Key result
The majority of elite athletes (85.4%) had normal left ventricular geometry, with eccentric hypertrophy present in 13.4% and concentric remodeling or hypertrophy being very uncommon (<0.8%).
Why the study?
Debate persists regarding the magnitude of geometrical remodeling in the hearts of elite athletes, and limits of normality have not been established across different sports.
Observational (n=3,282)
No
This study provides sex- and sport-specific normative values for left ventricular dimensions in elite athletes, demonstrating that the vast majority have normal cardiac geometry and that concentric hypertrophy is extremely rare.
Normative LV geometry data may refine athlete echocardiogram interpretation; extends sex- and sport-specific references for future validation.
BACKGROUND: There is debate about the magnitude of geometrical remodeling [i.e., left ventricle (LV) cavity enlargement vs. wall thickening] in the heart of elite athletes, and no limits of normality have been yet established for different sports. We aimed to determine sex- and sport-specific normative values of LV dimensions in elite white adult athletes. METHODS: This was a single-center, retrospective study of Spanish elite athletes. Athletes were grouped by sport and its relative dynamic/static component (Mitchell's classification). LV dimensions were measured with two-dimensional-guided M-mode echocardiography imaging to compute normative values. We also developed an online and app-based calculator ( https://sites.google.com/lapolart.es/athlete-lv/welcome?authuser=0 ) to provide clinicians with sports- and Mitchell's category-specific Z-scores for different LV dimensions. RESULTS: We studied 3282 athletes (46 different sports, 37.8% women, mean age 23 ± 6 years). The majority (85.4%) showed normal cardiac geometry, particularly women (90.9%). Eccentric hypertrophy was relatively prevalent (13.4%), and concentric remodeling or hypertrophy was a rare finding (each < 0.8% of total). The proportion of normal cardiac geometry and eccentric hypertrophy decreased and increased, respectively, with the dynamic (in both sexes) or static component (in male athletes) of the sport irrespective of the other (static or dynamic) component. The 95th percentile values of LV dimensions did not exceed the following limits in any of the Mitchell categories: septal wall thickness, 12 mm (males) and 10 mm (females); LV posterior wall, 11 mm and 10 mm; and LV end-diastolic diameter, 64 mm and 57 mm. CONCLUSIONS: The majority of elite athletes had normal LV geometry, and although some presented with LV eccentric hypertrophy, concentric remodeling or hypertrophy was very uncommon. The present study provides sport-specific normative values that can serve to identify those athletes for whom a detailed examination might be recommendable (i.e., those exceeding the 95th percentile for their sex and sport).
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Boraíta et al. (2022) conducted an observational in Healthy elite athletes (n=3,282). Elite sports participation vs. Different sport categories (Mitchell's classification) was evaluated on Left ventricular geometry and dimensions. The majority of elite athletes (85.4%) had normal left ventricular geometry, with eccentric hypertrophy present in 13.4% and concentric remodeling or hypertrophy being very uncommon (<0.8%).
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