Gender Differences in Ventricular Remodeling and Function in College Athletes, Insights from Lean Body Mass Scaling and Deformation Imaging

Geneviève Giraldeau,Yukari Kobayashi,Gherardo Finocchiaro,Matthew Wheeler,Marco Perez,Tatiana Kuznetsova,Rachel Lord,Keith P George,David Oxborough,Ingela Schnittger,Victor Froelicher,David Liang,Euan Ashley,François Haddad

doi:10.1016/j.amjcard.2015.08.026

Abstract

Several studies suggest gender differences in ventricular dimensions in athletes. Few studies have, however, made comparisons of data indexed for lean body mass (LBM) using allometry. Ninety Caucasian college athletes (mixed sports) who were matched for age, ethnicity, and sport total cardiovascular demands underwent dual-energy x-ray absorptiometry scan for quantification of LBM. Athletes underwent comprehensive assessment of left and right ventricular and atrial structure and function using 2-dimensional echocardiography and deformation imaging using the TomTec analysis system. The mean age of the study population was 18.9 ± 1.9 years. Female athletes (n = 45) had a greater fat free percentage (19.4 ± 3.7%) compared to male athletes (11.5 ± 3.7%). When scaled to body surface area, male had on average 19 ± 3% (p <0.001) greater left ventricular (LV) mass; in contrast, when scaled to LBM, there was no significant difference in indexed LV mass -1.4 ± 3.0% (p = 0.63). Similarly, when allometrically scaled to LBM, there was no significant gender-based difference in LV or left atrial volumes. Although female athletes had mildly higher LV ejection fraction and LV global longitudinal strain in absolute value, systolic strain rate and allometrically indexed stroke volume were not different between genders (1.5 ± 3.6% [p = 0.63] and 0.0 ± 3.7% [p = 0.93], respectively). There were no differences in any of the functional atrial indexes including strain or strain rate parameters. In conclusion, gender-related differences in ventricular dimensions or function (stroke volume) appear less marked, if not absent, when indexing using LBM allometrically.

Highlights

Despite several years of investigation, the extent of sex differences in ventricular dimension and function in athletes remains a subject of debate.[1,2,3,4,5,6,7,8,9,10,11] Part of the controversy may be related to the fact that only few studies took into account body composition when scaling cardiac dimensions
When scaling to lean body mass (LBM) using allometric coefficients, no significant sex associated difference was observed for Left ventricular (LV) mass, LV volume or left atrial size
Small sex based differences in LV ejection fraction (LVEF) or LVGLS were observed in our study, these do not translate in differences in indexed stroke volume or ventricular strain rate, a potentially less load dependent metric of function

Summary

Introduction

Despite several years of investigation, the extent of sex differences in ventricular dimension and function in athletes remains a subject of debate.[1,2,3,4,5,6,7,8,9,10,11] Part of the controversy may be related to the fact that only few studies took into account body composition when scaling cardiac dimensions. We sought to determine, in college athletes, whether sex-related differences in ventricular dimensions persisted after adjustment for lean body mass (LBM). We sought to compare sex associated differences in functional parameters including ventricular and atrial strain analysis

Methods

Results

Conclusion