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Male-only cohorts made up 54% of studies ( n = 416), whereas female-only studies represented just 5% ( n = 38). Only 7% ( n = 56) of studies included a male-female subanalysis, whereas 3% of studies ( n = 21) used direct sex-comparative design. Notably, 6% of studies ( n = 44) did not report participant sex at all. Females accounted for less than one quarter of the total sample (24%, n = 23,061 participants). Football (soccer) was the most represented sport overall ( n = 13,582 participants) and in male-only studies ( n = 5,242 participants). Basketball was the most common in female-only studies ( n = 314 participants). Ethnicity was reported in 17% of studies ( n = 127; 43,683 participants), with 80% of participants identified as White and 16% as African\/Afro-Caribbean. Para-athletes comprised 0.4% of the total cohort. Echocardiography was the predominant imaging modality (88%), with 97% of studies reporting left ventricular parameters. Only 10 studies (3% of those including females) provided sufficient information to classify menstrual status, and none met best-practice recommendations. 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