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Introduction: Elite athletes develop functional and structural adaptation of the heart, presented as left ventricular hypertrophy. Identifying parameters to describe hypertrophy and remodeling might be useful to differentiate physiologic and pathologic conditions. Objectives: The aim of our study was to evaluate left ventricular (LV) hypertrophy and remodeling in elite athletes compared to hypertrophic (HCM) and dilated (DCM) cardiomyopathy patients.Methods: 57 endurance-strength elite athletes (A), 20 sedentary controls (S), 12 HCM, and 12 DCM patients underwent echocardiography study. LV end-diastolic, end-systolic diameters, LV wall thickness and LV systolic ejection fraction (Simpson-formula) were measured. LV hypertrophy and remodeling indexes as LV mass index, hypertrophy index, remodeling index as well as systolic and diastolic sphericity indexes were calculated.Results: LV end-diastolic diameters were significantly larger in athletes compared to controls (A 54,5±4,4 vs. S 50,3±4,5mm; p<0,001). In HCM patients, the LV end-diastolic and end-systolic diameters were smaller, in DCM patients larger than in athletes (A 54,5±4,4, 34,3±4 vs. HCM 39,3±6,6, 20,7±9,7 vs. DCM 75,2±8,1 63,5±10,1mm; p<0,001). The most prominent LV hypertrophy was found in HCM patients (A 13±1,56, 10,6±1,53 vs. S 9,9±1, 9,4±1,26 vs. HCM 25,8±5,57, 15,6±2,9mm; p<0,05). LV systolic ejection fraction was similar in athletes, controls and HCM patients, while significantly lower in DCM (A 66±7 vs. SV 65,4±7,2 vs. HCM 66,9±12,5; p=0,126 vs. DCM 27,6±6,6%; p<0,001). LV mass index was higher in athletes and HCM patients compared to controls (A 134,8±19,7, S 91,6±15, HCM 203,8±36,2g/m2; p<0,001). Hypertrophy index showed similar data to LV mass index (A 0,91±0,15 vs. S 0,75±0,1 vs. HCM 2,2±0,6; p<0,001). Remodeling index was comparable in athletes and control group, while significantly higher in HCM patients (A 0,96±0,2 vs. S 0,82±0,14 vs. HCM 4,41±1,85; p<0,001). Systolic and diastolic sphericity indexes were similar in athletes and controls, while out of normal range in HCM and DCM (Systolic A 1,66±0,17 vs. S 1,64±0,16 vs. HCM 2,11±0,34 vs. DCM 1,35±0,15; p<0,001; Diastolic A 2,09±0,35 vs. S 1,99±0,23 vs. HCM 5,8±10,3 vs. DCM 1,5±0,2; p<0,001).Conclusions: In elite athletes, LV hypertrophy did not alter LV geometry representing physiologic remodeling. In hypertrophic and dilated cardiomyopathy patients, the presence of pathologic remodeling was demonstrated. Evaluating LV hypertrophy and geometry indexes might be a feasible method to early identify pathologic remodeling of elite athletes.