The spectrum of eccentric left ventricular hypertrophy in endurance sports disciplines

Endurance sports disciplines largely differ in terms of specific training and event modalities, likely resulting in diverse morpho-functional cardiac changes. Our study aims to assess elite athletes engaged in different endurance disciplines and describe cardiac remodelling in each. We enrolled 282 Olympic athletes (58.5% males, mean age 26.7 ± 4.7) practising long-distance running (57, 20.2%), triathlon (18, 6.4%), canoeing/rowing (76, 26.9%), cycling (65, 23%), long-distance swimming (21, 7.4%), cross-country skiing & biathlon (45, 16%). athletes underwent ECG, echocardiogram and exercise stress-test. Eccentric LV hypertrophy (EH) was present in 73.8% of athletes, without gender differences (p = 0.847), varying greatly among disciplines (p = 0.0005). Triathlon (94.4%) and cycling (87.7%) showed the highest prevalence. The largest LV volumes were observed in triathlon-athletes and cyclists (LVEDVi: males, p = 0.009, females, p = 0.002). The lowest LV dimensions were found in rowing/canoeing (males: p < 0.0001; females: p < 0.0001). Long-distance runners and swimmer presented intermediate extent of LV remodelling. Positive correlation between hours of training and LVMi (p = 0.0004) and LVEDVi (p = 0.048) was observed among cyclists. Indeed, cyclists with the highest EH (i.e., lowest LVMi\LVEDVi ratio) achieved the highest workload at exercise stress-test (p = 0.045) and better athletic achievements. Among endurance athletes, cyclists and triathletes present the most marked extent of LV EH, while canoeists and rowers the lowest degree, with major increase in LV mass. Intra-group analysis showed an association between eccentric hypertrophy and superior exercise capacity and higher athletic performances that may be related to an increased stroke volume and cardiac output, which improve cardiovascular efficiency during endurance exercise. These findings could be useful both for clinicians in identifying potential health issues in athletes and for coaches when assessing athletes' training status.