Competitive athletes (CA) are a rapidly growing population worldwide. Habitual vigorous exercise, a defining characteristic of this population, is a potent stimulus for adaptive structural and functional cardiac remodeling and is an effective way to reduce the risk of cardiovascular disease (CVD). Manifestations of CVD in CA are highly variable ranging from subtle findings during pre-participation cardiovascular screening (PPCS) to collapse or cardiac arrest during exercise. In general, young CA are most commonly affected by congenital and genetic conditions while older CA most commonly harbor acquired CVD. Cardiac imaging using transthoracic echocardiography (TTE), cardiac computed tomography angiography (CTA), and cardiac magnetic resonance imaging (CMR) plays a fundamental role in the care of CA. This document was created to provide clinical imaging specialists with a comprehensive guide for the performance of multimodality imaging in CA.

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Background Initial protocols for return to play cardiac testing in young competitive athletes following SARS‐CoV‐2 infection recommended cardiac troponin (cTn) to screen for cardiac involvement. This study aimed to define the diagnostic yield of cTn in athletes undergoing cardiovascular testing following SARS‐CoV‐2 infection. Methods and Results This prospective, observational cohort study from ORCCA (Outcomes Registry for Cardiac Conditions in Athletes) included collegiate athletes who underwent cTn testing as a component of return to play protocols following SARS‐CoV‐2 infection. The cTn values were stratified as undetectable, detectable but within normal limits, and abnormal (>99% percentile). The presence of probable or definite SARS‐CoV‐2 myocardial involvement was compared between those with normal versus abnormal cTn levels. A total of 3184/3685 (86%) athletes in the ORCCA database met the inclusion criteria for this study (age 20±1 years, 32% female athletes, 28% Black race). The median time from SARS‐CoV‐2 diagnosis to cTn testing was 13 days (interquartile range, 11, 18 days). The cTn levels were undetectable in 2942 athletes (92%), detectable but within normal limits in 210 athletes (7%), and abnormal in 32 athletes (1%). Of the 32 athletes with abnormal cTn testing, 19/32 (59%) underwent cardiac magnetic resonance imaging, 30/32 (94%) underwent transthoracic echocardiography, and 1/32 (3%) did not have cardiac imaging. One athlete with abnormal troponin met the criteria for definite or probable SARS‐CoV‐2 myocardial involvement. In the total cohort, 21/3184 (0.7%) had SARS‐CoV‐2 myocardial involvement, among whom 20/21 (95%) had normal troponin testing. Conclusions Abnormal cTn during routine return to play cardiac screening among competitive athletes following SARS‐CoV‐2 infection appears to have limited diagnostic utility.

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The GLS in aortic stenosis patients can be reliably measured at the bedside by a sonographer without additional benefit of offline analysis.