Intensive exercise- and sport changes the heart of an athlete. Research led by Amsterdam UMC shows that the hearts of female athletes have different characteristics than those of male athletes. Whereas a thickening in combination with a dilation of the heart muscle is characteristic in male top athletes, dilation of the heart chambers is mainly seen in female elite athletes. An important observation that can help doctors to better distinguish between normal sports-related changes and possible heart disease in female athletes. These results were published today in European Heart Journal Cardiovascular Imaging.
Difference Between Men and Women
Despite the growing attention for biological differences between men and women in healthcare, women are still often underexposed in medical research. Harald Jorstad, sports cardiologist at Amsterdam UMC: "Women are still underrepresented in heart research, especially when it comes to sports cardiology research. But through our collaboration with the Dutch Olympic team, we have now also been able to gain knowledge from female elite athletes about adaptations in the morphology of the heart."
Knowing what is normal
With an MRI scan, the hearts of 173 female elite athletes were analysed down to the tissue level. Their hearts were compared to data from women who do not participate in professional sport. "We saw that in women who participate in professional sports, the heart chambers in particular become wider, while the heart muscle thickens only to a limited extent, and the heart tissue otherwise contains normal characteristics. This is different from a male athlete's heart: the heart muscle is frequently thicker than the heart muscle of a 'normal' heart. A characteristic that you also see in heart disease," says Jorstad. A thickened heart muscle is therefore to be expected in male elite athletes, while it is not normal in female elite athletes, and in females could indicate heart disease. "That is why it is important that we know from both men and women how the heart adapts through sport, and we know what is normal in an athlete," says Jorstad.
Differences in type of sport
Not only are there differences between men and women in how the heart adapts, but there is also a difference between different types of athletes. Maarten van Diepen, physician-researcher in sports cardiology at Amsterdam UMC: "Female endurance athletes, such as cyclists, had the largest heart chambers and the most heart muscle mass; more than strength athletes such as gymnasts. This shows that the way in which the heart of elite female athlete adapts also depends on the type of training load."
Better guidance and protection of athletes
This research underlines the importance of including not only sports history but also biological sex when assessing the heart of an elite or highly active recreational athlete. "This prevents heart disease in women from being overlooked. Or the other way around, that a healthy female athlete's heart is wrongly labeled as sick and the woman, for example, must stop with professional sport. More knowledge about the female athlete's heart helps doctors to better determine whether a heart is undergoing normal sports-related changes or whether further research into a possible heart disease is needed. This can ultimately help to better guide and protect female athletes, from professional to recreational, against heart problems," says Jorstad.
