Wrestler's Heart: Cardiac Remodeling in World Wrestling Entertainment Athletes

Background Evidence on cardiac adaptation in elite wrestlers remains limited. This study assessed electrical and structural cardiac remodeling in elite wrestlers, with particular focus on sex‐specific differences. Methods Elite World Wrestling Entertainment athletes undergoing electrocardiographic and echocardiographic evaluation during routine cardiovascular screening were included. Left ventricular (LV) geometry was classified according to relative wall thickness and LV mass on the basis of international recommendations. This was a retrospective analysis of prospectively acquired data. Results The cohort included 68 athletes (mean age, 28±6 years; 47 69% men), with similar weekly training volume between sexes (11.6±5 h/wk). No athlete reported performance‐enhancing drug use, although 1 admitted high‐energy drink consumption. Electrocardiographic abnormalities were observed in 2 athletes (3%). Women showed smaller absolute LV end‐diastolic diameter (46±4 versus 52±5 mm, P <0.001), but greater indexed LV dimensions (27±3 versus 25±3 mm/m 2 , P =0.003). Two female athletes had LV ejection fraction <50%. Right ventricular enlargement was observed in 23% of men and 14% of women ( P =0.52), without sex differences in right ventricular fractional area change (39±6% versus 40±6%, P =0.42). Two male athletes had right ventricular fractional area change <34%. LV geometry was predominantly normal (89% men, 95% women), while concentric remodeling was identified in 6 athletes (9%), including 5 men and 1 woman. Conclusions Elite wrestlers demonstrate predominantly normal cardiac electrical and structural profiles, with low prevalence of pathological findings. Sex‐related differences were observed in cardiac dimensions, particularly after indexation to body surface area.