The impact of sex, age and training on biventricular cardiac adaptation in healthy adult and adolescent athletes: Cardiac magnetic resonance imaging study.
AIMS
Physiological cardiac adaptation in athletes is influenced by multiple factors. This study aimed to investigate the impact of sex, age, body size, sports type and training volume on cardiac adaptation in healthy athletes with cardiac magnetic resonance imaging.


METHODS
A total of 327 athletes (242 male) were studied (adults ≥18 years old; adolescents 14-18 years old). Left and right ventricular ejection fractions, end-diastolic volume, end-systolic volume, stroke volumes and masses were measured. Left ventricular end-diastolic volume/left ventricular mass, right ventricular end-diastolic volume/right ventricular mass and derived right/left ventricular ratios were determined to study balanced ventricular adaptation. Athletes were categorised as skill, power, mixed and endurance athletes.


RESULTS
Male athletes had higher left and right ventricular volumes and masses in both adult (n = 215 (145 male); 24 ± 5 years old) and adolescent (n = 112 (97 male); 16 ± 1 years old) groups compared with women (all P < 0.05). In adults, male sex, age, body surface area, weekly training hours, mixed and endurance sports correlated with higher ventricular volumes and masses (all P < 0.05); and a combination of age, sex, training hours, endurance and mixed sports explained 30% of the variance of the left ventricular end-diastolic volume index (r = 0.30), right ventricular end-diastolic volume index (r = 0.34), right ventricular mass index (r = 0.30); and as much as 53% of the left ventricular mass index (r = 0.53) (all P < 0.0001). In adolescents, positive correlations were found between training hours and left ventricular hypertrophy (r = 0.39, P < 0.0001), and biventricular dilation (left ventricular end-diastolic volume r = 0.34, P = 0.0008; right ventricular end-diastolic volume r = 0.36, P = 0.0004). In adolescents, age and body surface area did not correlate with cardiac magnetic resonance parameters.


CONCLUSION
There are significant sex differences in the physiological adaptation of adult and adolescent athlete's heart; and male sex, higher training volume and endurance sports are major determinants of sports adaptation in adults.
['Csecs|Ibolya|I|', 'Czimbalmos|Csilla|C|', 'Toth|Attila|A|', 'Dohy|Zsofia|Z|', 'Suhai|Imre F|IF|', 'Szabo|Liliana|L|', 'Kovacs|Attila|A|', 'Lakatos|Balint|B|', 'Sydo|Nora|N|', 'Kheirkhahan|Mobin|M|', 'Peritz|David|D|', 'Kiss|Orsolya|O|', 'Merkely|Bela|B|', 'Vago|Hajnalka|H|']
D000222:Adaptation, Physiological D000293:Adolescent D000328:Adult D000367:Age Factors D056352:Athletes D059267:Cardiomegaly, Exercise-Induced D005260:Female D006352:Heart Ventricles D006801:Humans D019028:Magnetic Resonance Imaging, Cine D008297:Male D064797:Physical Conditioning, Human D011237:Predictive Value of Tests D012737:Sex Factors D016277:Ventricular Function, Left D016278:Ventricular Function, Right D020257:Ventricular Remodeling D055815:Young Adult
sex Cardiac magnetic resonance imaging athlete’s heart cardiac hypertrophy exercise remodelling