Is systolic blood pressure an early marker of concentric left ventricular geometry in young rugby athletes as a potential cardiac maladaptation?

Background: Long-term exercise training induces various morphological adaptations in the heart. Although concentric left ventricular (LV) geometry is occasionally observed in young athletes, its clinical significance is unclear. This study aimed to investigate the characteristics of young rugby athletes with concentric LV geometry and considered its clinical implications. Methods and results: This cross-sectional study assessed 120 male collegiate rugby freshmen, with a healthy lifestyle and without a family history, via physical and blood pressure evaluations, resting 12-lead electrocardiography (ECG), echocardiography, and cardiopulmonary exercise testing. The athletes were divided into three groups based on the 4-tiered echocardiographic classification for LV hypertrophy: normal geometry, concentric geometry, and eccentric hypertrophy. Concentric geometry was identified in 11 % of the athletes. No significant differences in anthropometry or exercise capacity were observed between athletes with normal and abnormal geometries. However, athletes with concentric geometry had significantly higher systolic blood pressure (SBP) compared to the other groups. SBP levels were significantly correlated with both LV mass index and concentricity; an SBP ≥136 mmHg could independently predict concentric geometry. In contrast, the ECG criteria for LV hypertrophy showed limited diagnostic accuracy for detecting concentric geometry. Conclusion: These findings suggest that elevated SBP can serve as an early marker for identifying and managing concentric geometry in young athletes, which potentially represents a mild, previously unrecognized form of hypertensive remodeling.