SCD in the family Echocardiography Cardiomyopathies Clinical and genetic family screening in selected cases Known cardiomyopathy in the family CMR Mitral valve prolapse Palpitations Echocardiography Cardiomyopathies Consider 24-h and/or long-term ambulatory ECG monitoring and/or electrophysiological study in selected cases Syncope CMR Coronary artery disease/ anomalies CT according to clinical suspicion Consider stress echo to rule out LV outflow obstruction Chest pain Echocardiography Coronary artery disease/ anomalies Consider the risk profile, age and radiation exposure CMR Consider exercise stress imaging CT Nuclear imaging Physical examination Imaging tests of choice Heart disease Additional testing Cardiac murmurs Echocardiography Valvular heart disease Additional tests on the basis of echocardiographic findings and clinical suspicion (e.g. CMR) Abnormal cardiac sound Congenital heart defects Marfanoid habitus Echocardiography Marfan disease Clinical and genetic family screening CT Accurate evaluation of thoracic aorta CMR 12-leads electrocardiogram Imaging tests of choice Heart disease Additional testing T-wave inversion Echocardiogram Cardiomyopathies Clinical and genetic family screening CMR Myocarditis Annual follow-up with imaging tests in athletes with normal findings at initial evaluation ST-segment depression Echocardiogram Cardiomyopathies Consider exercise stress imaging CMR Myocarditis Coronary CT or nuclear imaging in athletes with clinical suspicion of coronary artery disease Coronary artery disease Valve disease Pathologic Q-waves Echocardiogram Cardiomyopathies Consider exercise stress imaging CMR Myocarditis Coronary CT or nuclear imaging in athletes with clinical suspicion of coronary artery disease Coronary artery disease Complete LBBB Echocardiogram Cardiomyopathies Comprehensive cardiac evaluation for exclusion CMR Myocarditis of heart disease CT Cardiac sarcoidosis Consider exercise stress imaging Nuclear imaging Valve disease Coronary artery disease/ anomalies Bifascicular block (RBBB and left anterior hemiblock) Echocardiogram Cardiomyopathies Additional tests on the basis of echocardiographic findings and clinical suspicion Myocarditis Cardiac sarcoidosis Coronary artery disease Non-specific intraventricular conduction delay Echocardiogram Cardiomyopathies Additional tests on the basis of echocardiographic findings and clinical suspicion Coronary artery disease/ anomalies Minor non-voltage criteria for LV or RV hypertrophy (atrial enlargement and QRS axis deviation) Echocardiogram Cardiomyopathies Additional tests on the basis of echocardiographic findings and clinical suspicion Valve disease Congenital heart disease Pulmonary hypertension Abnormal exercise testing (repolarization abnormalities/ symptoms/arrhythmias) Echocardiography Coronary artery disease/ anomalies Consider the cardiovascular risk profile and age CMR Consider also exercise stress imaging CT Cardiomyopathies Low-radiation examinations advised in young individuals Nuclear imaging Myocarditis CMR, cardiac magnetic re...

In a large population of highly trained athletes, enlarged LA dimension > or = 40 mm was relatively common (20%), with the upper limits of 45 mm in women and 50 mm in men distinguishing physiologic cardiac remodeling ("athlete's heart") from pathologic cardiac conditions. Atrial fibrillation and other supraventricular tachyarrhythmias proved to be uncommon (prevalence < 1%) and similar to that in the general population, despite the frequency of LA enlargement. Left atrial remodeling in competitive athletes may be regarded as a physiologic adaptation to exercise conditioning, largely without adverse clinical consequences.

Background-Few data are available that address the impact of athletic training on aortic root size. We investigated the distribution, determinants, and clinical significance of aortic root dimension in a large population of highly trained athletes. Methods and Results-Transverse aortic dimensions were assessed in 2317 athletes (56% male), free of cardiovascular disease, aged 24.8Ϯ6.1 (range, 9 to 59) years, engaged in 28 sports disciplines (28% participated in Olympic Games). In males, aortic root was 32.2Ϯ2.7 mm (range, 23 to 44; 99th percentileϭ40 mm); in females, aortic root was 27.5Ϯ2.6 mm (range, 20 to 36; 99th percentileϭ34 mm). Aortic root was enlarged Ն40 mm in 17 male (1.3%) and Ն34 mm in 10 female (0.9%) subjects. Over an 8-year follow-up period, aortic dimension increased in these male athletes (40.9Ϯ1.3 to 42.9Ϯ3.6 mm; PϽ0.01) and dilated substantially (to 50, 50, and 48 mm) in 3, after 15 to 17 years of follow-up, in the absence of systemic disease. Aortic root did not increase significantly (34.9Ϯ0.9 to 35.4Ϯ2.1 mm; Pϭ0.11) in female athletes. Multiple regression and covariance analysis showed that aortic dimension was largely explained by weight, height, left ventricular mass, and age (R

RV remodeling occurs in Olympic athletes, with male sex and endurance practice playing the major impact. A significant subset (up to 32%) of athletes exceeds the normal TF limits; therefore, we recommend referring to the 95th percentiles here reported as referral values; alternatively, only major diagnostic TF criteria for arrhythmogenic RV cardiomyopathy may be appropriate.

The Italian national pre-participation screening programme including 12-lead ECG appears to be efficient in identifying young athletes with HCM, leading to their timely disqualification from competitive sports. These data also suggest that routine echocardiography is not an obligatory component of broad-based screening programmes designed to identify young athletes with HCM.