Athlete's heart in women. Echocardiographic characterization of highly trained elite female athletes.
Level 3 - non-randomized controlled study
Prospective controlled observational study comparing athletes to sedentary controls
PubMed 8667565 · doi:10.1001/jama.276.3.211
What was done
Echocardiographic parameters (2-dimensional, M-mode, and Doppler) were prospectively evaluated in 600 elite Italian female athletes (aged 12 to 49 years, mean 21 years; competing in 27 sports) and 65 sedentary healthy female controls (aged 14 to 41 years, mean 23.7 years) between 1986 and 1993. Left ventricular end-diastolic cavity dimension and maximal wall thickness were measured and compared between groups, as well as against historical data from 738 male athletes.
What was found
Athletes demonstrated larger left ventricular end-diastolic cavity dimension (49 +/- 4 mm vs 46 +/- 3 mm; P < .001; 6% larger) and maximal wall thickness (8.2 +/- 0.9 mm vs 7.2 +/- 0.6 mm; P < .001; 14% larger) than controls. Cavity dimension exceeded normal limits (>54 mm) in 47 athletes (8%) and was within the dilated cardiomyopathy range (>=60 mm) in 4 athletes (1%), predominantly among endurance athletes. Left ventricular wall thickness ranged from 6 mm to 12 mm and did not exceed normal limits in any female athlete. Compared with historical male athletes, female athletes had 11% smaller cavity dimensions and 23% smaller wall thickness (P < .001).
Why it matters
This study shows that physiological remodeling in elite female athletes does not induce wall thickness beyond normal limits, indicating that the diagnostic overlap between athlete's heart and hypertrophic cardiomyopathy is primarily restricted to male athletes.
Limits
The study is an observational cross-sectional assessment without longitudinal follow-up or deconditioning protocols. The sedentary control group was relatively small (n = 65) compared with the athlete cohort (n = 600), and male comparisons were derived from previously published historical data rather than concurrent controls.
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