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      The athlete’s heart: insights from echocardiography

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          Abstract

          The manifestations of the athlete’s heart can create diagnostic challenges during an echocardiographic assessment. The classifications of the morphological and functional changes induced by sport participation are often beyond ‘normal limits’ making it imperative to identify any overlap between pathology and normal physiology. The phenotype of the athlete’s heart is not exclusive to one chamber or function. Therefore, in this narrative review, we consider the effects of sporting discipline and training volume on the holistic athlete’s heart, as well as demographic factors including ethnicity, body size, sex, and age.

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          Article 0 comments Cited 348 times – based on 0 reviews     Review now
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            Prevalence of Inflammatory Heart Disease Among Professional Athletes With Prior COVID-19 Infection Who Received Systematic Return-to-Play Cardiac Screening

            Matthew Martinez, Andrew Tucker, O Bloom … (2021)
            The major North American professional sports leagues were among the first to return to full-scale sport activity during the coronavirus disease 2019 (COVID-19) pandemic. Given the unknown incidence of adverse cardiac sequelae after COVID-19 infection in athletes, these leagues implemented a conservative return-to-play (RTP) cardiac testing program aligned with American College of Cardiology recommendations for all athletes testing positive for COVID-19.
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              SARS-CoV-2 Cardiac Involvement in Young Competitive Athletes

              Nathaniel Moulson, Bradley J. Petek, Jonathan A. Drezner … (2021)
              Supplemental Digital Content is available in the text. Cardiac involvement among hospitalized patients with severe coronavirus disease 2019 (COVID-19) is common and associated with adverse outcomes. This study aimed to determine the prevalence and clinical implications of COVID-19 cardiac involvement in young competitive athletes. Methods: In this prospective, multicenter, observational cohort study with data from 42 colleges and universities, we assessed the prevalence, clinical characteristics, and outcomes of COVID-19 cardiac involvement among collegiate athletes in the United States. Data were collected from September 1, 2020, to December 31, 2020. The primary outcome was the prevalence of definite, probable, or possible COVID-19 cardiac involvement based on imaging definitions adapted from the Updated Lake Louise Imaging Criteria. Secondary outcomes included the diagnostic yield of cardiac testing, predictors for cardiac involvement, and adverse cardiovascular events or hospitalizations. Results: Among 19 378 athletes tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 3018 (mean age, 20 years [SD, 1 year]; 32% female) tested positive and underwent cardiac evaluation. A total of 2820 athletes underwent at least 1 element of cardiac triad testing (12-lead ECG, troponin, transthoracic echocardiography) followed by cardiac magnetic resonance imaging (CMR) if clinically indicated. In contrast, primary screening CMR was performed in 198 athletes. Abnormal findings suggestive of SARS-CoV-2 cardiac involvement were detected by ECG (21 of 2999 [0.7%]), cardiac troponin (24 of 2719 [0.9%]), and transthoracic echocardiography (24 of 2556 [0.9%]). Definite, probable, or possible SARS-CoV-2 cardiac involvement was identified in 21 of 3018 (0.7%) athletes, including 15 of 2820 (0.5%) who underwent clinically indicated CMR (n=119) and 6 of 198 (3.0%) who underwent primary screening CMR. Accordingly, the diagnostic yield of CMR for SARS-CoV-2 cardiac involvement was 4.2 times higher for a clinically indicated CMR (15 of 119 [12.6%]) versus a primary screening CMR (6 of 198 [3.0%]). After adjustment for race and sex, predictors of SARS-CoV-2 cardiac involvement included cardiopulmonary symptoms (odds ratio, 3.1 [95% CI, 1.2, 7.7]) or at least 1 abnormal triad test result (odds ratio, 37.4 [95% CI, 13.3, 105.3]). Five (0.2%) athletes required hospitalization for noncardiac complications of COVID-19. During clinical surveillance (median follow-up, 113 days [interquartile range=90 146]), there was 1 (0.03%) adverse cardiac event, likely unrelated to SARS-CoV-2 infection. Conclusions: SARS-CoV-2 infection among young competitive athletes is associated with a low prevalence of cardiac involvement and a low risk of clinical events in short-term follow-up.
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                Author and article information

                Contributors
                David Oxborough: d.l.oxborough@ljmu.ac.uk
                Journal
                Journal ID (nlm-ta): Echo Res Pract
                Journal ID (iso-abbrev): Echo Res Pract
                Title: Echo Research and Practice
                Publisher: BioMed Central (London )
                ISSN (Electronic): 2055-0464
                Publication date (Electronic): 18 October 2023
                Publication date PMC-release: 18 October 2023
                Publication date Collection: 2023
                Volume: 10
                Electronic Location Identifier: 15
                Affiliations
                [1 ]Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, ( https://ror.org/04zfme737) Tom Reilly Building, Byrom Street, Liverpool, L3 3AF UK
                [2 ]Royal United Hospitals Bath NHS Foundation Trust, ( https://ror.org/058x7dy48) Bath, UK
                [3 ]Institute of Sport, Manchester Metropolitan University and University of Manchester, ( https://ror.org/027m9bs27) Manchester, UK
                [4 ]Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, ( https://ror.org/024mrxd33) Leeds, UK
                [5 ]Imperial College Healthcare NHS Trust, ( https://ror.org/056ffv270) London, UK
                [6 ]Department for Health, University of Bath, ( https://ror.org/002h8g185) Bath, UK
                Article
                Publisher ID: 27
                DOI: 10.1186/s44156-023-00027-8
                PMC ID: 10583359
                PubMed ID: 37848973
                SO-VID: 71d5bffa-2236-4d26-8f6a-c1d8ae9fe6e0
                Copyright © © British Society of Echocardiography 2023
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 31 May 2023
                Date accepted : 7 August 2023
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © British Society of Echocardiography 2023

                Keywords: athlete’s heart,echocardiography,pre-participation screening,sports cardiology
                Data availability:
                Keywords: athlete’s heart, echocardiography, pre-participation screening, sports cardiology

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