Hinge point fibrosis in athletes is not associated with structural, functional or electrical consequences: a comparison between young and middle-aged elite endurance athletes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R De Bosscher ◽  
M Claeys ◽  
C Dausin ◽  
K Goetschalckx ◽  
J Bogaert ◽  
...  
Keyword(s):  
Female Athletes ◽  
Maximal Oxygen Consumption ◽  
Lateral Wall ◽  
Left Ventricular ◽  
Endurance Athletes ◽  
Funding Source ◽  
Middle Aged ◽  
National Budget ◽  
Hinge Point ◽  
Wave Inversion

Abstract Background The health benefits of extensive endurance training have been debated due to the report of myocardial fibrosis (MF), arrhythmias and temporary post-race cardiac impairment in middle-aged and veteran athletes. The extent of these changes is unknown in elite young athletes. Purpose To assess the prevalence of MF and its structural, functional and electrical impact in highly trained young endurance athletes (YA, 15–23 years) as compared to middle-aged athletes (MA, 30–50 years). We hypothesised that MF would be more frequent in MA and associated with more structural, functional and electrical abnormalities. Methods We prospectively assessed 197 YA and 34 MA. All had ECG, maximal oxygen consumption (VO2max) testing, cardiac magnetic resonance imaging (CMR), echocardiography and 24h-holter. Indexed left ventricular and right ventricular end diastolic volume (LVEDVi, RVEDVi), ejection fraction (LVEF, RVEF), left ventricular mass (LVMi), and MF defined as delayed gadolinium enhancement were assessed by CMR. LV and RV free wall strain (LVSL, RVfwSL) were assessed by 2D speckle tracking echocardiography. Ventricular premature beats (VPB) and non-sustained ventricular tachycardia (nsVT) were assessed by 24h-holter. Results YA and MA (18±2 vs 38±5 years [p<0.01]; 78% vs 80% male [p=0.99]) with an elite level of fitness (VO2max 61±8 vs 54±10 mL/min/kg [p<0.01]; % predicted VO2max 150±20 vs 158±30 [p=0.02]) had a large variance in LV and RV remodelling (Figure 1). MF was seen in 28 athletes (12.5%) and more prevalent in MA than in YA (23.5 vs 10.5%, p=0.048). MF was limited to the hinge points in all 8 MA with MF and 17 YA. 3 YA had LV lateral wall subepicardial MF. 27 of 187 (14.4%) male athletes had MF compared to 1 of 50 (2%) female athletes (p=0.01). MF+ MA(A) and YA(B) as well as MF− MA(C) and YA(D) had similar structural remodelling (LVEDVi 110±14 vs 118±14 vs 113±19 vs 110±16 mL/m2; RVEDVi 120±14 vs 128±17 vs 117±19 vs 125±23mL/m2; LVMi 77±11 vs 83±14 vs 81±14 vs 77±15g/m2, p>0.05). LVEF, LVSL and RVSL were similar (59±3 vs 58±5 vs 61±6 vs 58±6%; −18.8±2 vs −18.8±2 vs −19.8±2 vs −19.3±2%; −26.3±2.4 vs −24.4±2.4; −26.3±3 vs −25.8±3.5% respectively, p>0.05). LVEF <50% was seen in 19 (8.2%) athletes (0 [0%] vs [5%] 1 vs 1 [3.8%] vs 17 [9.6%]; p=0.51). RVEF was higher in D compared to C without further differences between groups (54±4 vs 54±6 vs 53±6 vs 57±5, p=0.005). RVEF<45% was seen 21 (9.1%) athletes (0 [0%] vs 1 [5%] vs 0 [0%] vs 20 [11.3%]; p=0.14). Abnormal T-wave inversion was similar (12.5 vs 5 vs 7.4 vs 6.2%, p=0.93) as was the prevalence of >100VPB/24h (12.5 vs 5 vs 11.1 vs 5.1%, p=0.42). 2 athletes had nsVT, both in D. All had similar exercise capacity (% predicted VO2max 157±26 vs 152±15 vs 147±24 vs 158±32%; p=0.11). Conclusion Hinge-point fibrosis was more prevalent in MA, possibly due to repeated hemodynamic stress during exercise, but is not associated with structural, functional or electrical consequences. Figure 1. Cardiac remodelling in elite athletes Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Fonds voor Wetenschappelijk Onderzoek (FWO)

You've got to be in it to win it: the importance of including female athletes in screening ECG cohorts

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Janssens ◽  
E Paratz ◽  
M Brosnan ◽  
A Lindqvist ◽  
A Mitchell ◽  
...  
Keyword(s):  
Athletic Training ◽  
Female Athletes ◽  
Left Ventricular ◽  
Endurance Athletes ◽  
Qtc Interval ◽  
Male Athletes ◽  
Wave Inversion ◽  
Training Response ◽  
Healthy Female ◽  
Qrs Duration

Abstract Background ECG screening is widely employed in athletic populations with the aim of identifying cardiac conditions associated with sudden death. Recommendations for athlete ECG interpretation are disproportionately reliant on data from male athletes and sex-specific differences have not been adequately elucidated. Purpose The aim of this study is to identify any different patterns in female athletic training response on ECG screening. Methods 444 elite athletes (156 male rowers, 135 female rowers, 117 male cricketers, 36 female cricketers) underwent electrocardiogram (ECG) screening. Standard definitions were used to characterize abnormalities identified on ECG. Comparisons were made according to sex and endurance (rowing) vs skill-based (cricket) athletes (EA and SBA respectively). Results “Potentially pathological” T-wave inversion extending to V3 was more prevalent in female athletes (9.9% vs. 2.9%, P=0.002), especially amongst endurance athletes (11.9% female EA vs. 2.8% female SBA, P=0.004) (Figure 1). As compared with males, the QTc interval was longer in female athletes (418 vs. 402ms), the QRS duration was shorter (90 vs. 100 ms) and left ventricular hypertrophy on voltage criteria were less prevalent (9.9% vs. 33.3%, P<0.001 for all). First-degree heart block and incomplete right bundle branch block were more prevalent amongst male athletes. Conclusion Female athletes exhibit different training-related cardiac remodelling responses to exercise compared to males. A greater proportion of ostensibly healthy female athletes, especially female endurance athletes, have ECG changes that would be deemed “potentially pathological” according to current sex-agnostic guidelines. Figure 1 Funding Acknowledgement Type of funding source: None

Cardiovascular adaptation to exercise and sport: (according to type of sport, gender, and ethnicity)

ESC CardioMed ◽  
2018 ◽  
pp. 2913-2916
Author(s):  
Michael Papadakis ◽  
Sanjay Sharma
Keyword(s):  
Female Athletes ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Endurance Athletes ◽  
Physiological Adaptation ◽  
Imaging Studies ◽  
Eccentric Hypertrophy ◽  
Athlete's Heart ◽  
Adaptation To Exercise

‘Athlete’s heart’ is associated with several structural and electrophysiological adaptations, which are reflected on the 12-lead electrocardiogram (ECG) and imaging studies. Most studies investigating cardiac remodelling in athletes are based on cohorts of white, adult, male athletes competing in the most popular sports. Evidence suggests, however, that sporting discipline and the athlete’s gender and ethnicity are important determinants of cardiovascular adaptation to exercise. Athletes competing in endurance sports demonstrate more pronounced adaptations in comparison to athletes performing static or resistance training. The ECG of endurance athletes is more likely to demonstrate repolarization anomalies in the anterior leads and ventricular dilatation on imaging studies, causing considerable overlap with arrhythmogenic right ventricular cardiomyopathy and dilated cardiomyopathy. Female athletes exhibit less pronounced adaptations compared to males, in terms of the prevalence of ECG changes and absolute cardiac dimensions. Importantly, female endurance athletes are more likely to demonstrate eccentric hypertrophy compared to males, suggesting that concentric remodelling or hypertrophy in female endurance athletes is unlikely to be the consequence of physiological adaptation to training. The most pronounced paradigm of ethnically distinct cardiovascular adaptation to exercise stems from black athletes, who exhibit a significantly higher prevalence of repolarization anomalies and left ventricular hypertrophy compared to white athletes, making the differentiation between athlete’s heart and hypertrophic cardiomyopathy challenging in this ethnic group.

Cardiac remodeling in middle-aged endurance athletes: relation between signal-averaged electrocardiogram and LV mass

2020 ◽  
Author(s):  
Laura Banks ◽  
Saif Al-Mousawy ◽  
Mustafa A Altaha ◽  
Kaja Koneiczny ◽  
Wesseem Osman ◽  
...  
Keyword(s):  
Cardiac Remodeling ◽  
Left Ventricular ◽  
Endurance Athletes ◽  
Electrical Remodeling ◽  
Middle Aged ◽  
Structural Remodeling ◽  
Endurance Sport ◽  
End Diastolic Volume ◽  
Lv Mass ◽  
Qrs Duration

Background: The relationship between structural and electrical remodeling in the heart, particularly after long-standing endurance training, remains unclear. Signal-averaged electrocardiogram (SAECG) may provide a more sensitive method to evaluate cardiac remodeling than a 12-lead electrocardiogram (ECG). Accurate measures of electrical function (SAECG filtered QRS duration (fQRSd) and late potentials (LP) and left-ventricular mass (cardiac magnetic resonance, CMR) can allow an assessment of structural and electrical remodeling. Methods: Endurance athletes (45-65 years old, >10 years of endurance sport), screened to exclude cardiac disease, had standardized 12-lead ECG, SAECG, resting echocardiogram (ECHO), and CMR performed. SAECG fQRSd was correlated with QRS duration on the 12-lead ECG, and ECHO and CMR-derived left ventricular (LV) mass. Results: Participants (n=82, 67% male, mean age: 54±6 years, mean VO2max: 50±7 ml/kg/min) had a CMR-derived LV mass of 118±28 g/m2 and a fQRSd of 112±8 ms (46% had abnormal fQRSd (>114 msec), and 51% met clinical threshold for abnormal SAECG). fQRSd was positively correlated with the 12-lead ECG QRS duration (r=0.83), ECHO-derived LV mass (r=0.60), CMR-derived LV mass (r=0.58) and LV end-diastolic volume (r=0.63, p<0.001 for all). fQRSd had higher correlations with ECHO and CMR-derived LV mass than 12-lead ECG (p<0.0008 and p<0.0005, respectively). Conclusion: In a healthy cohort of middle-aged endurance athletes, the SAECG is often abnormal by conventional criteria, and is correlated with structural remodeling, but CMR evaluation does not indicate pathologic structural remodeling. SAECG fQRSd is superior to the 12-lead ECG for the electrocardiographic evaluation of LV mass.

Left ventricular hypertrophy in middle-aged endurance athletes

2019 ◽  
Vol 24 (3) ◽  
pp. 110-113 ◽  
Author(s):  
Łukasz A. Małek ◽  
Anna Czajkowska ◽  
Anna Mróz ◽  
Katarzyna Witek ◽  
Marzena Barczuk-Falęcka ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Endurance Athletes ◽  
Middle Aged

Left atrial performance during exercise in endurance athletes: the impact of gender

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Simard ◽  
M Sanz-De La Garza ◽  
A Vaquer-Segui ◽  
I Blanco ◽  
S Prat-Gonzalez ◽  
...  
Keyword(s):  
Left Atrial ◽  
Female Athletes ◽  
Premenopausal Women ◽  
Underlying Mechanism ◽  
Cardiopulmonary Exercise Test ◽  
Endurance Athletes ◽  
Funding Source ◽  
Increased Risk ◽  
The Impact ◽  
Conduit Function

Abstract Background High-intensity endurance training is associated with an increased risk of atrial fibrillation (AF) in male athletes while it seems to have a protective effect for the development of atrial arrhythmias in female athletes. Mechanisms underlying this fact are unknown but a differential atrial adaptation to exercise may be involved. Aim To evaluate left atrial (LA) performance during exercise in endurance athletes (EAs) of both sexes. Methods Highly-trained (&gt;10 hours training/week) EAs performed a maximal cardiopulmonary exercise test. LA evaluation was performed at rest and immediately after exercise. LA analysis consisted of standard and speckle-tracking assessment: atrial contractile, reservoir and conduction strain. Results 80 EAs (55% women, 34.8±5.8 years) were enrolled. Baseline LA size and functional parameters were similar in both sexes (Table 1). Compared to men, women achieved a higher predicted VO2max (Δchange+11.9%, p&lt;0.01) but a similar increase of systolic blood pressure (Δ+63 vs +66%, p=0.58). Exercise induced a mild decrease in LA size but of similar amplitude for both sexes. LA strain parameters of EAs improved with exercise, but a significantly greater improvement in LA reservoir and conduit function was noted in women compared to men. In EAs with marked atrial remodelling (LA ≥35ml/m2), the same trend of greater improvement of LA reservoir and conduit function in women persisted. Conclusion In highly-trained EAs, premenopausal women have better LA function profile during exercise compared to men, even when the LA is significantly dilated. This discriminatory LA adaptation in female EAs could at least partly explain the dichotomous relationship between AF and exercise regarding sexes and warrants further studies to clarify the underlying mechanism. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Government of Spain - Plan Nacional I+D, Ministerio de Economia y Competitividad

scholarly journals The clinical atlas of cardiomyopathies: data from the prospective DZHK TORCH study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Sedaghat-Hamedani ◽  
J Trebing ◽  
A Kindermann ◽  
E Kayvanpour ◽  
K Tan ◽  
...  
Keyword(s):  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Left Ventricular ◽  
Favourable Outcome ◽  
Funding Source ◽  
Icd Implantation ◽  
Cardiovascular Research ◽  
National Budget ◽  
Public Grant ◽  
High Level

Abstract Introduction Cardiomyopathies (CMPs) are leading causes of heart failure (HF) and sudden cardiac death (SCD). Comparative data of the multiple cardiomyopathy forms are largely missing. The TranslatiOnal Registry for CardiomyopatHies (TORCH) is the largest prospective multicentre CMP registry world-wide. Enrolled patients are comprehensively phenotyped by clinical examinations, state-of-the-art imaging, and molecular investigations. In this study, we present the baseline and 1-year follow-up data. Methods TORCH is a national, prospective, multicentre registry within the German Centre for Cardiovascular Research (DZHK) and includes 2300 patients with non-ischemic (primary and secondary) CMP from 20 centres. The minimum follow up was one year. The DZHK-wide harmonization of datasets and SOPs ensure a high level of data quality and comparability across different CMP forms. Results Dilated cardiomyopathy (DCM) has the highest prevalence with 64% of all enrolled patients, followed by hypertrophic cardiomyopathy (HCM) with 16%. At baseline, patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) were treated more often with ICD implantation and showed high rates of adequate ICD therapies (65.8%, p&lt;0.05 and 47.8%, p&lt;0.05, respectively). The prevalence of stroke or transient ischemic attack (TIA) was in multivariate analysis significantly higher (p&lt;0.05) in left ventricular non-compaction cardiomyopathy (LVNC, 14.9%), while atrial fibrillation was lower than in other cardiomyopathy forms. Patients with amyloidosis had the worst outcome (HR: 6; 95% CI: 2.5–14.5, P&lt;0.05) with annual mortality of &gt;15% and 12% receiving heart transplantation. In DCM, reverse remodelling with improvement of functional parameters and biomarkers was more often observed in idiopathic and inflammatory cases compared to familial ones. HCM patients had the most favourable outcome. Conclusion and outlook TORCH is the largest prospective study focusing on CMPs. We provided for the first time prospectively the clinical data of patients with diverse cardiomyopathies with outcome. Furthermore, comparing the different CMP forms on the clinical and molecular level will be an important step to enable translational research projects. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): German Centre for Cardiovascular Research (DZHK)

Cardiovascular adaptation to exercise and sport: (according to type of sport, gender, and ethnicity)

ESC CardioMed ◽  
2018 ◽  
pp. 2913-2916
Author(s):  
Michael Papadakis ◽  
Sanjay Sharma
Keyword(s):  
Female Athletes ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Endurance Athletes ◽  
Physiological Adaptation ◽  
Imaging Studies ◽  
Eccentric Hypertrophy ◽  
Athlete's Heart ◽  
Adaptation To Exercise

‘Athlete’s heart’ is associated with several structural and electrophysiological adaptations, which are reflected on the 12-lead electrocardiogram (ECG) and imaging studies. Most studies investigating cardiac remodelling in athletes are based on cohorts of white, adult, male athletes competing in the most popular sports. Evidence suggests, however, that sporting discipline and the athlete’s gender and ethnicity are important determinants of cardiovascular adaptation to exercise. Athletes competing in endurance sports demonstrate more pronounced adaptations in comparison to athletes performing static or resistance training. The ECG of endurance athletes is more likely to demonstrate repolarization anomalies in the anterior leads and ventricular dilatation on imaging studies, causing considerable overlap with arrhythmogenic right ventricular cardiomyopathy and dilated cardiomyopathy. Female athletes exhibit less pronounced adaptations compared to males, in terms of the prevalence of ECG changes and absolute cardiac dimensions. Importantly, female endurance athletes are more likely to demonstrate eccentric hypertrophy compared to males, suggesting that concentric remodelling or hypertrophy in female endurance athletes is unlikely to be the consequence of physiological adaptation to training. The most pronounced paradigm of ethnically distinct cardiovascular adaptation to exercise stems from black athletes, who exhibit a significantly higher prevalence of repolarization anomalies and left ventricular hypertrophy compared to white athletes, making the differentiation between athlete’s heart and hypertrophic cardiomyopathy challenging in this ethnic group.

A physiological comparison of young and older endurance athletes

1981 ◽  
Vol 51 (3) ◽  
pp. 634-640 ◽  
Author(s):  
G. W. Heath ◽  
J. M. Hagberg ◽  
A. A. Ehsani ◽  
J. O. Holloszy
Keyword(s):  
Heart Rate ◽  
Ventricular Volume ◽  
Left Ventricular ◽  
Endurance Athletes ◽  
Middle Aged ◽  
Young Athletes ◽  
Echocardiographic Evaluation ◽  
Body Fat Content ◽  
Masters Athletes ◽  
O2 Pulse

Sixteen highly trained masters endurance athletes, 59 +/- 6 yr, were compared with 16 young athletes, with whom they were matched on the basis of their training regimens, and with 18 untrained middle-aged men. On echocardiographic evaluation, both groups of athletes had a significantly greater left ventricular volume and mass than the untrained men; their were no significant differences in percent fiber shortening or velocity of fiber shortening among the three groups. Maximum O2 uptake (VO2max) averaged 15% less in the masters than in the young athletes (58.7 vs. 69 ml.kg-1.min-1). When expressed in terms of lean body mass to correct for differences in body fat content, VO2max of the masters athletes was about 60% higher than that of the middle-aged untrained men. Maximum heart rate was 14% lower in the masters athletes than in the young athletes (169 vs. 197 beats/min). The O2 pulse during maximum exercise (i.e., VO2max/heart rate at VO2max) was identical in the masters and young athletes. This finding suggests that the major factor responsible for the lower VO2max of the masters athletes, compared with the young athletes, is their slower heart rate.

scholarly journals The relationship between glycosylation of proBNP at threonine 71, BNP, BNP1–32 and obesity in patients with heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L.K Lewis ◽  
S.D Raudsepp ◽  
T.G Yandle ◽  
C.J Pemberton ◽  
R.N Doughty ◽  
...  
Keyword(s):  
Heart Failure ◽  
New Zealand ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Funding Source ◽  
Obese Patients ◽  
Ventricular Ejection Fraction ◽  
National Budget ◽  
National Heart Foundation ◽  
Public Grant

Abstract Background Heart failure (HF) is a leading cause of morbidity and mortality worldwide. Measurement of BNP and NTproBNP are used in HF for diagnosis and prognosis but levels of these peptides are inappropriately low in obesity, a condition which is associated with increased HF. Cleavage of proBNP to produce BNP and NT-proBNP requires proBNP to be unglycosylated at threonine 71 (T71). Gycosylation at T71 is affected by obesity, resulting in lower plasma NT-proBNP concentrations in patients with higher BMI. However the relationships between BMI, proBNP glycosylation and BNP (particularly the bioactive cardio-protective peptide BNP1-32) have not previously been described. Methods Validated in-house assays for BNP, BNP1-32, proBNP, proBNP unglycosylated at T71 (NG-T71) and the commercial Roche assay for NT-proBNP were applied to plasma samples obtained from patients with HF (n=321, PEOPLE study: Prospective Evaluation of Outcome in Patients with Left Ventricular Ejection Fraction). Results Median (IQR) concentrations of BNP, BNP1-32, proBNP, NG-T71 and NTproBNP were 10.7 (5–21), 5 (2–9), 27.8 (9–62), 6.2 (3–22) and 217 (104–425) pmol/L respectively. BMI was inversely related to NG-T71, NT-proBNP, BNP and BNP1-32 (r=−0.19, −0.40, −0.36 and −0.34 respectively, all p&lt;0.01) but not proBNP (r=0.11, ns). ProBNP levels in patients with BMI above or below 30 kg/m2 were similar (29.8 (11.2–56.6) and 22.5 (3.9–65) pmol/L, p=0.51), whereas NG-T71, NT-proBNP, BNP and BNP1-32 levels were increased (p&lt;0.001) in patients with BMI &lt;30 (11.6 (3–25.6), 263 (153–486), 13.8 (6.5–25.5) and 6.3 (2.8–10.4)) compared to BMI &gt;30 (3 (1–16), 127 (63–274), 7.8 (3–14) and 3.6 (1.1–7) respectively. The BMI &gt;30 group had increased ProBNP:NT-proBNP, ProBNP:BNP and ProBNP:BNP1-32 ratios (all p&lt;0.001) and proBNP:NG-T71 (p=0.037), whereas ratios of NG-T71 to BNP, BNP1-32 or NT-proBNP were not related to BMI. Patients with diabetes (n=90) also had lower BNP, BNP1-32 (both p&lt;0.01), NG-T71 and NT-proBNP concentrations (both p&lt;0.05), but not proBNP (p=0.46), and a trend towards a higher proBNP:BNP1-32 ratio (p=0.06). Discussion and conclusion The negative association between BMI and plasma NT-proBNP and BNP is not well understood. We recently reported that obese patients with HF have reduced circulating levels of proBNP unglycosylated at T71. In this expanded sample we show that whilst proBNP remains unaffected by BMI, both immunoreactive BNP and more specifically bioactive BNP1–32 levels, and NT-proBNP, are decreased with obesity in conjunction with increased glycosylation at T71. Increased glycosylation at proBNP-T71 reduces the amount of proBNP cleaved to form NT-proBNP and BNP resulting in decreased production and lowered circulating concentrations of these clinically used marker peptides. Our results provide a robust mechanism to explain the reduction in NT-proBNP and BNP levels observed in obese patients and confirm this is associated with reduced bioactive BNP1–32. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Heart Foundation of New Zealand, nHealth Research Council of New Zealand

Cardiac hypertrophy in response to dynamic conditioning in female athletes

1978 ◽  
Vol 44 (6) ◽  
pp. 849-852 ◽  
Author(s):  
S. M. Zeldis ◽  
J. Morganroth ◽  
S. Rubler
Keyword(s):  
Athletic Performance ◽  
Female Athletes ◽  
Treadmill Exercise ◽  
Maximal Oxygen Consumption ◽  
Posterior Wall ◽  
Left Ventricular ◽  
Male Athletes ◽  
Posterior Wall Thickness ◽  
Hockey Players ◽  
Dynamic Conditioning

Ten female field hockey players were studied to determine if prolonged dynamic conditioning results in an increased left ventricular internal dimension at end diastole (LVIDD) and if this increase correlates with maximal oxygen consumption (VO2max). At peak season, echocardiograms were obtained and VO2max determined during maximal treadmill exercise. VO2max, LVIDD index (LVIDD/body surface area (BSA)), and ventricular septal and posterior wall thickness were compared to agematched nonathletic women. Mean LVIDD index was significantly greater in athletes than in controls: 29.3 +/- 0.9 mm/m2 vs. 26.3 +/- 0.6, P less than 0.005. Echocardiographic wall measurements did not differ significantly in the two groups. Mean VO2max for the athletes was significantly greater than controls: 51.7 +/- 4.0 ml O2.kg-1.min-1 vs. 41.2 +/- 2.1, P less than 0.001. VO2max correlated significantly with LVIDD index; r = 0.92, P less than 0.001. Female athletes show an increased LVIDD in response to dynamic conditioning similar to that seen in male athletes. The proficiency of athletic performance as measured by VO2max may be related to the heart's ability to increase LVIDD since there is a high correlation between VO2max and LVIDD index.

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