AimThis study was aimed to investigate the association of cardiometabolic and ECG markers with left ventricular diastolic dysfunction (LVDD) in physically active Asian young adults, which has not been clarified in prior studies. Methods and resultsA total of 2,019 men aged 18-43 years were included from the military in Taiwan. All the subjects underwent anthropometric, hemodynamic, and blood metabolic marker measurements. Physical fitness was investigated by time for a 3,000-m run. LVDD was defined by presence of either one of the three echocardiographic criteria: (1) mitral inflow E/A ratio < 0.8 with a peak E velocity of > 50 cm/s, (2) tissue Doppler lateral mitral annulus e ' <10 cm/s, and (3) E/e ' ratio > 14. Multiple logistic regressions with adjustments for age, physical fitness, and pulse rate were conducted to determine the association of cardiometabolic and ECG markers with LVDD. The prevalence of LVDD was estimated to be 4.16% (N = 84). Of the cardiometabolic markers, central obesity, defined as waist circumference >= 90 cm, was the only independent marker of LVDD [odds ratio (OR) and 95% confidence interval: 2.97 (1.63-5.41)]. There were no association for hypertension, prediabetes, and dyslipidemia. Of the ECG markers, left atrial enlargement and incomplete right bundle branch block/intraventricular conduction delay were the independent ECG markers of LVDD [OR: 2.98 (1.28-6.94) and 1.94 (1.09-3.47), respectively]. There was borderline association for Cornell-based left ventricular hypertrophy and inferior T wave inversion [OR: 1.94 (0.97-3.63) and 2.44 (0.98-6.08), respectively]. ConclusionIn the physically active Asian young male adults, central obesity and some ECG markers for left heart abnormalities were useful to identify LVDD.