Maximum oxygen uptake also appears to correlate to athletic performance in horses. In the Thoroughbred industry, there has long been an empirical theory that heart size is related to athletic performance, despite a lack of scientific evidence supporting this assertion. To investigate the relationship between peak oxygen consumption (VO2max) and cardiac size measured by echocardiography, guided M-mode and 2-dimensional echocardiography were performed in 17 conditioned Thoroughbreds with a range of VO2max from 126 to 217 ml/min/kg STPD (mean +/- s.d. 158 +/- 28 m/min/kg). Horses were age 2-10 years and weighed 430-510 kg. Echocardiography was performed using a Vingmed System V echocardiograph with a 2.25 MHz phased array ultrasound transducer. All images were obtained from the right hemithorax using a short axis view of the left ventricle (LV) at the level of the chordae tendinae. All horses were free from significant regurgitation at the aortic or mitral valves. Maximal oxygen uptake was measured during a standardised incremental treadmill exercise test to fatigue. Maximal oxygen uptake was correlated significantly with LVIDd (r = 0.71; P = 0.001), MWT (r = 0.72; P = 0.001), LV mass (r = 0.78; P = 0.0002) and LV short-axis area (r = 0.69; P = 0.003). When indices of heart size were indexed to bodyweight, the correlation between VO2max and indices of heart size were LVIDd (r = 0.57; P = 0.01), MWT (r = 0.44; P = 0.07), LV mass (r = 0.78; P = 0.0002) and LV short-axis area (r = 0.69; P = 0.003). The current study suggests there is a strong relationship between VO2max and measurements of left ventricular size in Thoroughbred horses when individuals with a range of VO2max are compared.