The Female Athlete's Heart: Facts and Fallacies

Abstract

Purpose of the review: For many years, competitive sport has been dominated by men. Recent times have witnessed a significant increase in women participating in elite sports. As most studies investigated male athletes, with few reports on female counterparts, it is crucial to have a better understanding on physiological cardiac adaptation to exercise in female athletes, to distinguish normal phenotypes from potentially fatal cardiac diseases. This review reports on cardiac adaptation to exercise in females.

Recent findings: Recent studies show that electrical, structural, and functional cardiac changes due to physiological adaptation to exercise differ in male and female athletes. Women tend to exhibit eccentric hypertrophy, and while concentric hypertrophy or concentric remodeling may be a normal finding in male athletes, it should be evaluated carefully in female athletes as it may be a sign of pathology. Although few studies on veteran female athletes are available, women seem to be affected by atrial fibrillation, coronary atherosclerosis, and myocardial fibrosis less than male counterparts. Males and females exhibit many biological, anatomical, and hormonal differences, and cardiac adaptation to exercise is no exception. The increasing participation of women in sports should stimulate the scientific community to develop large, longitudinal studies aimed at a better understanding of cardiac adaptation to exercise in female athletes.

Keywords: Cardiac remodeling; Female athletes; Sudden cardiac death.

Fig. 1

ECG patterns in male (a) and female (b) athletes. Note the combination of anterior T wave inversion and significant (> 0.1 mV) J point elevation and the voltage criteria for LVH in the male athlete’s ECG. Conversely, the female athlete’s ECG is characterized by the absence of J point elevation and voltage criteria for LVH.

Fig. 2

Main gender differences in cardiac adaptation to exercise. Abbreviations: AF: atrial fibrillation; BSA: body surface area; CAC: coronary artery calcification; CAD: coronary artery disease; CH: concentric hypertrophy; CR: concentric remodeling; EH: eccentric hypertrophy; LAD: left atrial dilation; LVEDD: left ventricular end diastolic diameter; LVH: left ventricular hypertrophy; LVM: left ventricular mass; LVWT: left ventricular wall thickness; RVH: right ventricular hypertrophy; VC: voltage criteria.