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Sport category is an important determinant of cardiac adaptation: an MRI study
  1. Tim Luijkx1,
  2. Maarten J Cramer2,
  3. Niek H J Prakken1,
  4. Constantinus F Buckens1,3,
  5. Arend Mosterd2,3,4,
  6. Rienk Rienks2,5,
  7. Frank J G Backx6,
  8. Willem P Th M Mali1,
  9. Birgitta K Velthuis1
  1. 1Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
  3. 3Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  4. 4Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands
  5. 5Department of Cardiology, Central Military Hospital, Utrecht, The Netherlands
  6. 6Department of Rehabilitation, Nursing Science & Sports, University Medical Center Utrecht, Utrecht, The Netherlands
  1. Correspondence to Tim Luijkx, Department of Radiology, University Medical Center Utrecht, Utrecht 3584 CX, The Netherlands; tluijkx{at}


Background Physiological cardiac adaptation in athletes is influenced by body surface area, gender, age, training intensity and sport type. This study assesses the influence of sport category and provides a physiological reference for sport category and gender.

Methods Three hundred and eighty-one subjects (mean age 25±5 years, range 18 to 39 years; 61% men) underwent cardiac MRI and ECG: 114 healthy non-athletes (≤3 training h/week) and 267 healthy elite athletes (mean 17±6.6 training h/week). Athletes performed low-dynamic high-static (LD-HS, n=42), high-dynamic low-static (HD-LS, n=144) or high-dynamic high-static sports (HD-HS, n=81).

Results Left ventricular (LV) end-diastolic volume (EDV) index (ml/m2) for non-athletes/LD-HS/HD-LS/HD-HS, respectively, was 101/107/122/129 in men and 90/103/106/111 in women. LV end-diastolic mass (EDM) index (g/m2) for non-athletes/LD-HS/HD-LS/HD-HS was, respectively, 47/49/57/69 for men and 34/38/42/51 for women. Left or right ventricular EDV ratios were alike in all groups. LV EDV/EDM ratios were similar in non-athletes/LD-HS/HD-LS athletes, and only lower in HD-HS athletes, disproving selective ventricular wall thickening in LD-HS athletes. Multivariate linear regression demonstrated HD-LS and HD-HS sport category coefficients (p<0.01) larger than those of training hours, gender and age (LV EDV/EDM coefficients for sport category LD-HS 6/0.75, HD-LS 16/7, HD-HS 21/17). ECG abnormalities were most frequent in HD-HS athletes and in male subjects.

Conclusions This study demonstrates a balanced cardiac adaptation with preserved ratios of LV/right ventricular volume (in all sport categories) and LV volume/wall mass (in LD-HS and HD-LS sports). Sport category has a strong impact on cardiac adaptation. HD-HS sports show the largest changes, whereas LD-HS sports show dimensions similar to non-athletes.

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  • Competing interests None.

  • Ethics approval Medical-Ethical Comittee of the University Medical Center Utrecht.

  • Provenance and peer review Not commissioned; externally peer reviewed.