Outcomes of cardiovascular screening in female football players

Background and Purpose Elite sporting organizations in the Western world advocate cardiac screening to mitigate sudden cardiac death (SCD) risks. Data relating to the diagnostic yield of such programmes in sport are dominated by male athletes. A previous study of >11,000 soccer players, predominantly male, reported a 0.38% prevalence of cardiac disorders linked to sudden cardiac death (SCD), a 2% prevalence of minor cardiac disorders, and 0.9% of participants presenting with concerning symptoms. The aim of this study was to investigate the prevalence of cardiac disease and subsequent outcomes amongst screened female football players in the UK. We also report ECG and echocardiogram characteristics in this previously underreported population. Methods From 2000 to 2024, 3,121 female football players underwent cardiac screening as part of the English Football Association (FA) programme, which comprised a health questionnaire, physical examination, 12-lead ECG and transthoracic echocardiogram. The FA registry was reviewed for cardiac morbidity and SCD over a 6.1-year follow-up period. ECG and echocardiogram characteristics were compared to an age- and ethnicity- matched cohort of 3000 male football players. Results Female athletes had a mean age of 19.8 ± 5.4 years and 2,716 (87%) were white. 284 (9.1%) athletes reported one or more cardiac symptom, and 165 (5.3%) required additional investigations. Six (0.2%) athletes were identified with significant cardiac disorders associated with SCD, and 33 (1.1%) had minor cardiac conditions. Over a follow-up of 6.1 ± 4.7 years (16,507 cumulative person-years), there were no cases of SCD, and one (0.03%) case of non-ischaemic cardiomyopathy diagnosed 18 months post-screening. Compared with age- and ethnicity-matched male football players, females had a lower prevalence of sinus bradycardia (39.1% vs 45.2%; p<0.0001), sinus arrhythmia (15.0% vs 38.5%; p<0.0001), left ventricular hypertrophy (8.7% vs 24.8%; p<0.0001), and right ventricular hypertrophy (0.4% vs 2.3%; p<0.0001), but a longer PR interval (150 ± 24 vs 140 ± 14 ms; p<0.0001) and QTc interval (417 ± 26 vs 398 ± 16 ms; p<0.0001). T-wave inversion (TWI) was more common in females (13.4% vs 2.8%; p<0.0001), with a distribution of 12.2% in anterior leads, 1.1% in inferior leads, and 0.2% in lateral leads. Echocardiography revealed smaller left ventricular diameters (47.3 ± 3.7 vs 51.1 ± 4.3 mm; p<0.0001) and right ventricular diameters (34.0 ± 5.2 vs 37.7 ± 4.7 mm; p<0.0001) in females compared to males. Conclusion Despite more frequent cardiac symptoms in female athletes, the prevalence of life-threatening conditions was lower compared to males. Female football players demonstrated electrical diseases most commonly at screening with one case of cardiomyopathy and no cases of SCD recorded during the six-year follow-up.