Echocardiographic Characterization of Major League Soccer Players

Figures

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  Figure 1. Distribution of Left Ventricular Internal Diameter Diastole Top: Distribution of LVIDd in athletes. Most athletes (91%) had left ventricular internal diameter in diastole (LVIDd) between 4.2 and 5.8 cm, with 8.5% exceeding the ASE upper reference limit of 5.8 cm. Bottom: Scatter plot demonstrating a statistically significant positive association between body surface area (BSA) and LVIDd among athletes (β = 1.12; 95% CI: 0.98-1.27; R2 = 0.143; P < 0.001). Each point represents an individual athlete, and the solid line indicates the linear regression model. ASE = American Society of Echocardiography.

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  Figure 2. Left Ventricular End-Diastolic Volume Indexed LVEDVi histogram showing the distribution of left ventricular end-diastolic volume indexed to body surface area among athletes. 34% of athletes had enlarged left ventricle by ASE standard.

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  Figure 3. Distribution of Posterior Wall Thickness and Intraventricular Septum Thickness Top: Left ventricular posterior wall thickness (LVPWd) ASE normal ≤1.0 cm. Overall, 43% of athletes had an LVPWd >1.0 cm. Bottom: Intraventricular septum thickness (IVSD) (ASE normal indexed (NI) ≤ 1.0 cm.) 31% of athletes had an IVSD >1.0 cm. Abbreviation as in Figure 1.

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  Figure 4. Distribution of Relative Wall Thickness and Left Ventricular Mass Index Histogram showing the distributions of RWT and LVMI among athletes. Vertical references lines indicate ASE cutoff for increased relative wall thickness (RWT = 0.42) and left ventricular hypertrophy (LVMI = 115 g/m2).

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  Figure 5. American Society of Echocardiography Criteria for Hypertrophy Diagram illustrating ASE-based classification of left ventricular geometry using relative wall thickness (RWT) and left ventricular mass index (LVMI), with counts and percentages of athletes in each category.

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  Figure 6. Distribution of Athletes by Category of Remodeling 67.7% of athletes had normal geometry, 18.2% with concentric remodeling, 9.6% eccentric hypertrophy, and 4.5% concentric hypertrophy.

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  Figure 7. Distribution of Aortic Root Diameter in Male Athletes Top: Distribution of absolute aortic root diameter measured by 2D echocardiography. Bottom: Distribution of aortic root diameter indexed to body surface area (BSA). Bars represent the number of athletes within 0.1-cm units. Vertical red lines indicate ASE upper normal limits for males (≤4.0 cm for absolute diameter and ≤2.1 cm/m2 for BSA-indexed diameter). The proportion of athletes exceeding each threshold is shown.

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  Figure 8. Scatter Plots Demonstrating the Relationship Between Aortic Root Diameter and Body Size Top: Aortic root diameter vs height demonstrated a modest positive association (β = 4.99; 95% CI: 3.72-6.26; R2 = 0.045; P < 0.001). Bottom: Aortic root diameter vs weight also demonstrated a modest positive association (β = 7.51; 95% CI: 6.12-8.90; R2 = 0.082; P < 0.001). Each point represents an individual athlete; solid lines indicate linear regression models with 95% prediction intervals.

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  Central Illustration. Echocardiographic Remodeling in Professional Soccer Athletes In this large cross-sectional echocardiographic study of 1,368 male Major League Soccer athletes, physiologic cardiac remodeling was common. Left ventricular dilation, right ventricular enlargement, increased left ventricular wall thickness, and concentric remodeling patterns were frequently observed. Left atrial enlargement was also common, while aortic root enlargement was rare. These findings provide sport-specific echocardiographic reference data that may assist clinicians in distinguishing physiologic athletic remodeling from potential cardiovascular pathology. ASE = American Society of Echocardiography; LA = left atrial; LV = left ventricular; MLS = Major League Soccer; RV = right ventricular.