Echocardiographic Characterization of Major League Soccer Players

There are limited data detailing cardiac structural changes associated with intensive athletic training in professional soccer athletes. The lack of sport-specific cardiac reference ranges may complicate differentiation of physiologic athletic remodeling from underlying cardiac pathology.

The objective of the study was to characterize echocardiographic cardiac remodeling patterns in a large cohort of male professional soccer athletes and provide sport-specific reference data for clinical interpretation.

We performed a cross-sectional echocardiographic study of 1,368 male Major League Soccer athletes screened during the 2018 to 2023 seasons using standardized transthoracic echocardiography protocols in accordance with American Society of Echocardiography guidelines.

Athletes ranged in age from 21 to 39 years (mean age 25.8 [3.7] years). Among the cohort, 324/1,368 (23.7%) athletes were Black, 392/1,368 (28.7%) Hispanic, and 623/1,368 (45.5%) White. Increased left ventricular (LV) internal diameter in diastole (>58 mm) was present in 115/1,368 athletes (8.5%; 95% CI: 7.0%-10.0%), whereas 262/878 athletes (29.8%; 95% CI: 26.8%-32.8%) demonstrated right ventricular enlargement. The mean LV mass index was 97.2 [16.9] g/m² (95% CI: 96.3-98.1), with 187/1,326 athletes (14.1%; 95% CI: 12.2%-16.0%) meeting the criteria for LV hypertrophy. Eccentric hypertrophy was present in 127/1,326 athletes (9.6%), concentric hypertrophy in 60/1,326 athletes (4.5%), and concentric remodeling in 241/1,326 athletes (18.2%).

Increased cardiac dimensions and concentric remodeling patterns are frequently present in professional soccer athletes. These findings provide sport-specific echocardiographic reference data that may assist clinicians in distinguishing physiologic athletic remodeling from cardiovascular pathology in elite soccer athletes.