Schellenberg J; Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14, Ulm 89075, Germany.
& School of Sport Science, UiT the Arctic University of Norway, Tromsø, Norway.
Matits L; Kersten J; Bizjak DA; SKirsten J; Fremo T;Tjønna AE; Skovereng K; Sandbakk Ø; Aksetøy IA; Langlo KAR; Dalen H; Letnes JM;
European heart journal. Imaging methods and practice [Eur Heart J Imaging Methods Pract] 2025 Oct 30; Vol. 3 (4), pp. qyaf138.
Date of Electronic Publication: 2025 Oct 30 (Print Publication: 2025)
Aims: Left ventricular (LV) enlargement is a common training-induced adaptation in athletes, particularly in endurance sports. Previous research indicates that indexing LV volumes and mass to absolute peak oxygen uptake (VO₂ peak ) better reflects physiological adaptation than traditional indexing to body surface area (BSA). Therefore, we investigated whether indexing LV end-diastolic volume (LVEDV) and mass to VO 2peak could eliminate differences in LV size among athletes from different sport categories (endurance, mixed, power, and technical).
Methods and Results: This analysis included 70 athletes from the multicenter COSMO-S in Germany and 15 elite endurance athletes from Norway. All participants (29 ± 8 years, 52 male) underwent echocardiography and cardiopulmonary exercise testing. In regression analyses, VO 2peak (L/min) accounted for a significantly greater proportion of the variance in LVEDV than BSA (R 2 0.64 vs. 0.19, P < 0.001), while this difference was not significant for LV mass (R 2 0.54 vs. 0.36, P = 0.06). When indexed to BSA, both LVEDV and LV mass revealed significant differences across sports (both P ≤ 0.019), that disappeared when indexed to VO₂ peak (all P ≥ 0.40). In a cohort of 12 dilated cardiomyopathy (DCM) patients serving as a pathological reference group, indexing LVEDV and LV mass to VO 2peak better differentiated DCM patients from athletes than indexing to BSA.
Conclusion: Indexing LV size to VO₂ peak may provide a more physiological interpretation of cardiac adaptations in athletes and reduce sport-specific differences due to better consideration of training-induced adaptations. These findings should be replicated in larger cohorts and tested for the ability to detect subtle pathologies.