Background Enlargement of an athlete's heart results from sustained hemodynamic overload during intensive exercise. Elite female ice hockey athletes exhibit larger left ventricular (LV) dimensions than healthy controls, but intrinsic myocardial contractile characteristics and their coupling with intracardiac hemodynamics remain unclear. This study explored coordinated adaptations of myocardial strain and intraventricular pressure in elite female ice hockey athletes. Methods Fifty-three female ice hockey athletes (27 elite and 26 casual players) and 24 age-matched healthy controls were included. Vector flow mapping (VFM) quantified peak intraventricular pressure gradient (IVPG) values during rapid ejection, late systole (LSy), rapid filling, and atrial systole; two-dimensional tissue tracking (2DTT) measured LV global longitudinal strain, LV global longitudinal strain rate (LVGLSR), time to peak longitudinal strain (TTPLS), and peak strain dispersion (PSD). Group differences and correlations among VFM and 2DTT indices were examined, including associations with training level. Results Compared with controls, elite athletes demonstrated significantly lower IVPG during LSy (p = 0.002), reduced LVGLSR (p = 0.008), prolonged TTPLS (p < 0.001), and decreased PSD (p < 0.001). LVGLSR was significantly correlated with IVPD (p = 0.017) and IVPG (p = 0.039). IVPD (p = 0.005) and IVPG (p = 0.001) during LSy demonstrated positive associations with technical hierarchy. LVGLSR (p = 0.028), TTPLS (p < 0.001), and PSD (p < 0.001) were significantly associated with weekly training time. Conclusions The coupling between hemodynamic enhancement and strain modulation may represent new echocardiographic markers for assessing cardiac adaptation in young elite female ice hockey athletes.
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