DOI: 10.1002/clc.24121 ISSN:

Longitudinal cardiac remodeling in collegiate American football players as assessed by echocardiography during their collegiate career

Robert F. Hamburger, Yasmeen Taha, Mohammed Ruzieh, James R. Clugston, Eileen M. Handberg, Fred Reifsteck, Matthew W. Martinez, Carl J. Pepine, Katherine M. Edenfield
  • Cardiology and Cardiovascular Medicine
  • General Medicine



Studies on the longitudinal effects of intense physical training on cardiac remodeling are limited, especially in American collegiate football players.


College‐level American football training will result in remodeling in a pattern consistent of a sport with moderate static and dynamic demands with increases in both wall and chamber sizes.


We studied 85 American collegiate football players who underwent transthoracic echocardiogram (TTE) for asymptomatic or mild COVID‐19‐related illness and compared the changes in echo dimensions to their preparticipation screening TTE. Pre‐ and posttraining variables were compared using a paired t‐test for normally distributed variables.


Mean age was 19 years ± 1 and 61% of athletes were Black. Mean follow‐up between TTEs was 21 ± 13 months. There was an increase in left atrial volume index (26.4 ± 5.5 to 32.8 ± 8.4 mL/m2, p < .001), LV end diastolic diameter (5.13 ± 0.4 to 5.27 ± 0.4 cm, p = .003), basal RV diameter (3.28 ± 0.7 to 3.83 ± 0.5 cm, p = <.001), LV mass index (86.7 ± 15.3 to 90.1 ± 15.3, p = .015), and aortic root diameter (3.1 ± 0.4 to 3.2 ± 0.3 cm, p = .03) from pre‐ to posttraining, with a slightly greater magnitude in athletes with >2 years of training. Presence of left atrial enlargement (≥35 mL/m2) increased from 2.9% to 29% pre‐ to postparticipation in athletes with >2 years training. No significant changes in wall thickness, diastolic function, or right ventricular systolic function were observed.


American football players college‐level training was associated with increases in left and right ventricular chamber sizes, left atrial size, and aortic root diameter.

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