Echocardiography in the evaluation of athletes

Abstract

Echocardiography is currently a widely available imaging technique that can provide useful data in the field of sports cardiology particularly in two areas: pre-participation screening and analysis of the cardiac adaptation induced by exercise. The application of pre-participation screening and especially, the type and number of used diagnostic tests remains controversial. Echocardiography has shown though, higher sensitivity and specificity as compared to the ECG, following a protocol adapted to athletes focused on ruling out the causes of sudden death and the most common disorders in this population. It is still a subject of controversy the actual cost of adding it, but depending on the type of sport, echocardiography might be cost-effective if added in the first line of examination. Regarding the evaluation of cardiac adaptation to training in athletes, echocardiography has proved to be useful in the differential diagnosis of diseases that can cause sudden death, analysing both the left ventricle (hypertrophy cardiomyopathy, dilated cardiomyopathy, left ventricle non compaction) and the right ventricle (arrhythmogenic right ventricular cardiomyopathy). The aim of this paper is to review the current knowledge and the clinical practical implications of it on the field of echocardiography when applied in sport cardiology areas.

Keywords: athletes; athlete’s heart; echocardiography; pre-participation screening.

Figure 1.. Echocardiographic assessment of an athlete with left ventricular hypertrophic adaptation (Figure 1: A, B, C) and a patient with a mild form of hypertrophic cardiomyopathy (Figure 1: D, E, F).

Patients with hypertrophic cardiomyopathy present smaller LV end-diastolic diameters, reduced radial strain values and reduced velocities of the mitral annulus as compared to athletes.

Figure 2.. Echocardiographic assessment of an athlete with right ventricle remodelling (Figure 2: A, B, C); and a patient with arrhythmogenic right ventricular dysplasia in early stage (Figure 2: D, E, F).

Patients with arrhythmogenic right ventricular dysplasia in early stage can present only mild RV dilatation but the relationship between LV and RV cavity tend to be less than 1 and the RVOT is at least mildly dilated and they present reduced RV global and segmental strain values as compared to athletes.