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Echocardiographic measurements of left ventricular end-diastolic diameter and interventricular septal diameter in collegiate football athletes at preparticipation evaluation referenced to body surface area
  1. Katherine M Edenfield1,2,3,
  2. Fred Reifsteck4,5,
  3. Stephen Carek1,
  4. Kimberly G Harmon6,
  5. Breton M Asken7,
  6. Michael C Dillon8,
  7. Joan Street3,
  8. James R Clugston1,2,3
  1. 1Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA
  2. 2University Athletic Association, University of Florida, Gainesville, Florida, USA
  3. 3Student Health Care Center, University of Florida, Gainesville, Florida, USA
  4. 4University Health Center, University of Georgia, Athens, Georgia, USA
  5. 5Athletic Association, University of Georgia, Athens, Georgia, USA
  6. 6Family Medicine and Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
  7. 7Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
  8. 8The Cardiac and Vascular Institute, Gainesville, Florida, USA
  1. Correspondence to Dr Katherine M Edenfield; kedenfield{at}


Background Are borderline echocardiogram structural measurements due to physiological adaptation or pathology in college football players? The normal reference data are very limited in this population. We report left ventricular end-diastolic diameter (LVEDD) and interventricular septal diameter (IVSD) echocardiogram findings in college football athletes.

Methods and results A retrospective cohort review of preparticipation examination transthoracic echocardiogram measurements of LVEDD and IVSD from 375 American collegiate football athletes cleared for participation from the University of Florida in 2012–2017 and University of Georgia in 2010–2015 was performed.

LVEDD and IVSD were analysed by field position (lineman, n=137; non-lineman, n=238), race (black, n=216; white, n=158) and body surface area (BSA) for associations. Values were compared with non-athlete norms, and collegiate football athlete-specific reference norm tables were created.

Twenty-one (5.6%) athletes had LVEDD and 116 (31%) had IVSD measurements above the reference normal non-athlete values. Univariate analyses indicated that the lineman position and increasing BSA were associated with larger values for LVEDD and IVSD. Black race was associated with larger IVSD values, and white race was associated with larger LVEDD values. Player position correlated strongly with BSA (r>0.7); we created normal reference tables for LVEDD and IVSD, stratified by BSA group classification (low, average and high BSA). Proposed clinical cut-offs for normal and abnormal values are reported for raw echocardiograph metrics and BSA-indexed scores.

Conclusions A significant number of collegiate football athletes had LVEDD and IVSD values above non-athlete norms. BSA-specific normal values help clinicians interpret results for football athletes.

  • pre-participation cardiac screening
  • echocardiogram
  • body surface area

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  • Contributors KE, FR, KH and JC contributed to the conception and the design of the study. KE, FR, SC, BMA, JS and JC contributed to the analysis and interpretation of the data. KE, FR, SC, KH, MD and JC drafted and revised the manuscript for important intellectual content. All authors approved the final submitted version of the manuscript.

  • Funding This work was supported in part by the American Medical Society for Sports Medicine (AMSSM) Foundation Research Grant 2016 awarded to KE, and the University of Florida REDCap uses the NIH National Center for Advancing Translational Sciences (NCATS) grant UL1 TR000064. Publication of this article was funded by the University of Florida Open Access Publishing Fund and the University of Florida Department of Community Health and Family Medicine.

  • Competing interests JS is a part-time consultant in the capacity of quality assurance technologist for Athletic Heart. For the remaining authors, no conflicts of interest were declared.

  • Patient and public involvement statement This research was done without patient involvement. Patients were not invited to comment on the study design and were not consulted to develop patient relevant outcomes or interpret the results. Patients were not invited to contribute to the writing or editing of this document for readability or accuracy.

  • Patient consent for publication Not required.

  • Ethics approval The University of Florida Institutional Review Board and the University of Georgia Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Any qualified investigator may contact the corresponding author (KE) or senior author (JC) with a specific request that includes details of (1) the resources requested, (2) how the data and resources will be used in the proposed research, and (3) the qualifications of the investigator requesting the resources. Investigators may be asked to provide further details if necessary. All requests will be reviewed for availability of the requested resources, potential for duplication of ongoing studies and scientific merit. Due to the multicentre nature of the study and FERPA and HIPPA concerns with this particular cohort, sharing data may be more complicated. The requesting investigator may be asked to partner with a University of Florida investigator and a University of Georgia investigator to better understand the available data, and will sometimes be encouraged to include a Florida and Georgia representative as an academic consultant or collaborator. Requesting investigators will also be required to sign a Data Use Agreement ensuring data will not be shared with third parties.

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