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Original Investigation
June 24, 2020

Echocardiographic Characterization of Female Professional Basketball Players in the US

Author Affiliations
  • 1Division of Cardiology, Columbia University Irving Medical Center, New York, New York
  • 2Heart and Vascular Institute of Texas, Tenet Health Systems, San Antonio
  • 3Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
  • 4Department of Medicine (Sports Medicine), Hospital for Special Surgery, New York, New York
  • 5National Basketball Association, New York, New York
JAMA Cardiol. Published online June 24, 2020. doi:10.1001/jamacardio.2020.0988
Key Points

Question  What is the spectrum of cardiac remodeling in elite female basketball players?

Findings  In this cross-sectional echocardiographic study of 140 Women's National Basketball Association athletes with mean body surface area of 2.02 m2, left ventricular enlargement was present in 26.0% and right ventricular enlargement in 42.2% of athlete and maximal left ventricular wall thickness was 1.0 cm or greater in 55.7% and greater than 1.3 cm in 0.7% of athletes; 16.0% of athletes met criteria for left ventricular hypertrophy, mean aortic root diameter was 3.1 cm, and only 1.4% of athletes had guideline-defined aortic enlargement.

Meaning  In this study, increased cardiac dimensions except for aortic root were frequently present in Women’s National Basketball Association athletes.


Importance  There is a paucity of data detailing cardiac remodeling in female athletes compared with male athletes. The lack of reference cardiac data for elite female basketball players or female athletes of similar size makes it difficult to differentiate athletic remodeling from potential underlying cardiac disorders in this population of athletes.

Objective  To assess cardiac structure and function in elite female basketball players.

Design, Setting, and Participants  This cross-sectional echocardiographic study included 140 Women's National Basketball Association (WNBA) athletes on active rosters for the 2017 season. The WNBA mandates annual preseason stress echocardiograms for each athlete. The WNBA has partnered with Columbia University to annually perform a review of these studies. Data analysis was performed from June 7, 2017, to October 5, 2017.

Main Outcomes and Measures  Echocardiographic variables included left ventricular (LV) dimensions, wall thickness, mass, prevalence of LV hypertrophy, aortic dimensions, right ventricular (RV) dimension, and right and left atrial size. Linear regression was used to assess the associations between cardiac structure and function with body size quantified as body surface area (BSA) in the primary analysis.

Results  A total of 140 female athletes (mean [SD] age, 26.8 [3.9] years; 105 [75.0%] African American) participated in the study. Mean (SD) athlete height was 183.4 (9.0) cm, and mean (SD) BSA was 2.02 (0.18) m2. Compared with guideline-defined normal values, LV enlargement was present in 36 athletes (26.0%) and 57 athletes (42.2%) had RV enlargement. There was a linear correlation between LV and RV cavity sizes and BSA extending to the uppermost biometrics (LV cavity size: r, 0.48; RV cavity size: r, 0.32; P < .001 for both). Maximal left ventricular wall thickness (LVWT) ranged from 0.6 to 1.4 cm, with 78 athletes (55.7%) having LVWT of 1.0 cm or greater and only 1 athlete (0.7%) having LVWT greater than 1.3 cm. Twenty-three athletes (16.4%) met the criteria for left ventricular hypertrophy (LVH) (>95 g/m2). Eccentric LVH was present in 16 athletes (69.6%), concentric LVH in 7 athletes (30.4%), and concentric remodeling in 27 athletes (19.3%). Mean aortic root diameter was 3.1 cm (95% CI, 3.0-3.2). Only 2 athletes (1.4%) had guideline-defined aortic enlargement compared with a range of 18% to 42% for left and right ventricular and atrial enlargement.

Conclusions and Relevance  In this study, increased cardiac dimensions were frequently observed in WNBA athletes. Both BSA and physiologic remodeling affected cardiac morphologic findings. This study may provide a framework to define the range of athletic cardiac remodeling exhibited by elite female basketball players.