Abstract

Purpose: Studies assessing female and male athletes indicate that they exhibit qualitatively similar changes compared with sedentary counterparts, but female athletes reveal smaller increases in left ventricular (LV) wall thickness and cavity size compared to male athletes. However, data on gender specific changes in LV geometry in athletes is scarce. We sought to investigate the effect of different types of exercise on LV geometry in a large group of female and male athletes. Methods: 1083 healthy, elite, white athletes (41% females, mean age 21.8 ± 5.7 years) underwent electrocardiogram (ECG) and echocardiogram as part of their cardiovascular evaluation. Sporting disciplines were divided into static, dynamic or mixed. Left ventricular geometry was classified into 4 groups according to relative wall thickness (RWT) and left ventricular mass (LVM) in accordance with the guidelines presented by the European and American Society of Echocardiography : normal (normal LVM/normal RWT), concentric hypertrophy (increased LVM/increased RWT), eccentric hypertrophy (increased LVM/normal RWT), concentric remodelling (normal LVM/increased RWT). Results: Athletes were engaged in 40 different sporting disciplines (62% mixed, 28% dynamic, 10% static) with similar participation rates with respect to the type of exercise between females and males. Females exhibited lower LV mass (83 ± 17 vs 101 ± 21 g/m2, p<0.001) and RWT (0.35 ± 0.05 vs 0.36 ± 0.05, p<0.001) compared to male athletes. Females also demonstrated lower absolute LV dimensions (49 ± 4 vs 54 ± 5 mm, p<0.001) but following correction for BSA the indexed LV dimensions were greater in females (28.6 ± 2.7 vs 27.2 ± 2.7 mm/m2, p<0.001). The majority of athletes showed normal LV geometry (69% of males vs 71% of females, p=0.54). There were no significant gender differences between LV geometry in athletes competing in static or mixed sport, however a greater proportion of females competing in dynamic sport exhibited eccentric hypertrophy compared to males (22% vs 14%, p<0.001). In this subgroup only 4% of females compared to 15% of males demonstrated concentric hypertrophy/remodelling (p<0.001). Conclusions: Highly trained athletes generally show normal LV geometry, however female athletes participating in dynamic sport often exhibit eccentric hypertrophy. Our results indicate that although concentric remodelling or hypertrophy in male athletes engaged in dynamic sport is a relatively common phenotype, it is rare in female athletes and may be a marker of cardiac pathology in a symptomatic athlete.