Physiological versus pathological left ventricular remodeling in athletes

Abstract

Intense and chronic athletic training is associated with left ventricular remodeling, including an increase in wall thickness, cavity size and mass. The extent of morphological cardiac changes depends on a variety of factors, namely body size, gender, type of sport, ethnicity and, likely, genetic factors. A subset of male athletes engaged in intense endurance sports, such as cycling and rowing, develops a more substantial increase in left ventricular dimensions that may overlap with the phenotypic expression of cardiomyopathies. A common clinical challenge in sports cardiology is the differential diagnosis between physiological left ventricular hypertrophy (i.e., "athlete's heart") and hypertrophic cardiomyopathy, which is one of the most common causes of sudden cardiac death in young athletes. This review describes the physiological determinants, characteristics and upper limits of left ventricular hypertrophy in athletes, and analyzes the criteria that can be useful in the differential diagnosis between "athlete's heart" and hypertrophic cardiomyopathy.