{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T05:38:11Z","timestamp":1792647491005,"version":"4.5.0"},"reference-count":41,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,10,20]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Elite athletes frequently exceed conventional left ventricular (LV) and left atrial thresholds when guideline\u2010recommended linear scaling for body size is applied, prompting unnecessary investigation. Few athlete\u2010specific allometric equations yield percentage predicted values or\n                      <jats:italic toggle=\"no\">Z<\/jats:italic>\n                      scores. We aimed to develop allometric equations for LV and left atrial structure and function in elite cyclists, accounting for body size, sex, discipline, and heart rate, and to compare these with body surface area (BSA) indexing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We evaluated 181 elite cyclists (105 male, 76 female; age 22.7\u00b15.5\u2009years; 128 endurance, 53 sprint) with normal preparticipation cardiac screening. Weighted least squares allometric regression determined optimal scaling exponents for height, weight, and BSA, with models advancing in complexity only when prediction accuracy significantly improved. Equations were externally validated in 62 independent elite male endurance cyclists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Men had larger BSA\u2010scaled LV and left atrial size than women (both\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). Many cyclists exceeded conventional thresholds (American Society of Echocardiography 2015: LV end\u2010diastolic volume indexed to BSA 69.6%, LV end\u2010systolic volume indexed to BSA 62.9%; British Society of Echocardiography 2020: LV end\u2010diastolic volume indexed to BSA 50.8%, left atrial volume indexed to BSA 28.7%). Height provided superior allometric fit versus weight or BSA. Height, sex, discipline, and RR interval were key determinants. On external validation, only 6.5% exceeded the\n                      <jats:italic toggle=\"no\">Z<\/jats:italic>\n                      score threshold for LV end\u2010diastolic volume indexed to BSA, compared with 90.3% classified abnormal by ASE guidelines.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Height\u2010based allometric scaling outperformed weight or BSA for cardiac dimensions and function in elite cyclists. These sport\u2010specific equations, validated in an independent cohort, provide clinically usable percentage predicted values and\n                      <jats:italic toggle=\"no\">Z<\/jats:italic>\n                      scores that permit quantitative assessment rather than binary thresholds and may reduce misclassification of physiological adaptation as disease in preparticipation cardiac screening programs.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.126.050142","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T11:28:48Z","timestamp":1792150128000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Allometric Scaling of Left Heart Structure and Function in Elite Cyclists: Development of Sport\u2010Specific Prediction Equations"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9223-4052","authenticated-orcid":false,"given":"Nancy","family":"Herrera\u2010Lea\u00f1o","sequence":"first","affiliation":[{"name":"Stanford University School of Medicine","place":["Stanford, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8670-3764","authenticated-orcid":false,"given":"Aneil","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Manchester Metropolitan University","place":["Manchester, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Cooper","sequence":"additional","affiliation":[{"name":"Liverpool John Moores University","place":["Liverpool, UK"]},{"name":"Liverpool Heart and Chest Hospital NHS Foundation Trust","place":["Liverpool, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9461-9389","authenticated-orcid":false,"given":"Shaun","family":"Robinson","sequence":"additional","affiliation":[{"name":"Liverpool John Moores University","place":["Liverpool, UK"]},{"name":"Imperial College Healthcare NHS Foundation Trust","place":["London, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0197-0722","authenticated-orcid":false,"given":"Tristan","family":"Ramcharan","sequence":"additional","affiliation":[{"name":"Birmingham Women's and Children's NHS Foundation Trust","place":["Birmingham, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Maxwell","sequence":"additional","affiliation":[{"name":"Liverpool John Moores University","place":["Liverpool, UK"]},{"name":"Liverpool University Hospitals NHS Foundation Trust","place":["Liverpool, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Place","sequence":"additional","affiliation":[{"name":"Liverpool John Moores University","place":["Liverpool, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith","family":"George","sequence":"additional","affiliation":[{"name":"Liverpool John Moores University","place":["Liverpool, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7425-2238","authenticated-orcid":false,"given":"Nigel","family":"Jones","sequence":"additional","affiliation":[{"name":"British Cycling","place":["Manchester, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2755-4541","authenticated-orcid":false,"given":"Patrick","family":"Khoury","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine","place":["Stanford, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9418-9577","authenticated-orcid":false,"given":"Euan A.","family":"Ashley","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine","place":["Stanford, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9648-7671","authenticated-orcid":false,"given":"Francois","family":"Haddad","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine","place":["Stanford, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1334-3286","authenticated-orcid":false,"given":"David","family":"Oxborough","sequence":"additional","affiliation":[{"name":"Liverpool John Moores University","place":["Liverpool, 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The right heart of the elite cyclist: a comparative study of sprint versus endurance disciplines. 2025. 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