The athlete's heart: different training responses, gender and ethnicity dependencies

Summary Since the first description of the athlete’s heart in 1899 by Henschen and Darling, the knowledge on cardiovascular adaptations to exercise conditioning has expanded considerably. There is an ongoing debate about the true nature of the athlete’s heart, whether it is only a physiological adaption or a potentially pathological condition, fuelled by reports about elevated biomarkers after prolonged endurance exercise. Age, gender, ethnicity and sporting discipline have a substantial impact on the magnitude of cardiac remodelling. Black athletes in particular exhibit striking repolarisation abnormalities and left ventricular (LV) hypertrophy which may be regarded as an ethnic variant of the athlete’s heart. Sport is thought to be a trigger and not a cause for life-threatening arrhythmias in athletes with underlying cardiovascular diseases. The overall incidence of sudden cardiac death in athletes is extremely low. Figures of 0.6 to 2.3 cases/100 000 athletes per year have been reported, with a striking male predominance and a greater risk for black athletes. In this article, we review the current literature of the athlete’s heart with a focus on gender and ethnicity.