Introduction
Left ventricular (LV) enlargement is common in athletes, especially those in endurance sports. Traditional assessments of the athlete’s heart account for factors like age, sex, body size, and sporting discipline, with sports classified by cardiovascular demand. Recently, indexing LV end-diastolic volume (EDV) to peak oxygen uptake (aVO₂peak) has shown promise in distinguishing athletic heart remodeling from pathological changes, without the need for body surface area (BSA) adjustments. This study examines whether indexing LV EDV and mass to aVO₂peak could reduce the need for sport-specific reference ranges by minimizing variations across disciplines.
Methods
This secondary analysis used data from the COSMO-S study of athletes (>18 years) across endurance, mixed, power, and technical sports who tested positive for SARS-CoV-2 or displayed antibodies. An additional cohort of elite endurance athletes from Trondheim, Norway, was included. Exclusions were age >50 years and resting LVEF <45%. All participants underwent clinical evaluations, including TTE to measure LV dimensions, mass, and diastolic function, as well as CPET to assess VO₂peak and peak heart rate. LV EDV and mass indexed to BSA and aVO₂peak were compared across disciplines using Kruskal-Wallis tests and correlation analyses.
Results
In this study, 85 athletes across endurance, mixed, power, and technical sports were analyzed, with significant differences observed in sex, BMI, height, and VO₂peak among groups. Endurance athletes had the highest VO₂peak and greater LVEDV, LVIDd, and LV mass compared to power and technical athletes. Indexing LVEDV and LV mass to aVO₂peak eliminated significant differences across sports, whereas indexing to BSA showed significant variation. VO₂peak accounted for a larger proportion of variance in LVEDV and LV mass than BSA, particularly for LVEDV. Overall, LVEDV/aVO₂peak and LV mass/aVO₂peak ratios were stable across athletes, supporting their use over BSA for assessing cardiac size in athletes.
Conclusion
Indexing left ventricular mass and volume to aVO₂peak may provide a more accurate physiological assessment by integrating both body size and training status. Applying this approach in clinical practice could help differentiate between normal athletic cardiac enlargement and pathological changes, though further studies are needed to confirm its effectiveness.
