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Athlete’s Heart: Diagnostic Challenges and Future Perspectives

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Abstract

Distinguishing between adaptive and maladaptive cardiovascular response to exercise is crucial to prevent the unnecessary termination of an athlete’s career and to minimize the risk of sudden death. This is a challenging task essentially due to the substantial phenotypic overlap between electrical and structural changes seen in the physiological athletic heart remodeling and pathological changes seen in inherited or acquired cardiomyopathies. Stress testing is an ideal tool to discriminate normal from abnormal cardiovascular response by unmasking subtle pathologic responses otherwise undetectable at rest. Treadmill or bicycle electrocardiography, transthoracic echocardiography, and cardiopulmonary exercise testing are common clinical investigations used in sports cardiology, specifically among participants presenting with resting electrocardiographic abnormalities, frequent premature ventricular beats, or non-sustained ventricular arrhythmias. In this setting, as well as in cases of left ventricular hypertrophy or asymptomatic left ventricular dysfunction, stress imaging and myocardial tissue characterization by cardiovascular magnetic resonance show promise. In this review, we aimed to reappraise current diagnostic schemes, screening strategies and novel approaches that may be used to distinguish adaptive remodeling patterns to physical exercise from early phenotypes of inherited or acquired pathological conditions commanding prompt intervention.

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Author notes

  1. Carlo De Innocentiis and Fabrizio Ricci are equal first authors.

Authors and Affiliations

  1. Department of Neuroscience, Imaging and Clinical Sciences, Institute of Cardiology, “G. d’Annunzio” University, 66100, Chieti, Italy

    Carlo De Innocentiis, Fabrizio Ricci, Elvira Verrengia & Sabina Gallina

  2. Department of Neuroscience, Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, “G. d’Annunzio” University of Chieti-Pescara, Via Luigi Polacchi, 11, 66100, Chieti, CH, Italy

    Fabrizio Ricci & Sabina Gallina

  3. Department of Clinical Sciences, Malmö, Faculty of Medicine, Clinical Research Center, Lund University, 214 28, Malmö, Sweden

    Fabrizio Ricci

  4. William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, UK

    Mohammed Y. Khanji, Nay Aung & Steffen E. Petersen

  5. Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, West Smithfield, London, UK

    Mohammed Y. Khanji, Nay Aung & Steffen E. Petersen

  6. Internal Medicine and Critical Subacute Care Unit, Medicine and Geriatrics Rehabilitation Department, University-Hospital of Parma, Parma, Italy

    Claudio Tana

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  1. Carlo De Innocentiis
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  6. Elvira Verrengia
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  7. Steffen E. Petersen
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  8. Sabina Gallina
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Correspondence to Fabrizio Ricci.

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Conflict of interest

Carlo De Innocentiis, Fabrizio Ricci, Mohammed Y Khanji, Nay Aung, Claudio Tana, Elvira Verrengia, Steffen E Petersen, and Sabina Gallina declare that they have no conflicts of interest.

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No financial support was received for the conduct of this study or preparation of this manuscript.

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De Innocentiis, C., Ricci, F., Khanji, M.Y. et al. Athlete’s Heart: Diagnostic Challenges and Future Perspectives. Sports Med 48, 2463–2477 (2018). https://doi.org/10.1007/s40279-018-0985-2

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