title: THE ATHLETIC HEART PHENOTYPE IN ELITE FEMALE FOOTBALLERS
Creators: name: Mohammad, A
Publisher: name: Liverpool John Moores University
Year: 2022

description: Elite athletes can present with electrical (ECG) as well as structural and functional (echocardiography) changes to the heart, compared to healthy controls, referred to as the athlete’s heart (AH). In the setting of cardiac pre-participation screening (PPS), both ECG and echocardiographic AH data are valuable to aid differential diagnosis of AH from various cardiac pathologies that increase the risk of sudden cardiac death (SCD). At present, there are limited data describing the AH in elite female footballers to feed into PPS. This thesis presents four studies whose aims were to, (i) critically evaluate the 12-lead ECG in elite female professional footballers, (ii) assess the effect of performing ECG assessments across a competitive season in elite professional female footballers, (iii) document resting cardiac structure and function in elite professional female footballers, and (iv) determine the variability in resting ECG as well as cardiac structure and function across the menstrual cycle in a healthy cohort of young women. The first study employed a cross-sectional descriptive design with all testing and data collection occurring in one session. 12-lead ECGs were recorded in eighty-one elite female footballers. ECGs were interpreted using 3 published criteria used in PPS. The key findings were that training-related ECG changes were very common in elite female footballers and that the “Seattle” and “International” ECG Criteria significantly reduced the number of ECG false-positives, from 16.2% to 0%. In the second study, a prospective repeated-measures design was employed with ECG data acquired in thirteen elite female football players, at three different time points (pre-season, mid-season, and end-season) across a single competitive season. The key finding was that ECG data in elite female footballers were largely stable across a competitive season. Consequently, the time point of PPS within a competitive season is unlikely to alter clinical decision making in PPS. The third study employed a cross-sectional design to characterize cardiac structure and function in seventy-nine elite female footballers using standard and novel echocardiography. The key findings were that absolute data for a range of LV and RV chamber size indices as well as LV wall thicknesses and global measures of LV function were greater in elite female footballers than in sedentary controls. This data will contribute to our population specific knowledge of the AH and support PPS in elite female footballers. In the fourth study, a repeated-measures design was employed that assessed resting ECG as well as cardiac structure, and function across three different time points of the menstrual cycle in seventeen healthy, eumenorrheic, female participants. The key findings were that there were no major differences in ECG data as well as cardiac structural and functional indices observed across 3 phases of the menstrual cycles. These data will help inform testing plans and data analysis in cardiac PPS in elite female athletes.