Athlete's Heart Research Articles

Normative Values for Sport-Specific Left Ventricular Dimensions and Exercise-Induced Cardiac Remodeling in Elite Spanish Male and Female Athletes

BackgroundThere is debate about the magnitude of geometrical remodeling [i.e., left ventricle (LV) cavity enlargement vs. wall thickening] in the heart of elite athletes, and no limits of normality have been yet established for different sports. We aimed to determine sex- and sport-specific normative values of LV dimensions in elite white adult athletes.MethodsThis was a single-center, retrospective study of Spanish elite athletes. Athletes were grouped by sport and its relative dynamic/static component (Mitchell’s classification). LV dimensions were measured with two-dimensional-guided M-mode echocardiography imaging to compute normative values. We also developed an online and app-based calculator (https://sites.google.com/lapolart.es/athlete-lv/welcome?authuser=0) to provide clinicians with sports- and Mitchell’s category-specific Z-scores for different LV dimensions.ResultsWe studied 3282 athletes (46 different sports, 37.8% women, mean age 23 ± 6 years). The majority (85.4%) showed normal cardiac geometry, particularly women (90.9%). Eccentric hypertrophy was relatively prevalent (13.4%), and concentric remodeling or hypertrophy was a rare finding (each < 0.8% of total). The proportion of normal cardiac geometry and eccentric hypertrophy decreased and increased, respectively, with the dynamic (in both sexes) or static component (in male athletes) of the sport irrespective of the other (static or dynamic) component. The 95th percentile values of LV dimensions did not exceed the following limits in any of the Mitchell categories: septal wall thickness, 12 mm (males) and 10 mm (females); LV posterior wall, 11 mm and 10 mm; and LV end-diastolic diameter, 64 mm and 57 mm.ConclusionsThe majority of elite athletes had normal LV geometry, and although some presented with LV eccentric hypertrophy, concentric remodeling or hypertrophy was very uncommon. The present study provides sport-specific normative values that can serve to identify those athletes for whom a detailed examination might be recommendable (i.e., those exceeding the 95th percentile for their sex and sport).

Sex as a main determinant of bi-atrial acute and chronic adaptation to exercise.

Athlete's heart encompasses multiple physiological cardiac adaptations, although less is known at atrial level. How sex may influence the type and extent of atrial adaptations to exercise stimuli is also unknown. Our objective was to compare gender differences of echocardiographic atrial function indices in response to exercise in endurance athletes (EAs). Highly trained (> 10h/week) endurance athletes performed a maximal cardiopulmonary exercise test (CPET). Echocardiographic evaluation was performed at rest and immediately after exercise. Atria analysis consisted of standard and speckle-tracking echocardiographic assessment of atrial dimensions and contractile, reservoir, and conduit functions with myocardial deformation. 80 EAs (55% women) were enrolled and performed excellent CPET (129.6% of predicted VO2 maximal consumption). At rest, left atrial (LA) volumes and strain were similar between men and women. Women had lower right atrial (RA) volumes (26.7 vs 32.9ml/m2, p < 0.001) and higher reservoir and conduit strain absolute values. After exercise, women exhibited a larger improvement in reservoir and conduit LA strain, and the same trend was observed for the RA. In EAs with LA dilatation on baseline (~ 50%), women persistently showed higher increase in reservoir and conduit strain profile with exercise compared to men. In highly trained EAs, women have similar or even lower atrial dimensions remodelling compared to men, but better function based on reservoir and conduit strain values both at rest and in response to exercise. This phenomenon should be confirmed in larger studies and its potential role in the development of supraventricular arrhythmias, addressed in a specifically designed protocol.

Anaesthesia for elite athletes.

Sports participation has been growing rapidly since the 1960s. Anaesthesiologists are increasingly confronted with athletes in a peri-operative setting. The right choice of type of anaesthesia technique, pain management of injuries, specific physiologic adaptations of the athlete and knowledge of prohibited substances are eminent for a correct approach of this subpopulation. This review aims to give an overview of athletes' specific anaesthetic management in peri-operative and postoperative settings and to guide the nonspecialised anaesthetist. We comprehensively reviewed the literature, gathered all the information available on, and synthesised it in a narrative way, regarding preoperative evaluation, intraoperative implications and postoperative pain management of the elite athlete undergoing a surgical procedure. An anaesthesiologist should recognise the most common benign ECG findings in athletes like bradycardia, isolated left ventricle hypertrophy on voltage criteria and early repolarisation as normal features in the athlete's heart. Isotonic physiology typically produces four-chamber dilation. In contrast, isometric stress creates high intravascular pressure leading to left ventricular hypertrophy. Pre-operative evaluation should also identify possible consumers of performance-enhancing drugs. Intraoperative points of interest for the anaesthesiologist is mainly avoiding drugs on the prohibited list of the World Anti-Doping Agency (WADA). Postoperative and chronic pain management are still developing fields in this population. The International Olympic Committee (IOC) proposed treating acute pain with a combination of paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), topical analgesics, injectable NSAIDs and local anaesthetics. It may be suggested that chronic pain management in elite athletes could benefit from treatment in specialised multidisciplinary pain clinics. This literature review aims to serve as a guide for the anaesthesiologist taking care of the elite athlete.

Athletes heart in long distance runners: Fact or fiction?

Background and Aims : Since 1899 when Henschen (Sweden) described enlargement of the hearts in endurance sportsmen, there is much discussion about the effects of endurance sport on the heart. In 1959 Friedberg wrote that the athletes heart should be seen as an overloaded heart. Nowadays endurance sports like longdistance running, cycling and trathlon are very popular One of the most important questions is wether we could overload a healthy heart by extensive exercise. During extensive exercise the skeletal muscles will have een increase in bloodflow from 1 to 20 l/min.

Role of the electrocardiogram in differentiating genetically determined dilated cardiomyopathy from athlete's heart.

Physiological cardiac remodelling in highly trained athletes may overlap with dilated cardiomyopathy (DCM). The aim of this study was to investigate the role of the electrocardiogram (ECG) in differentiating between physiological and pathological remodelling. The study population consisted of 30 patients with DCM who revealed a pathogenic variant at genetic testing and 30 elite athletes with significant cardiac remodelling defined by a left ventricular (LV) end-diastolic diameter >62 mm and/or LV ejection fraction between 45% and 50%. The ECG was abnormal in 22 (73%) patients with DCM. The most common abnormalities were low voltages (n=14, 47%), lateral T-wave inversion (TWI) (n=6, 20%), ventricular ectopic beats (n=5, 17%) and anterior TWI (n=4, 13). Two athletes revealed an abnormal ECG: complete left bundle branch block (LBBB) in one case and atrial flutter in the other. The sensitivity, specificity and accuracy of the ECG in differentiating DCM from physiological adaptation to exercise in athletes was 73% (confidence interval [CI]: 54%-88%), 93% (CI: 78%-99%) and 0.83 (CI: 0.71-0.92) respectively. While the ECG is usually normal in athletes exhibiting significant LV dilatation and/or systolic dysfunction, this test is often abnormal in patients with DCM harbouring a pathogenic variant. Low voltages in the limb leads and lateral TWI are the most common abnormalities.

Impact of time-of-day on judo-specific performance

In judo tournaments, matches for each weight category are held on the same day and athletes competing at the finals have to compete at different times of the day. This study aimed to investigate the effect of time-of-day on judo specific performance and the changes in physiological load following judo specific performance. Fourteen male judo athletes (age 19.1±1.4 years) voluntarily participated in the study. At the 1st visit, anthropometrical measurements and familiarization procedures were conducted and the athletes’ chronotype was determined. Athletes performed the Special Judo Fitness Test (SJFT) during 2nd and 3rd visits. Athletes randomly performed two consecutive SJFTs with 15 min intervals at 10:00h, which is the official start time of matches, and at 18:00h which is the time when the finals start. During SJFT applications, athletes heart rate (HR), blood lactate (bLA), body temperature and rate of perceived exertion (RPE) were monitored. The changes in total throw numbers (F1, 13= 1.32, p=0.27) and SJFT index (F1, 13= 0.30, p=0.59) were not different between morning and evening. There were similar changes in bLA (F4, 52=0.66, p=0.63), RPE (F1, 13=1.42, p=0.26) and body temperature (F1.4, 18.0=1.18, p=0.31) which were measured before and after the tests. However, HR measured in the evening were higher compared to morning measurement at all measurement times (F1, 13=10.28, p=0.01), but there was no difference in SJFT throws (F3.8, 48.8=0.49, p=0.74). In conclusion, different times of the day did not affect judo specific performance as well as physiological variables in judo athletes.

Phenotyping the hypertensive heart.

Arterial hypertension remains the most frequent cardiovascular (CV) risk factor, and is responsible for a huge global burden of disease. Echocardiography is the first-line imaging method for the evaluation of cardiac damage in hypertensive patients and novel techniques, such as 2D and D speckle tracking and myocardial work, provide insight in subclinical left ventricular (LV) impairment that would not be possible to detect with conventional echocardiography. The structural, functional, and mechanical cardiac remodelling that are detected with imaging are intermediate stages in the genesis of CV events, and initiation or intensification of antihypertensive therapy in response to these findings may prevent or delay progressive remodelling and CV events. However, LV remodelling-especially LV hypertrophy-is not specific to hypertensive heart disease (HHD) and there are circumstances when other causes of hypertrophy such as athlete heart, aortic stenosis, or different cardiomyopathies need exclusion. Tissue characterization obtained by LV strain, cardiac magnetic resonance, or computed tomography might significantly help in the distinction of different LV phenotypes, as well as being sensitive to subclinical disease. Selective use of multimodality imaging may therefore improve the detection of HHD and guide treatment to avoid disease progression. The current review summarizes the advanced imaging tests that provide morphological and functional data about the hypertensive cardiac injury.

Endurance training-induced cardiac remodeling in a guinea pig athlete's heart model.

Besides the health benefits of regular exercise, high-level training-above an optimal level-may have adverse effects. In this study, we investigated the effects of long-term vigorous training and its potentially detrimental structural-functional changes in a small animal athlete's heart model. Thirty-eight 4-month-old male guinea pigs were randomized into sedentary and exercised groups. The latter underwent a 15-week-long endurance-training program. To investigate the effects of the intense long-term exercise, in vivo (echocardiography, electrocardiography), ex vivo, and in vitro (histopathology, patch-clamp) measurements were performed. Following the training protocol, the exercised animals exhibited structural left ventricular enlargement and a significantly higher degree of myocardial fibrosis. Furthermore, resting bradycardia accompanied by elevated heart rate variability occurred, representing increased parasympathetic activity in the exercised hearts. The observed prolonged QTc intervals and increased repolarization variability parameters may raise the risk of electrical instability in exercised animals. Complex arrhythmias did not occur in either group, and there were no differences between the groups in ex vivo or cellular electrophysiological experiments. Accordingly, the high parasympathetic activity may promote impaired repolarization in conscious exercised animals. The detected structural-functional changes share similarities with the human athlete's heart; therefore, this model might be useful for investigations on cardiac remodeling.

Myocardial Work Efficiency in Physiologic Left Ventricular Hypertrophy of Power Athletes

The athlete's heart in power training is characterized by physiologic concentric remodeling. Our aim was to analyze left ventricular (LV) myocardial deformation and contractile reserve (CR) in top-level power athletes (PA) at rest and during exercise and their possible correlations with functional capacity. Standard echo, lung ultrasound, and LV 2D speckle-tracking strain were performed at rest and during exercise in PA and in age- and sex-comparable healthy controls. 250 PA (male: 62%; 33.6 ± 4.8 years) and 180 age- and sex-comparable healthy controls were enrolled. LV ejection fraction (EF) at baseline was comparable between the two groups, while LV global longitudinal strain (GLS) was reduced in PA (GLS: -17.8 ± 2.4 in PA vs. -21.9 ± 3.8 in controls; P < 0.01). Conversely, myocardial work efficiency (MWE) did not show significant difference between the two groups (94.4 ± 3.2 in PA vs. 95.9 ± 4.6% in controls; P NS). At peak exertion during exercise stress echocardiography (ESE), PA showed better exercise capacity and peak VO2 consumption (51.6 ± 10.2 in EA vs. 39.8 ± 8.2 mL/Kg/min in controls, P < 0.0001), associated with augmented pulmonary artery systolic pressure (PASP). By multivariable analysis, MWE at rest was the most predictive factor of maximal watts (P < 0.0001), peak VO2, (P < 0.0001), PASP (P < 0.001), and number of B-lines (P < 0.001), all measured at peak effort. In power athletes, MWE showed less load dependency than GLS. Normal resting values of MWE in PA suggest a physiological LV remodeling, associated with a better exercise capacity and preserved CR during physical stress.

Cardiac Remodeling in Female Athletes with Relation to Sport Discipline and Exercise Dose – A Cardiac Magnetic Resonance Study

Abstract Purpose: To compare chronic cardiac adaptations to exercise at various intensities and in different sports categories of female athletes. Methods: This was a retrospective study including 30 elite female athletes (members of the National Team), 14 amateur female athletes training 3-6 h per week for several years, and 20 inactive female controls who underwent cardiac magnetic resonance. Results: Left and right ventricular end-diastolic volumes (LVEDVI and RVEDVI) differed between all studied groups. They rose from controls to elite athletes, with amateur athletes in-between (for LVEDVI 73 ± 9 vs. 83 ± 6 vs. 95 ± 13 ml/m2, P&lt; 0.001, for RVEDVI 74 ± 7 vs. 84 ± 6 vs. 97 ± 14 ml/m2, P&lt; 0.001, respectively). Left and right atrial areas (LAA and RAA) were larger in amateur and elite athletes than in controls (P &lt; 0.001), but there was no difference between the two athlete groups. The interventricular septal diameter was mildly higher only in elite female athletes (9 ± 1 mm vs. 8 ± 1 mm, P&lt; 0.001). No difference in the above parameters was found between power and endurance athletes. Three athletes presented with benign myocardial fibrosis in the lower left ventricular (LV)-right ventricle junction point. Conclusions: The hearts of female athletes differed from inactive controls. Part of the changes was related to exercise intensity (LVEDVI and RVEDVI, mild LV muscle thickening), but other changes were not (LAA and RAA). There was no difference in the heart chamber size and LV muscle thickness between studied athletes engaging in power and endurance disciplines. There were also no significant myocardial tissue changes observed in both elite and amateur female athletes.

Characteristics and Rehabilitation Training Effects of Shoulder Joint Dysfunction in Volleyball Players under the Background of Artificial Intelligence.

With the development of volleyball technology, the frequent competition, the fierce competition, and the increase of sports load, the requirements for the athletes' own body, intelligence, combat, heart, and skills are getting higher and higher. Volleyball is one of the most popular sports in the world. It attracts people all over the world with its strong team appeal and its own unique charm. This study mainly discusses the characteristics of shoulder joint dysfunction in volleyball players and the effect of rehabilitation training under the background of artificial intelligence. By sorting out the development process of artificial intelligence technology, it can be analyzed that artificial intelligence technology already has a certain knowledge reserve, can make corresponding mechanized feedback, and can make correct judgments based on experience in more complex situations. This study compared volleyball athletes with handicap and barrier-free shoulder joints and observed the characteristics of shoulder pain, stability, and flexibility caused by subacromial impingement syndrome. It also looked at whether subacromial impingement syndrome athletes differ in volleyball spiking sequence and mobilization and recruitment of muscle power during swing spikes compared to athletes with normal shoulder function in the full kinetic chain. According to the volleyball intelligent competition platform, the implementation and application of ideas such as data collection, result feedback, adjustment of training plan, implementation of training plan, and real-time monitoring are regularly monitored. On the one hand, through timely assessment and detection of shoulder function of volleyball players, functional training is carried out for weaknesses to prevent injury; on the other hand, after a mild injury occurs, timely targeted training should be taken to find and correct wrong actions, and strengthen the weak part of muscle strength, so as to reduce the probability of repeated injury and improve sports performance and athletic ability. In the new system, after collecting and sorting, testers can directly upload to the web page in the form of Excel for automatic filling, grasp the test information of athletes in time, generate automatic warning, and save time. The monitoring content determined by this study mainly includes three index systems, including load, training preparation performance, and recovery. According to the self-provided evaluation system of relevant test equipment and the experience of expert coaches, the evaluation standards for each index are formulated. There was a statistically significant difference in the scores between the rehabilitation group and the pre-rehabilitation group during the study (P < 0.05). This study attempts to find the characteristics and rules of FMS scores of women's volleyball players of different levels, so as to provide more targeted physical training for volleyball players, promote the all-round development of physical fitness, and avoid the risk of sports injuries. This study provides more effective and comprehensive recommendations for the prevention and recovery of shoulder injuries in volleyball players. This study provides more effective and comprehensive recommendations for the prevention and recovery of shoulder injuries in volleyball players. The results of the study can provide reference for the scientific training and rehabilitation of volleyball players and make suggestions for the treatment and prevention of subacromial impingement syndrome.

Right Heart Structure and Function in Lifelong Recreational Endurance Athletes with and without Paroxysmal Atrial Fibrillation

Healthy young athletes adapt to the increased demands of endurance exercise with symmetric cardiac remodeling. Male veteran endurance athletes have an increased risk for atrial fibrillation (AF), and some athletes seem susceptible to changes mimicking arrhythmogenic cardiomyopathy. Intense exercise puts a disproportionate hemodynamic load on the right-sided heart chambers. Despite this, data describing right heart structure and function in older veteran athletes are scarce. The aim of this study was to investigate structural and functional characteristics of the right heart in veteran athletes with and without AF to contribute to the understanding of exercise-induced cardiac remodeling in this group. Three hundred two male participants, of whom 151 were veteran skiers (62 with paroxysmal AF) and 151 were control subjects from the general population (62 with paroxysmal AF), underwent echocardiographic examinations in sinus rhythm to evaluate right atrial (RA) and right ventricular (RV) structure and function. While 87 of the participants had never exercised regularly, 50, 43, and 122 men had practiced regular endurance exercise for 1 to 20, 20 to 40, and >40years, respectively. RA volume and RV size increased with cumulative years of exercise (P<.001), with a disproportionate increase in RV size compared with left ventricular (LV) size, regardless of AF status (P<.001). RA and RV function assessed by strain remained similar despite lifelong exposure to endurance exercise. AF was associated with reduced RA strain irrespective of exposure to exercise (P<.001). RA and RV sizes and RV/LV ratio showed a dose-response relationship with cumulative years of endurance exercise, whereas RA and RV function did not, indicating that increasing RV/LV ratio may represent a physiologic adaptation to prolonged endurance exercise. AF was associated with reduced RA function, regardless of exposure to exercise, suggesting that RA functional parameters are more closely linked to AF than RA size in veteran athletes.

Indications and utility of cardiac genetic testing in athletes.

Sports Cardiology practice commonly involves the evaluation of athletes for genetically determined cardiac conditions that may predispose to malignant arrhythmias, heart failure, and sudden cardiac death. High-level exercise can lead to electrical and structural cardiac remodelling which mimics inherited cardiac conditions (ICCs). Differentiation between 'athlete's heart' and pathology can be challenging and often requires the whole armamentarium of available investigations. Genetic studies over the last 30 years have identified many of the genetic variants that underpin ICCs and technological advances have transformed genetic testing to a more readily available and affordable clinical tool which may aid diagnosis, management, and prognosis. The role of genetic testing in the evaluation and management of athletes with suspected cardiac conditions is often unclear beyond the context of specialist cardio-genetics centres. This document is aimed at physicians, nurses, and allied health professionals involved in the athlete's care. With the expanding role and availability of genetic testing in mind, this document was created to address the needs of the broader sports cardiology community, most of whom work outside specialized cardio-genetics centres, when faced with the evaluation and management of athletes with suspected ICC. The first part of the document provides an overview of basic terminology and principles and offers guidance on the appropriate use of genetic testing in the assessment of such athletes. It outlines key considerations when contemplating genetic testing, highlighting the potential benefits and pitfalls, and offers a roadmap to genetic testing. The second part of the document presents common clinical scenarios in Sports Cardiology practice, outlining the diagnostic, prognostic, and therapeutic implications of genetic testing, including impact on exercise recommendations. The scope of this document does not extend to a comprehensive description of the genetic basis, investigation, or management of ICCs.

Left ventricular noncompaction cardiomyopathy: Recent advances.

From its initial description to the present day, left ventricular noncompaction cardiomyopathy has been the subject of numerous studies and publications. In question as a real cardiomyopathy, left ventricular noncompaction can appear in isolation or in association with other cardiac malformations, genetic syndromes, and neuromuscular disorders. As a genetically heterogeneous disorder, it can be sporadic or familial, with an autosomal dominant pattern with variable penetrance most frequently observed. Different diagnostic criteria have been described through the years, first by using echocardiogram and later on by cardiac magnetic resonance. The lack of universally accepted diagnostic criteria has led to the condition being over-diagnosed in the general population. Differential diagnosis between real cardiomyopathy, epiphenomenon (phenocopy in the setting of loading conditions or even other cardiomyopathies), and physiological hypertrabeculation, like in the athlete's heart must be considered. Clinically it can present as heart failure, ventricular arrhythmias, and even sudden death, but it can also be asymptomatic during familial screening. The main prognosis factors are left ventricular dilatation, dysfunction, and fibrosis. There is no specific treatment. Familial screening is recommended and special recommendations in the case of athletes must be taken into account. In the present article, we review the myth and reality concerning main and more recent aspects of left ventricular noncompaction.

The athlete's heart from Philippides to the modern marathon runners.

The athlete's heart from Philippides to the modern marathon runners.

ST-Segment Elevation and T-Wave Inversion Confined to V1-V4 in Young Soccer Players: Prevalence and Differences from Afro-Brazilians to Ghanaians

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Hospital de Clínicas de Porto Alegre Research and Event Incentive Fund (FIPE-HCPA) Introduction Black athletes may present some peculiarities in the resting 12-lead electrocardiogram, such as T-wave inversion (TWI) confined to V1-V4 preceded by ST-segment and J-point elevation (‘domed’ ST-elevation and TWI in V1-V4), the so-called Afro-Caribbean pattern, a benign variant of the athlete's heart according to the "2017 International criteria for electrocardiographic interpretation in athletes". However, the prevalence of these findings in young Afro-Brazilian (AB) soccer players is unknown. Purpose To compare the prevalence of ‘domed’ ST-elevation and TWI in V1-V4 among young AB soccer players with Ghanaians black soccer players. Methods We sought to do this analysis visually, as the data from AB soccer players were as raw data; and those from Ghana’s were else aggregated. A forest plot with the point estimate and confidence intervals at 95% was built and, whenever any region from the lower limit up to the upper limit of the confidence interval of a given variable interpolate to the other, no differences could be claimed. The forest plot was built at R v. 4.1.2 using the package "metafor". Results Data from 517 young AB soccer players (mean age: 20 years) and 159 young black soccer players from Ghana (mean age: 19 years) were evaluated and compared. The average height and weight were similar (177.2 cm and 70.7 kg for AB, and 175.2 cm and 68.4kg for Ghanaians players). Ghanaians had a significant higher prevalence of ‘domed’ ST-elevation and TWI in V1-V4 than AB (16.7%; 95% CI, 13.1 to 25.8 versus 2.1%; 95% CI, 1.2 to 3.9, respectively). Conclusion To the best of our knowledge, this is the first study to describe the low prevalence of the ‘domed’ ST-elevation combined with TWI in V1-V4 in young AB soccer players. Interestingly, when compared to Ghanaians young soccer players (all of them black African individuals), AB athletes presented a significant lower frequency of this finding (16.7% versus 2.1%). Finally, we hypothesize that ‘domed’ ST-elevation and TWI in V1-V4 seen in African athletes appears to become less prevalent in the generations after the time of migration from Africa to Brazil. Whether this is due to environmental or genetic changes, further studies should clarify.

Cardiodiagnostic sex-specific differences of the female athlete in sports cardiology

The cardiovascular care of highly active individuals and competitive athletes has developed into an important focus within the field of sports medicine. An evolving understanding of exercise-induced cardiovascular remodeling in athletes has led to a more robust characterization of physiologic adaptation versus pathological dysfunction, but this distinction is often challenging due to diagnostic commonalities. Current data reflects sporting-focused analyses of mainly male athletes, which may not be easily applicable to the female athletic heart. Increasingly female-specific cardiac dimensional and physiologic data are starting to emerge from comparative studies that may be utilized to address this growing need, and further guide individualized care. Here, we review current literature evaluating female-specific cardiovascular adaptations of the athletic heart, and formulate a discussion on cardiac remodeling, cardiodiagnostic findings, etiologic mechanisms, limitations of currently available data, and direction for future research in the cardiovascular care of female athletes.

Role of cardiac magnetic resonance imaging in troponinemia syndromes.

Cardiac magnetic resonance imaging (MRI) is an evolving technology, proving to be a highly accurate tool for quantitative assessment. Most recently, it has been increasingly used in the diagnostic and prognostic evaluation of conditions involving an elevation in troponin or troponinemia. Although an elevation in troponin is a nonspecific marker of myocardial tissue damage, it is a frequently ordered investigation leaving many patients without a specific diagnosis. Fortunately, the advent of newer cardiac MRI protocols can provide additional information. In this review, we discuss several conditions associated with an elevation in troponin such as myocardial infarction, myocarditis, Takotsubo cardiomyopathy, coronavirus disease 2019 related cardiac dysfunction and athlete’s heart syndrome.

Diagnostic Yield of Cardiac Magnetic Resonance in Athletes with and without Features of the Athlete's Heart and Suspected Structural Heart Disease.

Cardiac magnetic resonance (CMR) is a second-line imaging test in cardiology. Balanced enlargement of heart chambers called athlete’s heart (AH) is a part of physiological adaptation to regular physical activity. The aim of this study was to evaluate the diagnostic utility of CMR in athletes with suspected structural heart disease (SHD) and to analyse the relation between the coexistence of AH and SHD. We wanted to assess whether the presence of AH phenotype could be considered as a sign of a healthy heart less prone to development of SHD. This retrospective, single centre study included 154 consecutive athletes (57 non-amateur, all sports categories, 87% male, mean age 34 ± 12 years) referred for CMR because of suspected SHD. The suspicion was based on existing guidelines including electrocardiographic and/or echocardiographic changes suggestive of abnormality but without a formal diagnosis. CMR permitted establishment of a new diagnosis in 66 patients (42%). The main diagnoses included myocardial fibrosis typical for prior myocarditis (n = 21), hypertrophic cardiomyopathy (n = 17, including 6 apical forms), other cardiomyopathies (n = 10) and prior myocardial infarction (n = 6). Athlete’s heart was diagnosed in 59 athletes (38%). The presence of pathologic late gadolinium enhancement (LGE) was found in 41 patients (27%) and was not higher in athletes without AH (32% vs. 19%, p = 0.08). Junction-point LGE was more prevalent in patients with AH phenotype (22% vs. 9%, p = 0.02). Patients without AH were not more likely to be diagnosed with SHD than those with AH (49% vs. 32%, p = 0.05). Based on the results of CMR and other tests, three patients (2%) were referred for ICD implantation for the primary prevention of sudden cardiac death with one patient experiencing adequate intervention during follow-up. The inclusion of CMR into the diagnostic process leads to a new diagnosis in many athletes with suspicion of SHD and equivocal routine tests. Athletes with AH pattern are equally likely to be diagnosed with SHD in comparison to those without AH phenotype. This shows that the development of AH and SHD can occur in parallel, which makes differential diagnosis in this group of patients more challenging.

Cardiac Structure and Function in Junior Athletes: A Systematic Review of Echocardiographic Studies.

In young athletes, the level of competitiveness in sports is increasing, as well as frequency and intensity of exercise training. Adaptations of the cardiac system to this increased workload imposed by exercise has not yet been studied sufficiently. In adults, studies point towards a shift from the functional athlete's heart towards pathological cardiac remodelling, with ventricular arrythmia and impaired cardiac function, that is exercise-related. This systematic review investigates cardiac adaptations to exercise in junior athletes compared to inactive controls. Three electronic databases (PubMed/Medline, ScienceDirect and Web of Science) were searched for studies assessing 2-dimensional transthoracic echocardiography (2D TTE) and 2-dimensional speckle tracking echocardiography (2D STE) parameters in junior athletes, aged 7-19 years, compared to inactive controls. Data was screened and extracted by two reviewers; study quality and risk of bias was assessed by three reviewers. Eight out of 1460 studies met all inclusion criteria, with all studies reporting results on 2D TTE and six studies reporting results on 2D STE parameters in 540 (51 girls) junior athletes and 270 (18 girls) controls. There is evidence for structural cardiac adaptations of the left ventricle and both atria in junior athletes. Results regarding left ventricular function are controversial with a tendency to improved function in dynamic exercising athletes. Left ventricular mass and relative wall thickness point towards higher values in static exercising athletes. Cardiac adaptations to exercise occur in children and adolescents. These adaptations are more pronounced in structural left ventricular parameters. Functional parameters are preserved or slightly improved in junior athletes but not impaired by exercise.