A Gender-based Comparative Study on Cardiac Adaptation of Elite Moroccan Football Players

Abstract

Objective: This study assessed the cardiac adaptation in elite Moroccan male and female football players using electrocardiography and echocardiography, with a focus on gender-specific similarities and differences. Methods: Cross-sectional electrocardiography and echocardiography data from male and female athletes from football clubs in the Marrakech-Safi region, were collected at the Avicenna Military Hospital, Marrakech, during pre-competition assessments for Royal Moroccan Football Federation (RMFF) and FIFA competitions (2024-2025). Electrocardiography and echocardiography findings were interpreted according to international athlete-specific reference criteria. Results: A total of 210 athletes were included (119 [56.1%] male; mean [SD] age, 22.5 [1.7] years). Female athletes showed a higher prevalence of normal training-related electrocardiography findings, while males displayed a slightly higher prevalence of mildly abnormal patterns (3.8% vs 2.8%, P < .001). Voltage criteria for left ventricular hypertrophy were present in 4.7% of males and 6.6% of females. No distinct electrocardiography abnormalities were detected. Echocardiography revealed no pathologic findings requiring restriction from sport, although some athletes exceeded ranges for exercise-induced remodeling defined in the guidelines. Increased left ventricular mass index was observed in 3 female athletes (3.1%) but in no males. Left ventricular wall thickness was normal in all athletes. Left ventricular cavity diameter >54 mm was observed in 6% of females, whereas no male athlete exceeded 60 mm.  Conclusions: Moroccan male and female football players exhibit limited electrocardiography and echocardiographic characteristics, consistent with physiological cardiac remodeling induced by intensive training. Accurate distinction between these benign adaptations and pathological findings is vital for reliable cardiovascular assessment and safe athletic performance.