exercise-induced cardiac remodelling in elite athletes is characterized by a stronger ventricular mass-volume association in females as compared with males: MRI results from the ELITE cohort

Abstract Background Differentiation between exercise-induced cardiac remodelling (EICR) and cardiac pathology constitutes a central challenge in sports cardiology. To assist clinicians, theoretical frameworks have been developed: i.e. dynamic sports are associated with ventricular dilatation, static sports with hypertrophy, and sports containing both components with both dilatation and hypertrophy. However, EICR frameworks have been almost exclusively based on findings in male athletes, and whether these associations are found in female athletes is to date unclear. Purpose We aimed to investigate intersex differences in left ventricular (LV) remodelling in the extreme phenotypes of elite athletes. Methods We included 227 healthy, elite athletes from the ELITE cohort who underwent cardiac magnetic resonance imaging (CMR). Our outcomes of interest were absolute and body surface area (BSA) indexed LV end-diastolic volume, LV end-diastolic wall mass, LV end-diastolic mass-volume ratio to express cardiac remodelling (LV end-diastolic wall mass / LV end-diastolic volume) and correlations of BSA-indexed LV mass with LV end-diastolic volume to compare LV remodelling between sexes. Results A total of 122 male and 105 female elite athletes (age 26±6 years) were included. The age and division in sports categories according to the ESC classification were similar between the sexes. Male athletes showed larger indexed LV end-diastolic volumes (127±19 versus 108±14 ml, p <0.001) and indexed LV wall mass (66±12 versus 50±11 grams, p <0.001) compared to female athletes. Male athletes had a proportionally larger LV mass-volume ratio than women (0.53±0.12 versus 0.46±0.09 g/ml, p <0.001). Female elite athletes showed a moderate association between indexed LV mass increase with indexed LV end-diastolic volume increase (Spearman’s rho 0.45, p <0.001), whereas male athletes showed a weak association (Spearman’s rho 0.25, p =0.006). Conclusions Elite male athletes have larger left ventricular volumes and wall mass, with a greater mass-volume ratio, than their female counterparts. However, female athletes demonstrate a stronger mass-volume association than males. Our findings suggest the presence of distinct sex-dependent features of EICR.