IntroductIonThe European Society of Cardiology (ESC) definition for sudden death (SD) is a nontraumatic, unexpected fatal event occurring within 1 h of the onset of symptoms in an apparently healthy control. If death is not witnessed, the definition applies when the victim was in good health 24 h before the event. [1] Cardiovascular (CV) diseases are responsible for approximately 17 million deaths every year in the world and about 25% of which are sudden cardiac death (SCD). [2] A SD may be defined as a SCD when a congenital, or acquired, potentially fatal cardiac condition was known to be present during life, or autopsy has identified a cardiac or vascular anomaly as the probable cause of the event, or no obvious extra cardiac causes have been identified by postmortem examination, and therefore, an arrhythmic event is a likely cause of death. [1] In last years, the number of sport practitioners has increased by many times. The benefits of sport practice in improving CV health are unquestionable, but an increase in CV events has also been demonstrated during its practice. Therefore, the absolute number of people at risk of SCD during exercise is also increasing. [3] SCD of an athlete is a rare, but tragic event, which devastates families, institutions, the community, and sports medicine team. It is widely publicized by the media with significant social implications, conveying the idea that such an event can be preventable.Sport activity might play a trigger role of cardiac arrest in athletes with structural or electrical heart abnormalities, generating malignant arrhythmias, as ventricular fibrillation. The culprit diseases are often clinically silent and unlikely to be suspected or identified on the basis of spontaneous symptoms. [4] Preparticipation screening (PPS) protocol proposed by the ESC focuses on three points: family and personal history, physical examination, and 12-lead electrocardiogram (ECG), showing Echocardiography is a noninvasive imaging technique useful to provide clinical data regarding physiological adaptations of athlete's heart. Echocardiographic characteristics may be helpful for the clinicians to identify structural cardiac disease, responsible of sudden death during sport activities. The application of echocardiography in preparticipation screening might be essential: it shows high sensitivity and specificity for identification of structural cardiac disease and it is the first-line imagining technique for primary prevention of SCD in athletes. Moreover, new echocardiographic techniques distinguish extreme sport cardiac remodeling from beginning state of cardiomyopathy, as hypertrophic or dilated cardiomyopathy and arrhythmogenic right ventricle dysplasia. The aim of this paper is to review the scientific literature and the clinical knowledge about athlete's heart and main structural heart disease and to describe the rule of echocardiography in primary prevention of SCD in athletes.

Left ventricular hypertrophy (LVH) develops in response to a variety of physical, genetic, and biochemical stimuli and represents the early stage of ventricular remodeling. In patients with LVH, subclinical left ventricular (LV) dysfunction despite normal ejection fraction (EF) may be present before the onset of symptoms, which portends a dismal prognosis. Strain measurement with two-dimensional speckle tracking echocardiography (STE) represents a highly reproducible and accurate alternative to LVEF determination. The present review focuses on current available evidence that supports the incremental value of STE in the diagnostic and prognostic workup of LVH. When assessing the components of LV contraction, STE has an incremental value in differentiating between primary and secondary LVH and in the differential diagnosis with storage diseases. In addition, STE provides unique information for the stratification of patients with LVH, enabling to detect intrinsic myocardial dysfunction before LVEF reduction.

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