From the Guidelines
Left Ventricular Ejection Fraction (LVEF) in Athletes
The left ventricular ejection fraction (LVEF) in athletes is typically within the normal range of 55-70% 1. However, intense physical training can lead to physiological adaptations, resulting in an LVEF range of 60-80% in highly trained athletes.
- Key factors to consider when evaluating LVEF in athletes include:
- Physiological adaptations: Intense physical training can lead to changes in cardiac structure and function, including increased left ventricular (LV) volume and wall thickness 1.
- Normal range: An LVEF of 55-70% is considered normal in athletes, although values up to 80% can be seen in highly trained individuals 1.
- Contractile reserve: Athletes with a normal LVEF typically demonstrate good myocardial contractile reserve, as evidenced by an increase in LVEF of at least 10% following exercise or achieving a maximal LVEF >63% 1.
- Notably, athletes with an LVEF above 80% may be at increased risk for cardiac fatigue, although this is not universally agreed upon and more research is needed to fully understand this relationship.
- It is essential to consider the individual athlete's characteristics, such as their sport, training level, and medical history, when interpreting LVEF values 1.
From the Research
Left Ventricular Ejection Fraction (LVEF) in Athletes
- The LVEF in athletes can vary, with some studies suggesting that highly trained athletes may show depressed LVEF (<52%) with nondilated left ventricular cavities, which seems to be linked to longer left ventricular contraction times 2.
- A study found that the normal modal LVEF is around 62% in healthy subjects, and this value is related to the golden ratio (Phi) 3.
- In trained athletes, the LVEF can increase during exercise, but the mechanisms used to achieve these increases may differ from those in untrained subjects, with athletes decreasing end-systolic volumes rather than increasing end-diastolic volumes 4.
- Exercise training, particularly moderate-intensity continuous training, can improve LVEF in patients with heart failure with reduced ejection fraction (HFrEF) 5.
- A recent study found that reduced LVEF occurs in approximately 1 in 6 elite endurance athletes and is related to genetic predisposition, with male sex and higher left ventricular end-systolic volume index polygenic risk score (LVESVi-PRS) being significant predictors of reduced LVEF 6.
Factors Influencing LVEF in Athletes
- Exercise training and genetic predisposition can influence LVEF in athletes 2, 6.
- The type and duration of exercise training can also impact LVEF, with moderate-intensity continuous training and high-intensity interval training showing benefits in improving LVEF 5.
- Ventricular-arterial coupling and left ventricular elastance can also affect LVEF, with the Ea/Ees ratio being a valuable clinical tool in patients with heart failure 3.
Clinical Implications
- Reduced LVEF in athletes may be associated with a higher burden of ventricular premature beats and lower left ventricular global longitudinal strain 6.
- Genetic and imaging markers may help identify endurance athletes who may be at risk of long-term clinical outcomes, such as symptomatic heart failure or arrhythmias 6.