Cardiac findings using advanced imaging according to sports activities: a review

Abstract

The athlete's heart is a condition characterized by a spectrum of morphologic and functional cardiac adaptations as a response to intensive exercise. Cardiac adaptations differ according to the type of sport and are usually within normal parameters. However, some athletes overtake criteria with cardiomyopathies such as hypertrophic, dilated, arrhythmogenic and left ventricular non-compaction cardiomyopathy. Cardiomyopathies can be associated with sudden cardiac death in athletes. Therefore, establishing the differential diagnosis between cardiac disease and physiological cardiac adaptions of exercise is crucial. The aim of this review is to describe cardiac findings according to sports activities, using advanced imaging such as speckle tracking echocardiography (STE), three-dimensional echocardiography, computed tomography angiography and cardiac magnetic resonance (CMR). This article describes the cardiac changes detected using these advanced imaging methods according to the four major groups of exercise modalities: endurance, power, mixed and skill sports. Additionally, the most useful characteristics in the differentiation of cardiac physiological adaptations of exercise from pathological alterations are presented. Physiological adaptations are usually homogenous and symmetrical and ventricular function is usually preserved or improved with exercise stress echocardiography. In contrast, focal and heterogeneous myocardium alterations, GLS values inferior to -15% on STE and late gadolinium enhancement on CMR suggest pathological alterations. Advanced cardiac imaging modalities are nowadays an essential tool, aiding physicians to differentiate physiological from pathological cardiac abnormalities. As the use of these techniques is rising among athletes it is helpful to have a summarized description of the most expected cardiac adaptations according to the sports modality.