Abergel E, Chatellier G, Hagege AA, et al. Serial left ventricular adaptations in world-class professional cyclists: Implications for disease screening and follow-up. J Am Coll Cardiol. 2004;44:144–9. https://doi.org/10.1016/j.jacc.2004.02.057.

Article  PubMed  Google Scholar 

Addleman JS, Lackey NS, DeBlauw JA, Hajduczok AG (2024) Heart rate variability applications in strength and conditioning: a narrative review. J Funct Morphol Kinesiol 2024; 9:93 9-93. https://doi.org/10.3390/JFMK9020093.

Afaghi S, Rahimi FS, Soltani P, et al. Sex-specific differences in cardiovascular adaptations and risks in elite athletes: bridging the gap in sports cardiology. Clin Cardiol. 2024;47: e70006. https://doi.org/10.1002/CLC.70006.

Article  PubMed  PubMed Central  Google Scholar 

Al-Othman S, Boyett MR, Morris GM, et al. Symptomatic bradyarrhythmias in the athlete—Underlying mechanisms and treatments. Hear Rhythm. 2024;21:1415–27. https://doi.org/10.1016/J.HRTHM.2024.02.050.

Article  Google Scholar 

Al-Shebel DK, Al-Sowayan NS. The effects of caffeine ingestion on blood pressure levels in athletic and non-athletic women. Afr J Reprod Health. 2024;28 84–89. https://doi.org/10.29063/AJRH2024/V28I5.10.

Albaeni A, Davis JW, Ahmad M. Echocardiographic evaluation of the athlete’s heart. Echocardiography. 2021;38:1002–16. https://doi.org/10.1111/ECHO.15066.

Article  PubMed  Google Scholar 

Almalki WH, Khan MS. Burden of diabetes mellitus on health and economy of the Arab world: current situation and perspectives. J Public Heal 2025;1–20. https://doi.org/10.1007/S10389-025-02448-7/METRICS.

Assadi H, Alabed S, Li R, et al. Development and validation of AI-derived segmentation of four-chamber cine cardiac magnetic resonance. Eur Radiol Exp. 2024;8:1–14. https://doi.org/10.1186/S41747-024-00477-7/FIGURES/5.

Article  Google Scholar 

Baggish AL, Wang F, Weiner RB, et al. Training-specific changes in cardiac structure and function: a prospective and longitudinal assessment of competitive athletes. J Appl Physiol. 2008;104:1121–8. https://doi.org/10.1152/JAPPLPHYSIOL.01170.2007.

Article  PubMed  Google Scholar 

Baggish AL, Yared K, Wang F, et al. The impact of endurance exercise training on left ventricular systolic mechanics. Am J Physiol Heart Circ Physiol. 2008b;295. https://doi.org/10.1152/AJPHEART.00395.2008.

Bentley RF, Vecchiarelli E, Banks L, et al. Heart rate variability and recovery following maximal exercise in endurance athletes and physically active individuals. 2020; 45:1138–1144. https://doi.org/10.1139/apnm-2020-0154.

Caruso MR, Garg L, Martinez MW. Cardiac imaging in the athlete: shrinking the “Gray Zone.” Curr Treat Options Cardiovasc Med. 2020;22:1–14. https://doi.org/10.1007/S11936-020-0802-8/METRICS.

Article  Google Scholar 

Carvalho A, Dos SRC, Gomes R, et al. Myocardial work in athletes: a novel approach to differentiate athletic heart adaptations from cardiomyopathy? J Am Coll Cardiol. 2024;83:2406. https://doi.org/10.1016/S0735-1097(24)04396-1.

Article  Google Scholar 

Chihaoui Mamlouk A, Ouergui I, Ben Waer F, et al. Telic-paratelic dominance and heart rate variability in athletes engaged in power and endurance training. 2024;131:861–875. https://doi.org/10.1177/00315125241237045.

Conti V, Migliorini F, Pilone M, et al. Right heart exercise-training-adaptation and remodelling in endurance athletes. Sci Reports. 2021;111(11):1–12. https://doi.org/10.1038/s41598-021-02028-1.

D’andrea A, Sperlongano S, Russo V, et al. The role of multimodality imaging in athlete’s heart diagnosis: current status and future directions. J Clin Med. 2021;10:5126. https://doi.org/10.3390/JCM10215126.

D’Ascenzi F, Anselmi F, Mondillo S, et al. The use of cardiac imaging in the evaluation of athletes in the clinical practice: a survey by the sports cardiology and exercise section of the european association of preventive cardiology and University of Siena, in collaboration with the european association of cardiovascular imaging, the european heart rhythm association and the esc working group on myocardial and pericardial diseases. Eur J Prev Cardiol. 2021;28:1071–7. https://doi.org/10.1177/2047487320932018.

Article  PubMed  Google Scholar 

D’Ascenzi F, Biella F, Lemme E, et al. Female athlete’s heart: sex effects on electrical and structural remodeling. Circ Cardiovasc Imaging. 2020;13:E011587. https://doi.org/10.1161/CIRCIMAGING.120.011587/ASSET/995D87C8-BFE3-495A-A0E7-19650E26B2FC/ASSETS/IMAGES/LARGE/CIRCIMAGING.120.011587.FIG04.JPG.

Article  PubMed  Google Scholar 

D’Ascenzi F, Cavigli L, Marchese A, et al. Electrical and structural remodelling in female athlete’s heart: a comparative study in women vs men athletes and controls. Int J Cardiol. 2024;400. https://doi.org/10.1016/j.ijcard.2024.131808.

D’Ascenzi F, Fiorentini C, Anselmi F, Mondillo S. Left ventricular hypertrophy in athletes: how to differentiate between hypertensive heart disease and athlete’s heart. Eur J Prev Cardiol. 2021;28:1125–33. https://doi.org/10.1177/2047487320911850.

Article  PubMed  Google Scholar 

Dalen H, Letnes JM, Hoydal MA, Wisløff U. Diastolic function and dysfunction in athletes. Eur Hear J - Cardiovasc Imaging. 2024;25:1537–45. https://doi.org/10.1093/EHJCI/JEAE155.

Article  Google Scholar 

Danielian A, Shah AB. Differentiating physiology from pathology: the gray zones of the athlete’s heart. Clin Sports Med. 2022;41:425–40. https://doi.org/10.1016/J.CSM.2022.02.005/ASSET/363D75AC-D33D-48E6-B014-36A134578650/MAIN.ASSETS/GR1.SML.

Article  PubMed  Google Scholar 

Diaz-Rodriguez PE, Molina-Lopez VH, Burgos BAG, Escabi J. A patient with athlete’s heart syndrome: when the abnormal is normal. Cureus. 2024;16: e56143. https://doi.org/10.7759/CUREUS.56143.

Article  PubMed  PubMed Central  Google Scholar 

DuManoir GR, Haykowsky MJ, Syrotuik DG, et al. The effect of high-intensity rowing and combined strength and endurance training on left ventricular systolic function and morphology. Int J Sports Med. 2007;28:488–94. https://doi.org/10.1055/S-2006-955897.

Article  CAS  PubMed  Google Scholar 

Ehsani AA, Hagberg JM, Hickson RC. Rapid changes in left ventricular dimensions and mass in response to physical conditioning and deconditioning. Am J Cardiol. 1978;42:52–6. https://doi.org/10.1016/0002-9149(78)90984-0.

Article  CAS  PubMed  Google Scholar 

Eroğlu O, Zileli R, Nalbant MA, et al. Which polymorphism is the distinguishing factor for fitness athletes: the ace indel or Actn3 rs1815739? J Basic Clin Heal Sci. 2024;8:319–326. https://doi.org/10.30621/JBACHS.1264683.

Fagard R, Aubert A, Lysens R, et al. Noninvasive assessment of seasonal variations in cardiac structure and function in cyclists. Circulation. 1983;67:896–901. https://doi.org/10.1161/01.CIR.67.4.896.

Article  CAS  PubMed  Google Scholar 

Flanagan H, Cooper R, George KP, et al. The athlete’s heart: insights from echocardiography. Echo Res Pract. 2023;10:1–17. https://doi.org/10.1186/S44156-023-00027-8/TABLES/8.

Article  Google Scholar 

Fogante M, Agliata G, Basile MC, et al (2021) Cardiac imaging in athlete’s heart: the role of the radiologist. Med. 2021;57:455. https://doi.org/10.3390/MEDICINA57050455.

Hastings MH, Castro C, Freeman R, et al. Intrinsic and extrinsic contributors to the cardiac benefits of exercise. JACC Basic to Transl Sci. 2023;9:535. https://doi.org/10.1016/J.JACBTS.2023.07.011.

Article  Google Scholar 

Hu J, Zhuo W, Cheng J, Liu Y, Xue W, Ni D. EchoONE: segmenting multiple echocardiography Planes in One Model. 2024. https://doi.org/10.48550/arXiv.2412.02993

Hu S, Zhang H, Ma H, et al. Assessment of right ventricular structure and systolic function in amateur marathon runners using three-dimensional speckle tracking echocardiography. Int J Cardiovasc Imaging. 2023;39:1473–82. https://doi.org/10.1007/S10554-023-02869-Z/FIGURES/4.

Article  PubMed  PubMed Central  Google Scholar 

Huang H, Chen Z, Huang Y, Luo G, Chen C, Song Y. Automatic diagnosis of cardiac magnetic resonance images based on semi-supervised learning. 2024. https://doi.org/10.48550/arXiv.2405.14300.

Kusy K, Błażejewski J, Gilewski W, et al. Aging athlete’s heart: an echocardiographic evaluation of competitive sprint- versus endurance-trained master athletes. J Am Soc Echocardiogr. 2021;34:1160–9. https://doi.org/10.1016/J.ECHO.2021.06.009.

Article  PubMed  Google Scholar 

La Gerche A, Wasfy MM, Brosnan MJ, et al. The athlete’s heart—challenges and controversies: JACC focus seminar 4/4. J Am Coll Cardiol. 2022;80:1346–62. https://doi.org/10.1016/J.JACC.2022.07.014.

Article  PubMed  Google Scholar 

Lasocka-Koriat Z, Lewicka-Potocka Z, Kaleta-Duss A, et al. Morphological, functional and biochemical differences in cardiac adaptation to endurance exercise among male and female amateur marathon runners. Front Physiol. 2025;16:1547894. https://doi.org/10.3389/FPHYS.2025.1547894/BIBTEX.

Article  PubMed  PubMed Central  Google Scholar 

Letnes JM, Nes BM, Langlo KAR, et al. Indexing cardiac volumes for peak oxygen uptake to improve differentiation of physiological and pathological remodeling: from elite athletes to heart failure patients. Eur Hear J - Cardiovasc Imaging. 2023;24:721–9. https://doi.org/10.1093/EHJCI/JEAD034.

Article  Google Scholar 

Lundstrom CJ, Foreman NA, Biltz G. Practices and applications of heart rate variability monitoring in endurance athletes. Int J Sports Med. 2023;44:9–19. https://doi.org/10.1055/A-1864-9726.

Article  PubMed  Google Scholar 

Martin TG, Leinwand LA. Hearts apart: sex differences in cardiac remodeling in health and disease. J Clin Invest. 2024;134. https://doi.org/10.1172/JCI180074.

Mishica C, Kyröläinen H, Hynynen E, et al. Relationships between heart rate variability, sleep duration, cortisol and physical training in young athletes. J Sports Sci Med. 2021;20:778. https://doi.org/10.52082/JSSM.2021.778.

Mratbaevna WN, Farrux S. The structure of the heart and its physiology in regular athletes. Acad An Int Multidiscip Res J. 2023;13:41–6. https://doi.org/10.5958/2249-7137.2023.00079.4.

Article  Google Scholar 

Myrstad M, Johansen KR, Sørensen E, et al. Atrial fibrillation in female endurance athletes. Eur J Prev Cardiol. 2024;31:e27–9. https://doi.org/10.1093/EURJPC/ZWAD218.

Article  PubMed