The influence of sports-related factors on left heart chambers in young female athletes

Abstract

Objective: Athletic heart syndrome (AHS) represents a physiological and morphological adaptation of the heart to long-standing intensive training. Left ventricular (LV) chamber sizes are primarily affected by the complex interplay of sports-associated factors. AHS in females substantially varies from males due to underlying physiological, hormonal, and anthropometric differences. This study aims to explore the influence of sports-related factors on left heart chambers in young female athletes (FA). Methods: A cross-sectional study was conducted in 28 young FA, who undergo training for at least 3 months with a minimum of 3 times weekly sessions. They were divided in 2 groups: endurance (END) and mixed-training (MIX). We assessed using echocardiography: left atrial volume index (LAVI), end-diastolic (EDV) and end-systolic (ESV) LV volumes, LV mass index (LVMI). Comparisons were performed using t-tests or Mann-Whitney U tests. A MANCOVA was selected to determine the relationship between sports-related factors and left heart indices. Post-hoc contrast and margins tests were conducted to show a correlation with exact cardiac parameters. Results: Groups were matched by age, body surface area, and total training duration. However, weekly training time (WTT) was higher in END athletes (12.7 (5.3) vs. 5.7 (0.8), p<0.001) and left cardiac indices were greater in END athletes than in MIX counterparts: LAVI (28.8 vs.18.7 ml/m2, p=0.009), EDV (81.1 (11.7) vs 66.1 (16.8) ml, p=0.01), ESV (29.6 (10.8) vs. 20.5 (10) ml, p=0.01) and LVMI (68.3 (11.7) vs. 59.2 (8.2) gr/m2, p=0.02). According to MANCOVA, higher WTT (p=0.03, η² = 0.44), was associated with increased LAVI, EDV, and LVMI values. Mean differences obtained from contrast analysis showed significant variations of only LVMI between training groups (-13.17, p=0.04). Post-hoc analysis revealed significantly higher values of all chamber parameters in END athletes (p<0.001). Conclusions: Young FA have distinct cardiac adaptations based on training type and training load time. END athletes exhibited greater volumetric indices and LVM compared to MIX athletes, emphasizing the significant influence of training intensity and modality on cardiac remodeling. Furthermore, the hypothetical moderating role of the WTT in the relationship between training type and left heart chamber sizes was observed. These findings emphasize the importance of individualized cardiac evaluation in FA for the adequate management of the AHS.

Keywords

• athletic heart syndrome
• female athlete
• cardiac remodeling
• training type
• endurance training
• mixed training
• total training duration
• weekly training load