Physiological assessment of left ventricular size indexed by peak oxygen uptake across sporting disciplines

Abstract Aims Left ventricular (LV) enlargement is a common training-induced adaptation in athletes, particularly in endurance sports. Previous research indicates that indexing LV volumes and mass to absolute peak oxygen uptake (VO₂peak) better reflects physiological adaptation than traditional indexing to body surface area (BSA). Therefore, we investigated whether indexing LV end-diastolic volume (LVEDV) and mass to VO2peak could eliminate differences in LV size among athletes from different sport categories (endurance, mixed, power, and technical). Methods and results This analysis included 70 athletes from the multicenter COSMO-S in Germany and 15 elite endurance athletes from Norway. All participants (29 ± 8 years, 52 male) underwent echocardiography and cardiopulmonary exercise testing. In regression analyses, VO2peak (L/min) accounted for a significantly greater proportion of the variance in LVEDV than BSA (R2 0.64 vs. 0.19, P 0.001), while this difference was not significant for LV mass (R2 0.54 vs. 0.36, P = 0.06). When indexed to BSA, both LVEDV and LV mass revealed significant differences across sports (both P ≤ 0.019), that disappeared when indexed to VO₂peak (all P ≥ 0.40). In a cohort of 12 dilated cardiomyopathy (DCM) patients serving as a pathological reference group, indexing LVEDV and LV mass to VO2peak better differentiated DCM patients from athletes than indexing to BSA. Conclusion Indexing LV size to VO₂peak may provide a more physiological interpretation of cardiac adaptations in athletes and reduce sport-specific differences due to better consideration of training-induced adaptations. These findings should be replicated in larger cohorts and tested for the ability to detect subtle pathologies.