Athlete's Heart in Women's Contact Sports: Echocardiographic and Strain-Based Insights From Elite Rugby Players

Abstract

Background

Athlete's heart encompasses cardiac adaptations to long-term intensive training. Although male-dominated sports have been widely studied, limited data exist on structural and functional cardiac remodeling in female contact-sport athletes. This study aimed to evaluate cardiac changes in elite female rugby players using conventional and strain echocardiography.

Methods

This cross-sectional study included 66 elite female rugby players and 50 sedentary controls. Anthropometric measurements and transthoracic echocardiographic assessments, including speckle tracking-derived global longitudinal strain (GLS), were performed. Linear, multivariable, and partial correlation analyses evaluated associations between GLS, active playing years (APY), and body mass index (BMI).

Results

Compared to controls, athletes exhibited increased ventricular diameters, wall thicknesses, and left atrial size, with preserved left ventricular ejection fraction (LVEF). GLS values were significantly lower in rugby players (p < 0.001), though within normal limits. APY and BMI both showed significant inverse correlations with GLS (r = –0.456 and −0.370, respectively). In multivariable analysis, APY (β = −0.392, p = 0.001) and BMI (β = −0.225, p = 0.013) independently predicted GLS. Partial correlation confirmed the independent association of APY with GLS (r = −0.412, p = 0.001). GLS showed strong discriminative performance for ≥5 years of play (AUC = 0.816) and moderate performance for BMI ≥ 24.13 (AUC = 0.666).

Conclusion

Elite female rugby athletes demonstrate physiological cardiac remodeling, including reduced GLS associated with training duration and BMI. These findings highlight the need for sex- and sport-specific echocardiographic reference values and further longitudinal research to clarify long-term clinical implications.