Echocardiographic evaluation of the Athlete’s heart

Abstract

Adaptive, exercise-induced cardiac changes versus those related to underlying pathology may manifest with similar echocardiographic findings. These changes in cardiac structure and function have been the focus of many investigations over the last century. Initial reports of normal adaptive cardiac remodeling came in the late 1800s and early 1900s when scientists observed cardiac enlargement and bradycardia among athletes. 1,2 Thereafter, electrocardiographic and radiographic studies demonstrated cardiac hypertrophy and changes in electrical activities in highly trained athletes. [3][4][5] Subsequently, the development of echocardiography revolutionized our visualization of the cardiac structures and the changes in response to exercise. 6 The increasing number of athletes and highly active individuals, who require regular screening and follow-up to maintain sports participation, presents a growing need for optimally distinguishing the athlete's heart (AH) from life-threatening mimic pathologies. 7,8 These observations have led to multiple clinical investigations and the establishment of the sports and exercise council by the American College of Cardiology. 9 The objective of this review is to provide a summary of the cardiac adaptive changes to exercise and their evaluation by echocardiography.

Time domain adaptation of left ventricular diastolic intraventricular pressure in elite female ice hockey athletes

“…The LV mass index in elite athletes was significantly higher than in casual players and healthy controls ( Table 2 ). This observation is consistent with a previous study showing that exercise-induced cardiac remodeling is related to an increase in the LV mass, which is correlated with an increase in venous return volume and cardiometabolic demand ( 39 ). Steding-Ehrenborg et al ( 33 ) concluded that LV mass was an independent predictor of the diastolic kinetic energy of the LV.…”

Normative values of non-invasively assessed RV function and pulmonary circulation coupling for pre-participation screening derived from 497 male elite athletes

“…Understanding the structural and functional adaptations in highly trained athletes is essential for differentiating physiological from pathological remodeling in the context of preparticipation evaluation [2,4] and, therefore, constitutes a relevant clinical issue. In any individual, cardiac adaptations to exercise are influenced by several factors including training mode, intensity, duration and volume [1,3,19,[23][24][25][26]. Cardiac remodeling of the right ventricle in athletes was intensively investigated [6,10,[26][27][28][29][30][31][32] and different echocardiographic approaches were proposed to identify pathological changes [1,3,33].…”

“…In any individual, cardiac adaptations to exercise are influenced by several factors including training mode, intensity, duration and volume [1,3,19,[23][24][25][26]. Cardiac remodeling of the right ventricle in athletes was intensively investigated [6,10,[26][27][28][29][30][31][32] and different echocardiographic approaches were proposed to identify pathological changes [1,3,33]. However, so far, accepted reference values for athletes exist mainly for morphological echocardiographic measurements as highlighted in recent meta-analyses [28,32].…”

“…Functional and structural changes of the right and left ventricle, known as the "athlete´s heart", have been described in elite athletes performing mixed and endurance sports disciplines [1][2][3]. These physiological adaptations are considered beneficial to generate high performance levels [4].…”

Prevention and Management of Sudden Cardiac Death in Athletes

“…Cardiac MRI is very helpful in distinguishing athletes' heart from cardiomyopathy conditions such as HCM and ARVC, particularly in extreme cases of overlap which are seen in elite athletes. Enlargement of cardiac chambers, a modest increase in wall thickness w ith preser ved systolic function, normal or enhanced diastolic f u n c t i o n , a n d n o r m a l s t r a i n measurements support adaptive changes [11]. The endurance athlete will develop morphological, functional, and electrical characteristics of the athletic heart and for a small minority this will place them in a diagnostic "grey zone. "…”