Abstract
Individuals who exercise intensively for more than 4 h per week, develop a constellation of physiological, structural and electrical alterations within the heart which are collectively termed the ‘athlete’s heart’. The role of these changes is to facilitate rapid filling of the heart and permit the augmentation of stroke volume to generate a large and sustained increase in cardiac output for prolonged periods. On occasion, these physiological adaptations overlap with those observed in the morphologically mild primary cardiomyopathies. The distinction between physiological cardiac enlargement and a cardiomyopathy is crucial considering that the cardiomyopathies account for up to 40% of all sudden cardiac deaths in athletes. An erroneous diagnosis has the potential for very serious consequences; for example, an incorrect diagnosis of athlete’s heart in someone with a cardiomyopathy may jeopardize a young life, whereas an incorrect diagnosis of cardiomyopathy in someone with athlete’s heart may lead to unnecessary disqualification from competitive sport. The aim of this chapter is to provide a methodical approach in the echocardiographic assessment of an athlete with view to differentiation between physiological adaptation and cardiac pathology.
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References
Mitchell JH, Haskell W, Snell P, Van Camp SP. Task force 8: classification of sports. J Am Coll Cardiol. 2005;45(8):1364–7.
Maron BJ. Structural features of the athlete heart as defined by echocardiography. J Am Coll Cardiol. 1986;7(1):190–203.
Zaidi A, Ghani S, Sharma R, Oxborough D, Panoulas VF, Sheikh N, et al. Physiological right ventricular adaptation in elite athletes of African and Afro-Caribbean origin. Circulation. 2013;127(17):1783–92.
Oxborough D, Sharma S, Shave R, Whyte G, Birch K, Artis N, et al. The right ventricle of the endurance athlete: the relationship between morphology and deformation. J Am Soc Echocardiogr. 2012;25(3):263–71.
D’Andrea A, Caso P, Sarubbi B, Limongelli G, Liccardo B, Cice G, et al. Right ventricular myocardial adaptation to different training protocols in top-level athletes. Echocardiography. 2003;20(4):329–36.
Rodriguez CJ, Diez-Roux AV, Moran A, Jin Z, Kronmal RA, Lima J, et al. Left ventricular mass and ventricular remodeling among Hispanic subgroups compared with non-Hispanic blacks and whites: MESA (Multi-ethnic Study of Atherosclerosis). J Am Coll Cardiol. 2010;55(3):234–42.
Maron BJ, Pelliccia A. The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death. Circulation. 2006;114(15):1633–44.
Pelliccia A, Culasso F, Di Paolo FM, Maron BJ. Physiologic left ventricular cavity dilatation in elite athletes. Ann Intern Med. 1999;130(1):23–31.
Sharma S, Merghani A, Mont L. Exercise and the heart: the good, the bad, and the ugly. Eur Heart J. 2015;36:1445.
Zaidi A, Sharma S. Exercise and heart disease: from athletes and arrhythmias to hypertrophic cardiomyopathy and congenital heart disease. Futur Cardiol. 2013;9(1):119–36.
Pelliccia A, Maron BJ, Spataro A, Proschan MA, Spirito P. The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. N Engl J Med. 1991;324(5):295–301.
Basavarajaiah S, Boraita A, Whyte G, Wilson M, Carby L, Shah A, et al. Ethnic differences in left ventricular remodeling in highly-trained athletes relevance to differentiating physiologic left ventricular hypertrophy from hypertrophic cardiomyopathy. J Am Coll Cardiol. 2008;51(23):2256–62.
Papadakis M, Carre F, Kervio G, Rawlins J, Panoulas VF, Chandra N, et al. The prevalence, distribution, and clinical outcomes of electrocardiographic repolarization patterns in male athletes of African/Afro-Caribbean origin. Eur Heart J. 2011;32(18):2304–13.
Rawlins J, Carre F, Kervio G, Papadakis M, Chandra N, Edwards C, et al. Ethnic differences in physiological cardiac adaptation to intense physical exercise in highly trained female athletes. Circulation. 2010;121(9):1078–85.
Sheikh N, Papadakis M, Carre F, Kervio G, Panoulas VF, Ghani S, et al. Cardiac adaptation to exercise in adolescent athletes of African ethnicity: an emergent elite athletic population. Br J Sports Med. 2013;47(9):585–92.
Sheikh N, Papadakis M, Schnell F, Panoulas V, Malhotra A, Wilson M, et al. Clinical profile of athletes with hypertrophic cardiomyopathy. Circ Cardiovasc Imaging. 2015;8(7):e003454.
Caselli S, Maron MS, Urbano-Moral JA, Pandian NG, Maron BJ, Pelliccia A. Differentiating left ventricular hypertrophy in athletes from that in patients with hypertrophic cardiomyopathy. Am J Cardiol. 2014;114(9):1383–9.
Butz T, van Buuren F, Mellwig KP, Langer C, Plehn G, Meissner A, et al. Two-dimensional strain analysis of the global and regional myocardial function for the differentiation of pathologic and physiologic left ventricular hypertrophy: a study in athletes and in patients with hypertrophic cardiomyopathy. Int J Cardiovasc Imaging. 2011;27(1):91–100.
Schnell F, Riding N, O’Hanlon R, Axel Lentz P, Donal E, Kervio G, et al. Recognition and significance of pathological T-wave inversions in athletes. Circulation. 2015;131(2):165–73.
Sharma S, Elliott PM, Whyte G, Mahon N, Virdee MS, Mist B, et al. Utility of metabolic exercise testing in distinguishing hypertrophic cardiomyopathy from physiologic left ventricular hypertrophy in athletes. J Am Coll Cardiol. 2000;36(3):864–70.
Abernethy WB, Choo JK, Hutter AM. Echocardiographic characteristics of professional football players. J Am Coll Cardiol. 2003;41(2):280–4.
Claessen G, Schnell F, Bogaert J, Claeys M, Pattyn N, De Buck F, et al. Exercise cardiac magnetic resonance to differentiate athlete’s heart from structural heart disease. Eur Heart J Cardiovasc Imaging. 2018.
La Gerche A, Burns AT, Mooney DJ, Inder WJ, Taylor AJ, Bogaert J, et al. Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes. Eur Heart J. 2012;33(8):998–1006.
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s guidelines and standards committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440–63.
Marcus FI, McKenna WJ, Sherrill D, Basso C, Bauce B, Bluemke DA, et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the task force criteria. Circulation. 2010;121(13):1533–41.
Zaidi A, Sheikh N, Jongman JK, Gati S, Panoulas VF, Carr-White G, et al. Clinical differentiation between physiological remodeling and Arrhythmogenic right ventricular cardiomyopathy in athletes with marked electrocardiographic repolarization anomalies. J Am Coll Cardiol. 2015;65(25):2702–11.
Chin TK, Perloff JK, Williams RG, Jue K, Mohrmann R. Isolated noncompaction of left ventricular myocardium. A study of eight cases. Circulation. 1990;82(2):507–13.
Jenni R, Oechslin E, Schneider J, Attenhofer Jost C, Kaufmann PA. Echocardiographic and pathoanatomical characteristics of isolated left ventricular non-compaction: a step towards classification as a distinct cardiomyopathy. Heart. 2001;86(6):666–71.
Gati S, Chandra N, Bennett RL, Reed M, Kervio G, Panoulas VF, et al. Increased left ventricular trabeculation in highly trained athletes: do we need more stringent criteria for the diagnosis of left ventricular non-compaction in athletes? Heart. 2013;99(6):401–8.
Gati S, Papadakis M, Papamichael ND, Zaidi A, Sheikh N, Reed M, et al. Reversible De Novo left ventricular Trabeculations in pregnant women: implications for the diagnosis of left ventricular non-compaction in low risk populations. Circulation. 2014;130:475.
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D’Silva, A., Sharma, S. (2018). The Athlete’s Heart. In: Nihoyannopoulos, P., Kisslo, J. (eds) Echocardiography. Springer, Cham. https://doi.org/10.1007/978-3-319-71617-6_37
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DOI: https://doi.org/10.1007/978-3-319-71617-6_37
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