The Impact of Elite Endurance Activity on Cardiac Remodelling in Asians - an Echocardiographic Case Control Study

Prolonged endurance training causes significant cardiac adaptations like thickened left ventricular (LV) walls and dilated ventricles, which may mimic cardiomyopathies. While reference ranges for elite black and white athletes exist, Asian athletes’ data remains scarce. This study aimed to compare echocardiographic parameters between elite endurance athletes (EAs) and non-endurance controls.Elite athletes in endurance sport were identified from the Singapore Sports cardiology Registry (SSCR) from January to October 2018. Controls were (a) skill-based athletes from the SSCR, healthy non-athletic volunteers from (b) a national atrial fibrillation registry, and (c) a national heart failure registry. All underwent resting two-dimensional, M-mode and Doppler transthoracic echocardiography.163 participants (55 EAs, 108 controls) were analysed (mean age 28.9 years, male 54.6%; Chinese 100% among EAs). Baseline characteristics were similar. EAs had larger LV wall thickness (9.2 vs. 8.0 mm, p < 0.001), LVIDd (50.7 vs. 48.2 mm, p < 0.001), larger LV mass (168.8 vs. 130.4g, p < 0.001), larger right ventricular dimensions and biatrial volumes, even after indexing for body surface area, age and ethnicity.Endurance activity in elite Singaporean Chinese athletes was associated with significant cardiac remodelling. This study described echocardiographic reference ranges to better distinguish physiology from pathology in Asian athletes.