Echocardiography in the evaluation of athletes

Abstract

Echocardiography is currently a widely available imaging technique that can provide useful data in the field of sports cardiology particularly in two areas: pre-participation screening and analysis of the cardiac adaptation induced by exercise.The application of pre-participation screening and especially, the type and number of used diagnostic tests remains controversial. Echocardiography has shown though, higher sensitivity and specificity as compared to the ECG, following a protocol adapted to athletes focused on ruling out the causes of sudden death and the most common disorders in this population. It is still a subject of controversy the actual cost of adding it, but depending on the type of sport, echocardiography might be cost-effective if added in the first line of examination.Regarding the evaluation of cardiac adaptation to training in athletes, echocardiography has proved to be useful in the differential diagnosis of diseases that can cause sudden death, analysing both the left ventricle (hypertrophy cardiomyopathy, dilated cardiomyopathy, left ventricle non compaction) and the right ventricle (arrhythmogenic right ventricular cardiomyopathy).The aim of this paper is to review the current knowledge and the clinical practical implications of it on the field of echocardiography when applied in sport cardiology areas.

The echocardiographic assessment of the right ventricle in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia compared with athletes and matched controls

“…An understanding of how the athlete's heart adapts to improve athletic performance is essential to be able to differentiate the athlete heart from important disease states, such as ARVC/D, which may share similar morphologic features . The cardiac structural and functional adaptive changes in response to exercise, typically called “athlete's heart,” are well documented . Historically, the study of the athlete's heart was focused on the LV; however, with the introduction of more advanced imaging techniques, descriptions of RV exercise‐remodeling have been better described .…”

Athlete's heart syndrome: A friend or foe?

“…Ovaj parametar može da omogući razlikovanje koncentričnog (relativna debljina zida ≤ 0,45) od ekscentričnog remodelinga (relativna debljina zida < 0,3) (28,29). Poslednje dve decenije istraživači ukazuju i na remodelovanje desne komore u kojoj vladaju niski pritisci (30,31). Strukturno, dinamička fizička aktivnost može da poveća dimenzije desne komore u smislu hipertrofije koja prati hipertofiju leve komore (31).…”

“…Poslednje dve decenije istraživači ukazuju i na remodelovanje desne komore u kojoj vladaju niski pritisci (30,31). Strukturno, dinamička fizička aktivnost može da poveća dimenzije desne komore u smislu hipertrofije koja prati hipertofiju leve komore (31). Zato je važno odrediti i odnos dimenzija leve i desne komore (LV/RV), koji kod vrhunskih sportista ostaje nepromenjen (30).…”

“…Hipertrofična kardiomiopatija je udružena i sa smanjenjem end-dijastolnog prečnika leve komore (≤ 45 mm) (30). Konačnu dijagnozu i razlikovanje sindroma sportskog srca i HCM omogućavaju magnentna rezonanca i genetska ispitivanja (31).…”

“…U pitanju je bolest nepoznate etiologije koja se karakteriše infiltracijom srčanog mišića desne komore masnim i vezivnim tkivom (30,31,32). Razlikovanje ARVD od sportskog srca je izuzetno teško zato što u oba slučaja može da postoje uvećanje desne komore i poremećaji repolarizacije i sprovođenja.…”