

The secondary objectives are to analyze the impact of dyssynchrony on intraventricular flow, to evaluate the influence of primary and secondary deformations on intraventricular flow, and to study cardiac function from an energetic perspective using non-invasive reconstruction of pressure-volume loops for cardiac work estimation.

Methodology:

The study will include 80 endurance athletes (ENT group) and 80 control subjects (CONT group). The main inclusion criteria common to both groups are: men and women aged 18-45 years, with no known heart disease and no cardiovascular risk factors (e.g., body mass index > 30 kg/m², arterial hypertension). Athletes must train at least 10 hours per week for the past 5 years. Control subjects must not engage in more than 3 hours of physical activity per week.

Athletes will be recruited from elite groups of various federations, during local long-distance races, or during clinical evaluations at Montpellier University Hospital (Dr. C. Hédon's department). Control subjects will be recruited in the Avignon area and in the cardiology department of Montpellier University Hospital during routine visits.

Echocardiographic examinations will be performed in the left lateral decubitus position using Vivid systems with 4D probes. 4D and tri-plane acquisitions with color Doppler will allow assessment of cardiac structure and intraventricular flow. Data analysis will be performed using TOMTEC software, and scripts developed in Matlab and RStudio will process information related to shape, mechanical dispersion, and dyssynchrony. Intraventricular hemodynamics will be analyzed in collaboration with the CREATIS laboratory (D. Garcia), particularly through measurements of intraventricular pressure gradients and vorticity indices.

Study Overview

• Status: Recruiting
• Conditions: Athlete Heart

• Study Type: Observational
• Enrollment (Estimated): 160

Contacts and Locations

Study Locations

• France
  • Avignon, France, 84000
    • Recruiting
    • LaPEC
    • Contact: Claire CM Claire Maufrais, PhD, PhD; Phone Number: +33682949447; Email: claire.maufrais@univ-avignon.fr
  • Montpellier, France, 34000
    • Recruiting
    • CHU Montpellier
    • Contact: Christophe Hédon Dr Christophe Hédon; Phone Number: 0033677586814; Email: c-hedon@chu-montpellier.fr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Participants in the ENT group will be recruited:

• At Montpellier University Hospital, in the cardiology department of Dr Hédon, during a follow-up visit.
• At various national training centers of the French Triathlon Federation and the French Athletics Federation;
• During local long-distance events (e.g., long-distance triathlons, ultramarathons), with assessments carried out at the time of race bib collection.

Healthy participants will be recruited in parallel In Avignon and the surrounding area.

Some participants from the CONT or ENT groups will also be recruited in the cardiology department of Dr Hédon at Montpellier University Hospital during a follow-up visit, for example as part of systematic cardiovascular screening. These participants will have undergone a preventive cardiology consultation that revealed no abnormalities or pathology. If these participants meet all inclusion criteria, they may then be included in the study.

Description

Inclusion criteria for athletes:

- Athlete practicing at least 10 hours of endurance training per week for a minimum of 5 years.

Inclusion criteria for controls:

- Individual not training in more than 3 hours of physical activity per week.

Exclusion Criteria for both groups:

• History of known heart disease;
• Current cardiac rhythm disorder;
• Individual with one or more cardiovascular risk factors (smoking, diabetes, hypertension, body mass index > 30 kg/m²);
• Individual in a period of relative exclusion in relation to another protocol, or for whom the annual maximum compensation amount of €4,500 has been reached;
• Individual not affiliated with a social security system, or not benefiting from such a system;
• Pregnant or breastfeeding woman; patient unable to give informed consent; protected adults; vulnerable persons;
• Individual deprived of liberty by judicial or administrative decision.

Exclusion criteria for athletes:

- Use of substances listed on the prohibited substances list of the French Anti-Doping Agency

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Controls; Sedentary controls
Athletes; Endurance athletes

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Left ventricular principal strains	The investigators will assess left ventricular principal strains in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Left ventricular secondary strains	The investigators will assess left ventricular secondary strains in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular principal and secondary strain rates	The investigators will assess left ventricular principal and secondary strain rates in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular global longitudinal strains	The investigators will assess left ventricular global longitudinal strains in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular global longitudinal strain rates	The investigators will assess left ventricular global longitudinal strain rates in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular global circumferential strains	The investigators will assess left ventricular global circumferential strains in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular global circumferential strain rates	The investigators will assess left ventricular global circumferential strain rates in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular global radial strains	The investigators will assess left ventricular global radial strains in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular global radial strain rates	The investigators will assess left ventricular global radial strain rates in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular global area strains	The investigators will assess left ventricular global area strains in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular global area strain rates	The investigators will assess left ventricular global area strain rates in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Standard deviation of the time-to-peak of left ventricular segmental strains	The investigators will assess standard deviation of the time-to-peak of left ventricular segmental strains in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Maximum delay	The investigators will assess maximum delay of left ventricular segmentary strains in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular longitudinal strain delay index	The investigators will assess left ventricular longitudinal strain delay index in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular post systolic strain index	The investigators will assess left ventricular post systolic strain index in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular myocardic work	The investigators will left ventricular myocardic work in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular potential energy	The investigators will assess left ventricular potential energy in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Right ventricular global longitudinal strains	The investigators will assess right ventricular global longitudinal strains in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Right ventricular global longitudinal strain rates	The investigators will assess right ventricular global longitudinal strain rates in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Right ventricular global circumferential strains	The investigators will assess right ventricular global circumferential strains in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Right ventricular global circumferential strain rates	The investigators will assess right ventricular global circumferential strain rates in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Right ventricular principal strains	The investigators will assess right ventricular principal strains in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Right ventricular secondary strains	The investigators will assess right ventricular secondary strains in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Right ventricular principal strain rates	The investigators will assess right ventricular principal strain rates in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Right ventricular secondary strain rates	The investigators will assess right ventricular secondary strain rates in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Right ventricular global area strain	The investigators will assess right ventricular global area strains in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Right ventricular global area strain rates	The investigators will assess right ventricular global area strain rates in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left atrial global longitudinal strains	The investigators will assess left atrial global longitudinal strains in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left atrial global longitudinal strain rates	The investigators will assess left atrial global longitudinal strain rates in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Right atrial global longitudinal strains	The investigators will assess right atrial global longitudinal strains in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular global longitudinal strains - 2D	The investigators will assess left ventricular global longitudinal strains in resting conditions using 2D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular global longitudinal strain rates - 2D	The investigators will assess left ventricular global longitudinal strain rates in resting conditions using 2D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Basal rotation - 2D	The investigators will assess left ventricular basal rotation in resting conditions using 2D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Apical rotation - 2D	The investigators will assess left ventricular apical rotation in resting conditions using 2D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Basal rotation - 3D	The investigators will assess left ventricular basal rotation in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Apical rotation - 3D	The investigators will assess left ventricular apical rotation in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular twist	The investigators will assess left ventricular twist in resting conditions using 2D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular torsion	The investigators will assess left ventricular torsion in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular twisting/untwisting rates - 2D	The investigators will assess left ventricular twisting/untwisting rates in resting conditions using 2D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular torsional rates - 3D	The investigators will assess left ventricular torsional rates in resting conditions using 3D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular basal/apical rotational rates	The investigators will assess left ventricular basal/apical rotational rates in resting conditions using 2D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular circumferential strains - 2D	The investigators will assess regional left ventricular circumferential strains in resting conditions using 2D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular circumferential strain rates - 2D	The investigators will assess left ventricular regional circumferential strain rates in resting conditions using 2D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular global myocardial work - 2D	The investigators will assess left ventricular global myocardial work in resting conditions using 2D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular myocardial constructive work - 2D	The investigators will assess left ventricular myocardial constructive work in resting conditions using 2D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular myocardial wasted work - 2D	The investigators will assess left ventricular myocardial wasted work in resting conditions using 2D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular myocardial work efficiency - 2D	The investigators will assess left ventricular myocardial work efficiency in resting conditions using 2D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Right ventricular longitudinal strains - 2D	The investigators will assess right ventricular longitudinal strains in resting conditions using 2D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Right ventricular longitudinal strain rates - 2D	The investigators will assess right ventricular longitudinal strain rates in resting conditions using 2D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left atrial longitudinal strain rates - 2D	The investigators will assess left atrial longitudinal strain rate components in resting conditions using 2D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Intraventricular pressure gradient	The investigators will assess intraventricular pressure gradient of the left ventricle in resting conditions using 2D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Vorticity indexes	The investigators will assess left ventricular vorticity indexes in resting conditions using 2D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Kinetic energy of left ventricular flow	The investigators will assess kinetic energy of left ventricular flow in resting conditions using 2D echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular wall thicknesses	The investigators will assess left ventricular wall thicknesses in resting conditions using echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular diameters	The investigators will assess left ventricular diameters in resting conditions using echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month..
Left ventricular volumes	The investigators will assess left ventricular volumes in resting conditions using echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular mass	The investigators will assess left ventricular mass in resting conditions using echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular ejection fraction	The investigators will assess left ventricular ejection fraction in resting conditions using echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular Tissue Doppler Imaging	The investigators will assess left ventricular myocardial velocities in resting conditions using echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular transmitral flow	The investigators will assess left ventricular transmitral flow in resting conditions using echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left ventricular filling pressure index	The investigators will assess left ventricular filling pressure index in resting conditions using echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Right ventricular outflow tract diameter	The investigators will assess right ventricular outflow tract diameter in resting conditions using echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Tricuspid annular plane systolic excursion	The investigators will assess tricuspid annular plane systolic excursion in resting conditions using echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Right ventricular fractional area change	The investigators will assess right ventricular fractional area change in resting conditions using echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Right ventricular ejection fraction	The investigators will assess right ventricular ejection fraction in resting conditions using echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month..
Right ventricular Tissue Doppler Imaging	The investigators will assess right ventricular myocardial velocities in resting conditions using echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Right ventricular transtricuspid flow	The investigators will assess right ventricular transtricuspid flow in resting conditions using echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Right ventricular filling pressure gradient	The investigators will assess right ventricular filling pressure gradient in resting conditions using echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Right ventricular systolic pressure	The investigators will assess right ventricular systolic pressure in resting conditions using echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Left atrial volumes	The investigators will assess left atrial volumes in resting conditions using echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Right atrial volumes	The investigators will assess right atrial volumes in resting conditions using echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Blood pressures	The investigators will assess blood pressures in resting conditions using a tensiometer in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Heart rate	The investigators will assess heart rate in resting conditions using echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Stroke volume	The investigators will assess stroke volume in resting conditions using echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.
Cardiac output	The investigators will assess cardiac output in resting conditions using echocardiography in the two groups.	From date of enrollment until the date of evaluation, assessed up to 1 month.

Collaborators and Investigators

• Sponsor: University of Avignon
• Collaborators: CHU Arnaud de Villeneuve MONTPELLIER

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2025
• Primary Completion (Estimated): August 31, 2027
• Study Completion (Estimated): August 31, 2027

Study Registration Dates

• First Submitted: January 8, 2026
• First Submitted That Met QC Criteria: January 16, 2026
• First Posted (Actual): January 23, 2026

Study Record Updates

• Last Update Posted (Actual): January 23, 2026
• Last Update Submitted That Met QC Criteria: January 16, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: regional myocardial function; intraventricular flow; cardiac geometry; echo-3D; athlete's heart
• Other Study ID Numbers: AU-112025-CM; LAPEC/2025/CARDIO-3D (Other Identifier: Avignon University)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No