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Athletic Remodeling in Female College Athletes

The “Morganroth Hypothesis” Revisited

Kooreman, Zoe, MD*,†; Giraldeau, Geneviève, MD*,†; Finocchiaro, Gherardo, MD*,†; Kobayashi, Yukari, MD*,†; Wheeler, Matthew, MD*,†; Perez, Marco, MD*,†; Moneghetti, Kegan, MD*,†; Oxborough, David, PhD; George, Keith P., PhD; Myers, Jonathan, PhD*,†; Ashley, Euan, MRCP, DPhil*,†; Haddad, François, MD*,†

Clinical Journal of Sport Medicine: May 2019 - Volume 29 - Issue 3 - p 224–231
doi: 10.1097/JSM.0000000000000501
Original Research

Background: There is limited data regarding ventricular remodeling in college female athletes, especially when appropriate scaling of cardiac dimensions to lean body mass (LBM) is considered. Moreover, it is not well established whether cardiac remodeling in female athletes is a balanced process with proportional increase in left ventricular (LV) mass and volume or the right and LV size.

Methods: During the preparticipation competitive screening, 72 female college athletes volunteered to undergo dual energy x-ray absorptiometry scan for quantification of LBM and comprehensive 2D echocardiography including assessment of longitudinal myocardial strain. The athletes were divided in 2 groups according to the intensity of the dynamic and static components of their sport categories, ie, a higher intensity dynamic and resistive group (n = 37 participating in rowing, water polo and lacrosse) and a lower intensity group (n = 35, participating in short distance running, sailing, synchronized swimming, and softball). In addition, we recruited a group of 31 age-matched nonathlete controls.

Results: The mean age of the study population was 18.7 ± 1.0 years. When scaled to body surface area, the higher intensity group had 17.1 ± 3.6% (P < 0.001) greater LV mass when compared with the lower intensity group and 21.7 ± 4.0% (P < 0.001) greater LV mass than the control group. The differences persisted after scaling to LBM with 14.2 ± 3.2% (P < 0.001) greater LV mass in the higher intensity group. By contrast, there was no difference in any of the relative remodeling indices including the LV mass to volume ratio, right to LV area ratio, or left atrial to LV volume ratio (P > 0.50 for all). In addition, no significant difference was noted among the 3 groups in LV ejection fraction (P = 0.22), LV global longitudinal strain (P = 0.55), LV systolic strain rate (P = 0.62), or right ventricular global longitudinal strain (P = 0.61).

Conclusion: Female collegiate athletes participating in higher intensity dynamic and resistive sports have higher indexed LV mass even when scaled to LBM. The remodeling process does however appear to be a balanced process not only at the intraventricular level but also at the interventricular and atrioventricular levels.

*Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California;

Faculty of Science; School: Sport and Exercise Sciences, Stanford Cardiovascular Institute, Stanford, California; and

Liverpool John Moores University, Liverpool, United Kingdom.

Corresponding Author: Francois Haddad, MD, FAHA, Stanford Cardiovascular Institute, Palo Alto, CA 94304 (

The authors report no conflicts of interest.

E. Ashley and F. Haddad are equivalent cosenior authors of the study.

Received November 21, 2016

Accepted May 04, 2017

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.