Electrical and structural remodelling in female athlete's heart: a study in women practising competitive sports

Abstract Funding Acknowledgements Type of funding sources: None. Background Athlete’s heart is associated with a physiological electrical and structural remodelling induced by training. While several data have been published in male athletes, data on female competitive athletes, and their comparison with male counterparts or sedentary women, are still inconclusive. Objectives This study aimed to analyze the electrical, structural, and functional cardiac remodelling in female and male competitive athletes and sedentary controls. Methods Competitive athletes were evaluated by 12-lead resting ECG and echocardiography and compared to the sedentary controls. Results The study population was composed of 1,096 individuals (360 female Olympic athletes, 410 male Olympic athletes, 130 sedentary women and 196 sedentary men). Female athletes had lower resting heart rate, longer PR interval, higher voltage of P, R, and T waves and more frequently incomplete RBBB, left ventricular (LV) hypertrophy, early repolarization, and anterior T-wave inversion as compared with non-athletes. Biventricular dimensions and LV wall thickness were greater in female athletes as compared to non-athletes. However, women showed a lower degree of training-induced structural remodelling than men. A progressive increase in biventricular dimensions and LV wall thickness was observed from athletes engaged in skill and power to those practicing mixed and endurance disciplines. However, in women, but not in men, the type of sport did not significantly influence ECG remodelling. Conclusions Highly-trained women demonstrate a relevant training-induced electrical and structural remodelling. However, the type of sport did not influence ECG parameters in women while it impacted on biventricular remodelling, with female endurance athletes showing the greatest degree of adaptation.