Athlete's Heart: The Potential for Multimodality Imaging to Address the Critical Remaining Questions

Abstract

Moderate exercise is a powerful therapy in the treatment and prevention of cardiac disease, but intense habitual exercise leads to cardiac adaptations for which the prognostic benefits are less clear. The athlete's heart syndrome refers to the morphological and electrical remodeling which occurs to varying extents dependent upon the sporting discipline. Its accurate differentiation from pathological entities is critical. This review describes the role multi-modality imaging serves in determining the limitations and consequences of intense exercise. Tissue characterization and imaging studies during exercise are emphasized as important future directions of inquiry with the potential to address remaining controversies.

Cardiac Imaging in Athletes

“…2,3 Cardiac output, the product of stroke volume and heart rate, may increase 5-to 6-fold during maximal exercise effort. Heart rate in the athlete may range from 40 bpm at rest to ≥ 200 bpm in a young maximally exercising athlete.…”

The Impact of Endurance Exercise Training on Left Ventricular Torsion

“…There continues to be debate about whether the cardiac remodeling associated with athletic training is beneficial or maladaptive (3). Reduced LVT in the context of dilated cardiomyopathy (23) and after myocardial infarction (24) has established a potential association between reduced LVT and myocardial pathology.…”

“…Initial cross-sectional data and more recent longitudinal studies demonstrate eccentric LV hypertrophy among trained individuals (1,2). LV functional adaptations to EET are not as well understood (3). Left ventricular torsion (LVT), an important marker of LV function in numerous cardiac diseases (4), has recently been investigated in the setting of exercise (5).…”

Should Pre-participation Cardiovascular Screening for Competitive Athletes be Introduced in Australia? A Timely Debate in a Sport-loving Nation

“…The plethora of pathology found seems at odds with the high fitness required of these elite athletes and strengthens argument that screening may provide major morbidity from exclusion and concern for conditions that are unlikely to cause symptoms at any stage in the future. This study also highlights the problems in translating a screening protocol to a population in which the range of normal ECG and echo findings may differ substantially from that which has been most studied -Caucasian males [23,24].…”