Physical, Cardiac Characteristics of Male Athletes With Left Ventricular Hypertrophy

Young man doing leg stretches in the gym
Young man doing leg stretches in the gym.
Comparing elite athletes with and without left ventricular hypertrophy, researchers assessed inter-individual variability of cardiac remodeling as a result of high-intensity exercise.

Left ventricular (LV) hypertrophy (LVH) among male elite athletes was associated with increased blood pressure, body weight, body mass index (BMI), fat percentage, and likely does not improve physical performance, according to a study published in the International Journal of Cardiology.

For the analysis, researchers retrospectively reviewed records of elite athletes (N=2120), who were evaluated at the Institute of Sports Medicine and Science in Italy between 2013 and 2018 for the Olympic Program. Athletes (n=48) with LVH during echocardiographic examination (LV wall ³13 mm) without other causative conditions were matched 1:1 with athletes who did not have LVH. Group differences were compared.

The athletes had a mean age of 25±4 years and all were men. Athletes with LVH engaged in endurance (71%), mixed (19%), or power sports (10%). A similar trend was observed among controls.

The LVH cohort had significantly higher BMI (P <.001), systolic blood pressure (BP; P =.002), diastolic BP (P =.002), weight (P =.006), body fat percentage (P =.016), body surface area (P =.018), and decreased exercise load index (P =.013) and lean body percentage (P =.016).

During exercise testing, athletes with LVH had significantly lower peak workload (mean, 3.7±0.9 vs 4.1±0.8 Watts/Kg; P =.013) and higher peak diastolic BP (mean, 79±10 vs 74±11 mm Hg; P =.012).

Many cardiovascular parameters were significantly higher among the LVH cohort, including LV maximum wall thickness, relative wall thickness, LV mass, LV mass index, left atrial size, peak diastolic BP, and end diastolic diameter (all P £.012). Tissue doppler image e’ was significantly lower among the LVH athletes (P =.019).

Normal LV geometry was observed among 0% of LVH and 21% of controls (P <.001), and more of the LVH athletes had concentric hypertrophy (27% vs 6%; P =.006).

Significant predictors of LVH included BMI (odds ratio [OR], 1.220; 95% CI, 1.016-1.465; P =.033) and diastolic BP (OR, 1.052; 95% CI, 1.011-1.130; P =.020).

This study was limited by its demographic bias, which included White men. It remains unclear whether similar patterns would be observed among women or more diverse populations.

The data indicated that a subset of elite athletes have LVH. Individuals with LVH had increased body weight, body mass, and fat percentage. The increased LV mass was not associated with better physical performance and may be disproportionate to sport activity.

“…[I]t is noteworthy the finding that we found [regarding] significant differences in terms of blood pressure, body weight, and composition,” the study authors noted. “Namely, we observed that athletes with LVH had higher systolic and diastolic [BP] compared to the non-LVH [participants], although the mean values still remained within the normal range. In our opinion, it is possible that the mild increase in mean [BP] may be responsible for a chronically higher hemodynamic load, consequently triggering a greater LV remodeling.”


Caselli S, Cicconetti M, Niederseer D, Schmied C, Attenhofer Jost C, Pelliccia A. Left ventricular hypertrophy in athletes, a case-control analysis of interindividual variability. Int J Cardiol. Published online December 9, 2021. doi:10.1016/j.ijcard.2021.12.009