A cross-sectional echocardiographic study of elite baseball players participating in the Major League Baseball Combine found frequent ventricular chamber dilation, normal biventricular systolic function and global longitudinal strain, and a low prevalence of structural abnormalities. The findings are scheduled to be presented as abstract SIA-01 at the American Society of Echocardiography (ASE) 2026 Scientific Sessions. The study was selected as a finalist in the Brian Haluska Sonographer Research Award Competition.
Exercise-induced cardiac remodeling refers to physiologic cardiac adaptations that occur in response to the hemodynamic stress of regular exercise. The investigators noted that sport-specific physiologic demands can produce varying degrees of remodeling and that the extent of exercise-induced cardiac remodeling in elite baseball players has remained unclear. According to the authors, establishing normative data is important for differentiating expected adaptations from pathologic changes in this population.
Methods
Investigators from Sanger Heart & Vascular Institute–Atrium Health and Major League Baseball conducted a cross-sectional study of players who participated in the MLB Combine in June 2022, 2023, and 2024.
Echocardiographic measurements of cardiac structure and function were obtained in accordance with American Society of Echocardiography guidelines. Data were analyzed using SAS 9.4, and descriptive statistics, including means, standard deviations, minimum values, and maximum values, were calculated for all variables.
Results
The analysis included 588 players.
Left ventricular dilation was noted in 37% of players, and right ventricular dilation was noted in 28%. Biventricular systolic function and global longitudinal strain were reported to be within normal limits.
Left ventricular hypertrophy was rare. Investigators reported one case of concentric left ventricular hypertrophy and two cases of eccentric left ventricular hypertrophy. The maximum wall thickness observed was 12 mm.
Aortic root dimensions were typically normal, with a mean diameter of 30 mm. Three athletes had aortic root diameters greater than 39 mm. The largest measured diameter was 44 mm and occurred in an athlete with a bicuspid aortic valve.
Overall, the authors reported normal echocardiographic findings in 98% of athletes. Ventricular chamber dilation was common and was described in the context of exercise-induced remodeling. The most common abnormality was bicuspid aortic valve, observed in 1% of the cohort.
Conclusions
The authors stated that this study is the first to characterize sport-specific exercise-induced cardiac remodeling in elite baseball players using echocardiography. They concluded that the findings establish normative data for expected cardiac adaptations in this population and may help clinicians differentiate physiologic remodeling from pathologic changes in elite baseball players.
The authors also reported that the prevalence of abnormalities in the cohort was comparable to that of the general population.
Limitations
The abstract reported findings from a cross-sectional analysis and did not include longitudinal follow-up. No clinical outcome analyses, subgroup analyses, or comparisons with nonathlete control populations were reported in the abstract. The abstract also did not describe how ventricular dilation findings were classified relative to overall normal echocardiographic findings. Disclosures were not reported in the abstract.
