{
  "abstract": "Objectives Exercise-induced cardiac remodelling is well described in male athletes but incompletely understood in females. This study aimed to examine sex differences in cardiac structure, function and fibrosis relative to fitness and to determine reference ranges for ‘normal’ chamber size in a large cohort of healthy male and female highly trained endurance athletes.Methods This multicentre international study used cardiac MRI and cardiopulmonary exercise testing (VO 2peak) to assess sex-specific relationships between measures of biventricular chamber size, function, fibrosis and VO2peak.Results Of the 364 endurance athletes included, 36.5% were female. Compared with males, female athletes achieved lower VO 2peak (51 (40–57) vs 59 (41–65) mL/kg/min, p<0.001), had smaller absolute and body surface area (BSA)-indexed left and right end-diastolic volumes (LVEDV, respectively) but similar volumes when indexed to fat-free mass. Both sexes showed a strong association between LVEDV and VO2peak (r=0.60–0.66) and a similar coefficient describing the linear relationship between VO2peak and LVEDV (Females: VO2peak(mL/min)=12.1×LVEDV+963.9; males: VO2peak=15.3×LVEDV+806.8, p=0.100) and BSA-indexed LVEDV (females: VO2peak (mL/kg/min)=0.37×LVEDV/BSA+12.5; males: VO2peak=0.51×LVEDV/BSA-1.2, p=0.059). There was no difference between right ventricular (RV) measures and VO2peak; however, males had 3.8 times higher odds of reduced RV ejection fraction. Prevalent myocardial scar was similar for both female (14.2%) and male (19.9%) athletes (p=0.180).Conclusions Female and male athletes demonstrate similar cardiac remodelling relative to fitness and no sex difference in myocardial scar. The female athlete’s heart can show profound adaptation, and previous assertions that female hearts have lesser capacity for remodelling should be reappraised.",
  "authors": [
    {
      "affiliations": [
        "Heart, Exercise and Research Trials, St Vincent’s Institute of Medical Research, Melbourne, Victoria, Australia",
        "Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia",
        "St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia"
      ],
      "name": "Stephanie Rowe"
    },
    {
      "affiliations": [
        "Heart, Exercise and Research Trials, St Vincent’s Institute of Medical Research, Melbourne, Victoria, Australia",
        "Exercise and Nutrition Research Program, Australian Catholic University Mary MacKillop Institute for Health Research, Melbourne, Victoria, Australia"
      ],
      "name": "Kristel Janssens"
    },
    {
      "affiliations": [
        "Heart, Exercise and Research Trials, St Vincent’s Institute of Medical Research, Melbourne, Victoria, Australia"
      ],
      "name": "Amy Mitchell"
    },
    {
      "affiliations": [
        "Heart, Exercise and Research Trials, St Vincent’s Institute of Medical Research, Melbourne, Victoria, Australia",
        "Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia"
      ],
      "name": "Paolo D’Ambrosio"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Sciences, UZ Leuven, Leuven, Belgium",
        "Department of Cardiovascular Diseases, KU Leuven, Leuven, Belgium",
        "Faculty of Medicine and Life Sciences/LCRC, UHasselt, Hasselt, Belgium"
      ],
      "name": "Jarne De Paepe"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Sciences, UZ Leuven, Leuven, Belgium"
      ],
      "name": "Sofie Van Soest"
    },
    {
      "affiliations": [
        "Heart, Exercise and Research Trials, St Vincent’s Institute of Medical Research, Melbourne, Victoria, Australia",
        "Department of Cardiology, Clinic Hospital, Barcelona, Spain"
      ],
      "name": "Margarita Calvo-Lopez"
    },
    {
      "affiliations": [
        "Heart, Exercise and Research Trials, St Vincent’s Institute of Medical Research, Melbourne, Victoria, Australia"
      ],
      "name": "Oscar Cullen"
    },
    {
      "affiliations": [
        "Heart, Exercise and Research Trials, St Vincent’s Institute of Medical Research, Melbourne, Victoria, Australia",
        "Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia"
      ],
      "name": "Luke Spencer"
    },
    {
      "affiliations": [
        "Department of Movement Sciences, KU Leuven, Leuven, Belgium"
      ],
      "name": "Christophe Dausin"
    },
    {
      "affiliations": [
        "Faculty of Medicine and Life Sciences/LCRC, UHasselt, Hasselt, Belgium",
        "Radiology, Jessa Hospital, Hasselt, Belgium"
      ],
      "name": "Olivier Ghekiere"
    },
    {
      "affiliations": [
        "Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium",
        "Department of Imaging and Pathology, KU Leuven, Leuven, Belgium"
      ],
      "name": "Jan Bogaert"
    },
    {
      "affiliations": [
        "Faculty of Medicine and Life Sciences/LCRC, UHasselt, Hasselt, Belgium",
        "Hartcentrum Hasselt, Hasselt, Belgium"
      ],
      "name": "Lieven Herbots"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Sciences, UZ Leuven, Leuven, Belgium",
        "Department of Cardiovascular Diseases, KU Leuven, Leuven, Belgium",
        "Faculty of Medicine and Life Sciences/LCRC, UHasselt, Hasselt, Belgium",
        "Hartcentrum Hasselt, Hasselt, Belgium"
      ],
      "name": "Youri Bekhuis"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Sciences, UZ Leuven, Leuven, Belgium",
        "Department of Cardiovascular Diseases, KU Leuven, Leuven, Belgium",
        "Faculty of Medicine and Life Sciences/LCRC, UHasselt, Hasselt, Belgium",
        "Hartcentrum Hasselt, Hasselt, Belgium"
      ],
      "name": "Rik Pauwels"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Sciences, UZ Leuven, Leuven, Belgium",
        "Department of Cardiovascular Diseases, KU Leuven, Leuven, Belgium"
      ],
      "name": "Rik Willems"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Sciences, University of Antwerp, Antwerpen, Belgium",
        "Department of Cardiology, University Hospital, Edegem, Belgium"
      ],
      "name": "Hein Heidbuchel"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Diseases, KU Leuven, Leuven, Belgium",
        "Faculty of Medicine and Life Sciences/LCRC, UHasselt, Hasselt, Belgium",
        "Hartcentrum Hasselt, Hasselt, Belgium"
      ],
      "name": "Guido Claessen"
    },
    {
      "affiliations": [
        "Heart, Exercise and Research Trials, St Vincent’s Institute of Medical Research, Melbourne, Victoria, Australia",
        "St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia",
        "Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia"
      ],
      "name": "André La Gerche"
    },
    {
      "affiliations": [],
      "name": "on behalf of the Pro@Heart Consortium"
    }
  ],
  "title": "Female endurance athletes: smaller hearts but similar relationship between ventricular size, fitness and fibrosis as male athletes",
  "uid": "bf175fcd-2329-5e00-8a2f-bec84f6aa83f"
}