Echocardiographic Characterization of Female Professional Basketball Players in the US

Abstract

Importance: There is a paucity of data detailing cardiac remodeling in female athletes compared with male athletes. The lack of reference cardiac data for elite female basketball players or female athletes of similar size makes it difficult to differentiate athletic remodeling from potential underlying cardiac disorders in this population of athletes.

Objective: To assess cardiac structure and function in elite female basketball players.

Design, setting, and participants: This cross-sectional echocardiographic study included 140 Women's National Basketball Association (WNBA) athletes on active rosters for the 2017 season. The WNBA mandates annual preseason stress echocardiograms for each athlete. The WNBA has partnered with Columbia University to annually perform a review of these studies. Data analysis was performed from June 7, 2017, to October 5, 2017.

Main outcomes and measures: Echocardiographic variables included left ventricular (LV) dimensions, wall thickness, mass, prevalence of LV hypertrophy, aortic dimensions, right ventricular (RV) dimension, and right and left atrial size. Linear regression was used to assess the associations between cardiac structure and function with body size quantified as body surface area (BSA) in the primary analysis.

Results: A total of 140 female athletes (mean [SD] age, 26.8 [3.9] years; 105 [75.0%] African American) participated in the study. Mean (SD) athlete height was 183.4 (9.0) cm, and mean (SD) BSA was 2.02 (0.18) m2. Compared with guideline-defined normal values, LV enlargement was present in 36 athletes (26.0%) and 57 athletes (42.2%) had RV enlargement. There was a linear correlation between LV and RV cavity sizes and BSA extending to the uppermost biometrics (LV cavity size: r, 0.48; RV cavity size: r, 0.32; P < .001 for both). Maximal left ventricular wall thickness (LVWT) ranged from 0.6 to 1.4 cm, with 78 athletes (55.7%) having LVWT of 1.0 cm or greater and only 1 athlete (0.7%) having LVWT greater than 1.3 cm. Twenty-three athletes (16.4%) met the criteria for left ventricular hypertrophy (LVH) (>95 g/m2). Eccentric LVH was present in 16 athletes (69.6%), concentric LVH in 7 athletes (30.4%), and concentric remodeling in 27 athletes (19.3%). Mean aortic root diameter was 3.1 cm (95% CI, 3.0-3.2). Only 2 athletes (1.4%) had guideline-defined aortic enlargement compared with a range of 18% to 42% for left and right ventricular and atrial enlargement.

Conclusions and relevance: In this study, increased cardiac dimensions were frequently observed in WNBA athletes. Both BSA and physiologic remodeling affected cardiac morphologic findings. This study may provide a framework to define the range of athletic cardiac remodeling exhibited by elite female basketball players.

Figure 1.. Associations Between Cardiac Chamber Size and Body Surface Area (BSA)

Solid lines represent the fitted mean values of cardiac dimensions compared with BSA, shaded areas representing 95% CIs. Dotted lines represent the American Society of Echocardiography (ASE) cutoffs for normal ventricular dimensions. A, The ASE cutoff for left ventricular end-diastolic diameter (LVEDD) was 5.2 cm. B, The ASE cutoff for right ventricular (RV) basal diameter was 4.2 cm. LA indicates left atrial; RA, right atrial.

Figure 2.. Association Between Left Ventricular (LV) Mass and Body Surface Area (BSA)

Solid line represents the fitted mean value for LV mass compared with BSA, with shaded areas representing 95% CIs. The dotted line represents the American Society of Echocardiography cutoff for normal LV mass of 162 g.

Figure 3.. Association Between Aortic Root Diameter and Body Surface Area (BSA)

Solid line represents the fitted mean value for aortic root diameter compared with BSA, with shaded areas representing 95% CIs. The dotted line represents the American Society of Echocardiography cutoff for normal aortic root diameter of 3.6 cm for women.