Sex and Sport vs. LV Adaption to Exercise

Study Questions:

What are the effects of different types of exercise on left ventricular (LV) geometry among female and male athletes?


A cohort of 1,083 healthy, elite, white athletes (41% female; mean age 21.8 ± 5.7 years) was assessed with electrocardiogram and echocardiogram. LV geometry was classified into four groups based on relative wall thickness (RWT) and LV mass (LVM) per European and American Society of Echocardiography guidelines: normal (normal LVM/normal RWT), concentric hypertrophy (increased LVM/increased RWT), eccentric hypertrophy (increased LVM/normal RWT), and concentric remodeling (normal LVM/increased RWT).


Athletes were engaged in 40 different sporting disciplines with similar participation rates among men and women with respect to the type of exercise. Females exhibited lower LVM (83 ± 17 g/m2 vs. 101 ± 21 g/m2; p < 0.001) and RWT (0.35 ± 0.05 vs. 0.36 ± 0.05; p < 0.001) compared with male athletes. Females also demonstrated lower absolute LV dimensions (49 ± 4 mm vs. 54 ± 5 mm; p < 0.001), but following correction for body surface area, the indexed LV dimensions were greater in females (28.6 ± 2.7 mm/m2 vs. 27.2 ± 2.7 mm/m2; p < 0.001). Most athletes had normal LV geometry. A greater proportion of females competing in a dynamic sport exhibited eccentric hypertrophy compared with males (22% vs. 14%; p < 0.001). In this subgroup, only 4% of females compared with 15% of males demonstrated concentric hypertrophy/remodeling (p < 0.001).


Highly trained athletes generally have normal LV geometry. However, female athletes participating in a dynamic sport often exhibit eccentric hypertrophy. Although concentric remodeling or hypertrophy in male athletes engaged in a dynamic sport is relatively common, it is rare in female athletes and may be a marker of disease in a symptomatic athlete.


Data on sex-specific changes in LV remodeling among athletes are rare. These data suggest that female athletes exhibit smaller increases in LV wall thickness compared with male athletes. Evidence of significant concentric remodeling or hypertrophy in a male athlete engaged in a dynamic sport might be more likely to represent normal LV adaption than the same findings in a female athlete.

Clinical Topics: Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Sports and Exercise Cardiology, Echocardiography/Ultrasound, Exercise, Sports and Exercise and Imaging

Keywords: Athletes, Body Surface Area, Diagnostic Imaging, Echocardiography, Electrocardiography, Exercise, Hypertrophy, Secondary Prevention, Sports, Ventricular Remodeling

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