Purpose Cardiac adaptation to intense physical training is determined by many factors. Eliminate the fat mass from the indexing of left ventricular parameters seems to better explain some heart modifications, characterizing the so-called “athlete’s heart". Fat free mass also contains the extracellular mass which does not represent a metabolically active compartment. The aim of this study is to verify a new left ventricular indexation with the metabolically active tissue of the body as body cell mass in elite athletes. Methods 18 females (F) were matched with 18 elite male (M) soccer players (F=26.2±2.4 yrs, M=26.9±2.5 years; p=NS). An accurate body composition analysis (skinfold and bioimpedance) and an echocardiography were performed. Results Greater relationship were found between left ventricular mass and body cell (r=0.827, r2=0.684, p<0.001) compared to fat free mass (r=0.822, r2=0.676, p<0.001). Differences in body composition were confirmed (hip circumference/height: F=0.55±0.03, M=0.52±0.02, p<0.01; fat mass index: F= 3.7±0.7 kg/m2, M=2.4±0.4 kg/m2, p<0.001), no difference were found in extra cellular mass index (F=7.1±1.2 kg/m2, M=7.6±0.4 kg/m2; p=NS). There are no differences in systo-diastolic parameters between sexes. Left ventricular dimension show higher values in males also with body cell indexation (F=126.62±16.08 g/m2, M=142.87±13.48 g/m2 ; p<0.001). Conclusions Analyzing body composition in three compartments appears a solution that physiologically can explain some aspects of the athlete's heart. These results could be considered a preliminary data in order to create a new indexation.