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Review
. 2023 May 19;24(5):151.
doi: 10.31083/j.rcm2405151. eCollection 2023 May.

Athlete's Heart: A Cardiovascular Step-By-Step Multimodality Approach

Stefano Palermi  1 , Elena Cavarretta  2   3 , Flavio D'Ascenzi  4 , Silvia Castelletti  5 , Fabrizio Ricci  6 , Marco Vecchiato  7 , Alessandro Serio  1 , Luna Cavigli  4 , Eduardo Bossone  8 , Giuseppe Limongelli  9 , Alessandro Biffi  10 , Emanuele Monda  9 , Andre La Gerche  11 , Aaron Baggish  12 , Antonello D'Andrea  13
Affiliations
Review

Athlete's Heart: A Cardiovascular Step-By-Step Multimodality Approach

Stefano Palermi et al. Rev Cardiovasc Med. .

Abstract

"Athlete's heart" is a spectrum of morphological, functional, and regulatory changes that occur in people who practice regular and long-term intense physical activity. The morphological characteristics of the athlete's heart may overlap with some structural and electrical cardiac diseases that may predispose to sudden cardiac death, including inherited and acquired cardiomyopathies, aortopathies and channelopathies. Overdiagnosis should be avoided, while an early identification of underlying cardiac life-threatening disorders is essential to reduce the potential for sudden cardiac death. A step-by-step multimodality approach, including a first-line evaluation with personal and family history, clinical evaluation, 12-lead resting electrocardiography (ECG), followed by second and third-line investigations, as appropriate, including exercise testing, resting and exercise echocardiography, 24-hour ECG Holter monitoring, cardiac magnetic resonance, computed tomography, nuclear scintigraphy, or genetic testing, can be determinant to differentiate between extreme physiology adaptations and cardiac pathology. In this context, cardiovascular imaging plays a key role in detecting structural abnormalities in athletes who fall into the grey zone between physiological adaptations and a covert or early phenotype of cardiovascular disease.

Keywords: athlete's heart; cardiovascular imaging; pre-participation screening; sports activity; sports cardiology; sudden cardiac death.

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Conflict of interest statement

The authors declare no conflict of interest. Elena Cavarretta is serving as one of the Guest editors and Giuseppe Limongelli is serving as one of the Editorial Board members of this journal. We declare that Elena Cavarretta and Giuseppe Limongelli had no involvement in the peer review of this article and have no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to Zhonghua Sun.

Figures

Fig. 1.
Fig. 1.
The step-by-step approach in the management of athlete’s heart. CV, cardiovascular; ECG, electrocardiogram; CPET, cardiopulmonary exercise test; CMR, cardiac magnetic resonance; CCT, cardiac computer tomography; SPECT, single photon emission computer tomography; PET, positron emission tomography.
Fig. 2.
Fig. 2.
Echocardiographic cardiovascular adaptations in the athlete’s heart. RA, right atrium; LA, left atrium; RV, right ventricle; RVOT, right ventricle outflow tract; FAC, fractional area change; GLS, global longitudinal strain; TAPSE, tricuspid area plane systolic excursion; PASP, pulmonary artery systolic pressure; LV, left ventricle; LVEDD, left ventricular end-diastolic diameter; LVM, left ventricular mass; SV, stroke volume; WT, wall thickness.
Fig. 3.
Fig. 3.
Global longitudinal strain (GLS) values of the left ventricle (A) and right ventricle (B) in a professional athlete: the bull’s eye is within normal values despite left ventricular hypertrophy (A) and right ventricular dilation (B). GS, global strain; FWS, free-wall strain; TAPSE, tricuspid annular plane excursion.
Fig. 4.
Fig. 4.
Cardiovascular magnetic resonance of an endurance athlete, investigated for premature ventricular beats and left ventricle (LV) dilatation and demonstrating balanced LV dilatation, borderline-low normal LV ejection fraction, no regional wall motion abnormalities, high-normal stroke volume, no late gadolinium enhancement, low-normal native myocardial T1, normal extracellular volume (25%).
See this image and copyright information in PMC

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