Endurance Sports Affect Female Hearts Differently From Male Hearts, Says Study

Deborah Brauser

September 09, 2015

LONDON, UK — Female endurance athletes may exhibit different cardiac effects from exercise compared with their male counterparts, suggests new research[1].

A prospective study of more than 1000 young adult athletes showed that eccentric hypertrophy, with normal relative wall thickness (RWT) but increased left ventricular mass (LVM), was common in women who regularly participated in sustained, vigorous activities that included long-distance running or biking. However, men who participated in these types of sports were more likely to have concentric hypertrophy or remodeling.

Dr Sanjay Sharma (George's University of London, UK) told attendees at the European Society of Cardiology (ESC) 2015 Congress that literature on female athletes "is very scarce" but should be revisited because they make up "an increasing proportion of athletes that excel at the highest level."

He added to heartwire from Medscape that absolute wall thickness and absolute dimensions shouldn't be assessed in women. "Instead, we should be looking at how thick the wall is in relation to how big the cavity is."

LV Geometry

Dr Sanjay Sharma
(© ESC Congress 2015)

Sharma reported that 20% of the endurance athletes competing at the 2012 Olympics were women, "and the number is increasing. The aim of this study was to compare left ventricular geometry in male and female athletes in relation to the type of sport they engaged in," he said.

The investigators assessed 1083 healthy athletes (100% white; 41% women; mean age 21.8 years). All participants underwent echocardiography and were then divided into four groups:

  • Normal LVM/normal RWT.

  • Increased LVM/normal RWT (eccentric hypertrophy).

  • Increased LVM/increased RWT (concentric hypertrophy).

  • Normal LVM/increased RWT (concentric remodeling).

In addition, the 40 different "sporting disciplines" that the study population predominantly participated in were grouped into the following three categories:

  • Dynamic (28%).

  • Static (10%, included weight training or judo).

  • Mixed (62%, included football, rugby, or rowing).

The investigators found that 72% of the women and 69% of the men had normal LV geometry (normal LVM/normal RWT). "But that left a significant proportion of athletes with abnormal geometry, which can sometimes raise the possibility of a heart-muscle disorder," said Sharma.

Overall, the female participants had significantly lower LVM vs the men (83 g/m2 vs 101 g/m2, respectively, P<0.001), as well as lower RWT (0.35 vs 0.36, P<0.001).

In addition, the women had "lower absolute but higher indexed for body-surface-area LV end-diastolic dimensions" (49.4 vs 54.5 mm, respectively, and 29.3 vs 27.3 mm/m2; P<0,001 for both comparisons).

However, 21% of the women had eccentric hypertrophy vs 19% of the men, which was even stronger in the dynamic sports groups (22% vs 16%, respectively). On the other hand, more male dynamic sports participants than women had concentric hypertrophy or remodeling (15% vs 4%).

"Women adapted by increasing their cavities more than males; but increasing their wall thickness was quite uncommon," noted Sharma, adding that any growth in wall thickness in women should be assessed for possible hypertrophic cardiomyopathy.

An RWT greater than 0.5 or an LVM greater than 145 g was not detected in any female. "That's an important point," said Sharma. Finally, there were no differences between the male and female athletes who participated in static or mixed sports.

Sharma noted that many sporting organizations in Europe now do mandatory screening. "Death in sport among females is extremely rare, but they still get screened. However, if a female has a dodgy ECG, then perhaps [LVM and RWT] could give a better idea of whether there is a serious cardiac condition."

Decrease "Overinvestigation"

Dr Barbara Casadei
(© ESC Congress 2015)

During a "Heart of the Woman" press conference, comoderator Dr Barbara Casadei (British Heart Foundation and University of Oxford, UK) told heartwire that clinicians need to realize there are some gender differences in LV remodeling among athletes.

"At my institution, I often see female athletes who are overinvestigated for suspected dilated cardiomyopathy," she said. "So it's very important that people remember these differences and continue to think about it."

Casadei added that presentation, complications, and interactions with other diseases, such as breast cancer, may also be different between the sexes. "All of these things may not be at the forefront of the mind of the cardiologist," she said.

"It's also important to not mistake these physiology adaptions for a disease. And equally, it's important to see that what might look like normal adaptation, which is the male adaptation, is not physiological in women."

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