Cardiac changes associated with dynamic exercise are different in male and female athletes, research shows.

In a study of elite athletes, Sanjay Sharma of St George’s University of London in the UK found that concentric remodelling or hypertrophy were common among males but rare in females. Women were more likely than men to have eccentric hypertrophy, especially if they played a dynamic sport.

‘Athlete’s heart’, the changes in structure, function and electrical activity that occur with long-term athletic training, has been studied extensively in men, but rarely in women, Sharma and colleagues write in their report, published in the Journal of the American College of Cardiology.

Understanding these changes in all athletes is important for distinguishing sport-related cardiac changes from pathology

To investigate sex differences, the researchers looked at 1,083 elite athletes aged 14 to 35 who underwent electrocardiography (ECG) and echocardiography. The athletes engaged in 40 different sports, with 62 per cent in mixed sport, 28 per cent dynamic, and 10 per cent pure static. Forty per cent were female.

There were no gender differences in left ventricular (LV) geometry among athletes engaged in static or mixed sport. However, 15 per cent of male athletes in dynamic sports had concentric hypertrophy/remodelling compared to four per cent of female athletes. Eccentric hypertrophy occurred in 22 per cent of females completing in dynamic sports, compared to 16 per cent of males.

Nine per cent of athletes had an abnormal ECG. Athletes with abnormal LV geometry were no more likely than those with normal LV geometry to have an abnormal ECG. However, the authors did observe gender differences in ECG patterns.

None of the female athletes in the study had an RWT above 0.48 or an LV mass over 145g/m2.

“Although none of the female athletes with concentric LVH/remodelling in this study showed other features of pathological LVH, these cut-off values may be an important starting point for the differential diagnosis with hypertrophic cardiomyopathy in a female athlete with cardiac symptoms or abnormal ECG,” they write.