Electrocardiographic and morphological cardiac remodelling in competitive female athletes – a scoping review

AIMS: To quantitatively analyse exercise-induced cardiac remodelling (EICR) data in female athletes. METHODS AND RESULTS: This scoping review included from the databases Medline, Embase, and Google Scholar, peer-reviewed original English-language articles on female athlete-populations aged ≥18 years containing data on electrocardiography (ECG), echocardiography or cardiac magnetic resonance (CMR), and excluded athletes with cardiovascular conditions. From the extracted ECG data, we calculated prevalence percentages, and from the imaging data we compared the results with the upper reference limits of the general female population (URL). We included 31 articles comprising 4896 female athletes, age mean of 22.2 ± 4.6 years. On ECG (n = 889), the most prevalent findings were increased QRS voltages for LV hypertrophy (LVH, n = 97), J-point elevation (JPE, n = 108), and T-wave inversion (TWI, n = 104). On echocardiography (n = 4644), we found increased mean of means BSA-indexed volumes for the LV 67.3 mL/m2 (95%CI, 66.8-67.8; URL = 61) and right ventricle (RV) 82.7 mL/m2 (95%CI, 79.5-86.0; URL = 74), while atrial volumes, septal wall thickness, and LV mass were within the upper reference limits of the general population (URL). On CMR (n = 309), the mean of means volumes of LA (62.0 mL/m2; 95%CI, 58.8-65.2; URL = 61), LV (103.4 mL/m2; 95%CI, 101.8-105.0; URL = 96), and RV (105.3 mL/m2; 95%CI, 103.3-110.6; URL = 107.2) were > URL. CONCLUSION: Female athletes demonstrate distinct features of electrical (increased QRS voltages for LVH, JPE, and TWI) and morphological EICR (biventricular dilatation). On CMR, LA was borderline dilated. Extensive studies on female athletes are needed to understand sex-specific EICR.