Rowe Stephanie, Janssens Kristel, Mitchell Amy, D'Ambrosio Paolo, De Paepe Jarne, Van Soest Sofie, Calvo-Lopez Margarita, Cullen Oscar, Spencer Luke, Dausin Christophe, Ghekiere Olivier, Bogaert Jan, Herbots Lieven, Bekhuis Youri, Pauwels Rik, Willems Rik, Heidbuchel Hein, Claessen Guido, La Gerche André
Heart, Exercise and Research Trials, St Vincent's Institute of Medical Research, Melbourne, Victoria, Australia
Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
Br J Sports Med. 2025 Aug 26;59(17):1211-1218. doi: 10.1136/bjsports-2024-109503.
Exercise-induced cardiac remodelling is well described in male athletes but incompletely understood in females. This study aimed to examine sex differences in cardiac structure, function and fibrosis relative to fitness and to determine reference ranges for 'normal' chamber size in a large cohort of healthy male and female highly trained endurance athletes.
This multicentre international study used cardiac MRI and cardiopulmonary exercise testing (VOpeak) to assess sex-specific relationships between measures of biventricular chamber size, function, fibrosis and VOpeak.
Of the 364 endurance athletes included, 36.5% were female. Compared with males, female athletes achieved lower VOpeak (51 (40-57) vs 59 (41-65) mL/kg/min, p<0.001), had smaller absolute and body surface area (BSA)-indexed left and right end-diastolic volumes (LVEDV, respectively) but similar volumes when indexed to fat-free mass. Both sexes showed a strong association between LVEDV and VOpeak (r=0.60-0.66) and a similar coefficient describing the linear relationship between VOpeak and LVEDV (Females: VOpeak(mL/min)=12.1×LVEDV+963.9; males: VOpeak=15.3×LVEDV+806.8, p=0.100) and BSA-indexed LVEDV (females: VOpeak (mL/kg/min)=0.37×LVEDV/BSA+12.5; males: VOpeak=0.51×LVEDV/BSA-1.2, p=0.059). There was no difference between right ventricular (RV) measures and VOpeak; however, males had 3.8 times higher odds of reduced RV ejection fraction. Prevalent myocardial scar was similar for both female (14.2%) and male (19.9%) athletes (p=0.180).
Female and male athletes demonstrate similar cardiac remodelling relative to fitness and no sex difference in myocardial scar. The female athlete's heart can show profound adaptation, and previous assertions that female hearts have lesser capacity for remodelling should be reappraised.
运动诱导的心脏重塑在男性运动员中已有充分描述，但在女性中尚未完全了解。本研究旨在探讨心脏结构、功能和纤维化方面的性别差异与体能的关系，并确定一大群健康的男性和女性高水平耐力运动员“正常”心腔大小的参考范围。
这项多中心国际研究使用心脏磁共振成像和心肺运动测试（VOpeak）来评估双心室腔大小、功能、纤维化测量值与VOpeak之间的性别特异性关系。
在纳入的364名耐力运动员中，36.5%为女性。与男性相比，女性运动员的VOpeak较低（51（40 - 57）对59（41 - 65）mL/kg/min，p<0.001），左、右舒张末期容积的绝对值和体表面积（BSA）指数较小，但按去脂体重指数化后的容积相似。两性的左心室舒张末期容积（LVEDV）与VOpeak之间均显示出强烈关联（r = 0.60 - 0.66），且描述VOpeak与LVEDV之间线性关系的系数相似（女性：VOpeak（mL/min）= 12.1×LVEDV + 963.9；男性：VOpeak = 15.3×LVEDV + 806.8，p = 0.100）以及BSA指数化的LVEDV（女性：VOpeak（mL/kg/min）= 0.37×LVEDV/BSA + 12.5；男性：VOpeak = 0.51×LVEDV/BSA - 1.2，p = 0.059）。右心室（RV）测量值与VOpeak之间无差异；然而，男性右心室射血分数降低的几率高3.8倍。女性（14.2%）和男性（19.9%）运动员的心肌瘢痕患病率相似（p = 0.180）。
相对于体能，女性和男性运动员表现出相似的心脏重塑，心肌瘢痕无性别差异。女性运动员的心脏可表现出深刻的适应性，先前关于女性心脏重塑能力较弱的论断应重新评估。
