Assessing the Athlete’s Heart
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
The initial report of the athlete’s heart dates back to the late 1890s. The concept that endurance-based exercise and strength-based exercise lead to distinctly different changes in left ventricular (LV) structure was proposed in the 1970s and has been confirmed by more recent studies. Advances in cardiac imaging, particularly echocardiography and cardiac magnetic resonance imaging, have allowed for more precise characterization of the structural changes that develop in the hearts of athletes engaged in different sporting disciplines. Despite our improved understanding of exercise-induced cardiac remodeling, the findings of: 1) increased LV chamber dimension, 2) increased LV wall thickness, and 3) increased right ventricular (RV) chamber dimension continue to be accompanied by significant diagnostic uncertainty in clinical practice. Determining whether these entities arise from exercise-induced cardiac remodeling or represent pathologic cardiomyopathy requires the integration of a number of diagnostic techniques, including evaluations with echocardiography and/or cardiac magnetic resonance imaging. Ambiguous cases require additional testing, such as cardiopulmonary exercise testing and assessing the response to a period of prescribed detraining. Novel imaging techniques coupled with physiologic provocation that assess regional LV and RV function may make the distinction between physiologic adaptation and pathology more clear in the future.
- Henschen S. Skidlauf und Skidwettlauf. Eine medizinische Sportstudie. Mitt Med Klin Upsala 1899;2(15)
- Darling EA. The Effects of Training. A Study of the Harvard University Crews. Boston Medical and Surgical Journal. 1899;CXLI:229–33. CrossRef
- White PD. Bradycardia in athletes, especially long distance runnners. JAMA. 1942;120:642. CrossRef
- White PD. The pulse after a marathon race. JAMA. 1918;71:1047. CrossRef
- Roskamm H, Reindell H, Musshoff K, Koenig K. Relations between heart size and physical efficiency in male and female athletes in comparison with normal male and female subjects. Arch Kreislaufforsch. 1961;35:67–102. CrossRef
- Reindell H, Roskamm H, Steim H. The heart and blood circulation in athletes. Med Welt. 1960;31:1557–63.
- Bulychev VV, Khmelevskii VA, Rutman l. Roentgenological and intrumental examination of the heart in athletes. Klin Med. 1965;43:108–14.
- Hunt EA. Electrocardiographic study of 20 champion swimmers before and after 110-yard sprint swimming competition. Can Med Assoc J. 1963;88:1251–3.
- Arstila M, Koivikko A. Electrocardiographic and vectorcardiographic signs of left and right ventricular hypertrophy in endurance athletes. J Sports Med Phys Fitness. 1966;6(3):166–75.
- Chignon JC, Distel R, Arnaud P. Morphologic variations of horizontal vectorcardiograms in athletes. J Physiol (Paris). 1967;59(4 Suppl):375.
- Chignon JC, Distel R, Courtois B, Leclerq J, Andrivet R. Orientation of the analysis of electrical tracings regarding athletes. J Sports Med Phys Fitness. 1969;9(4):241–4.
- Schamroth L, Jokl E. Marked sinus and A-V nodal bradycardia with interference-dissociation in an athlete. J Sports Med Phys Fitness. 1969;9(2):128–9.
- Fleischmann P, Kellermann JJ. Persistent irregular tachycardia in a successful athlete without impairment of performance. Isr J Med Sci. 1969;5(4):950–2.
- Rowell LB. Human circulation: regulation during physical stress. New York: Oxford University Press; 1986.
- Jose AD, Collison D. The normal range and determinants of the intrinsic heart rate in man. Cardiovasc Res. 1970;4(2):160–7. CrossRef
- Uusitalo AL, Uusitalo AJ, Rusko HK. Exhaustive endurance training for 6–9 weeks did not induce changes in intrinsic heart rate and cardiac autonomic modulation in female athletes. Int J Sports Med. 1998;19(8):532–40. CrossRef
- D’Andrea A, Caso P, Severino S, et al. Effects of different training protocols on left ventricular myocardial function in competitive athletes: a Doppler tissue imaging study. Ital Heart J. 2002;3(1):34–40.
- Pelliccia A, Culasso F, Di Paolo FM, Maron BJ. Physiologic left ventricular cavity dilatation in elite athletes. Ann Intern Med. 1999;130(1):23–31.
- Weiner RB, Wang F, Hutter Jr AM, et al. The feasibility, diagnostic yield, and learning curve of portable echocardiography for out-of-hospital cardiovascular disease screening. J Am Soc Echocardiogr. 2012;25(5):568–75. CrossRef
- Gilbert CA, Nutter DO, Felner JM, et al. Echocardiographic study of cardiac dimensions and function in the endurance-trained athlete. Am J Cardiol. 1977;40(4):528–33. CrossRef
- Abergel E, Chatellier G, Hagege AA, et al. Serial left ventricular adaptations in world-class professional cyclists: implications for disease screening and follow-up. J Am Coll Cardiol. 2004;44(1):144–9. CrossRef
- Baggish AL, Yared K, Wang F, et al. The impact of endurance exercise training on left ventricular systolic mechanics. Am J Physiol Heart Circ Physiol. 2008;295(3):H1109–16. CrossRef
- Nottin S, Doucende G, Schuster-Beck I, et al. Alteration in left ventricular normal and shear strains evaluated by 2D-strain echocardiography in the athlete's heart. J Physiol. 2008;586(Pt 19):4721–33. CrossRef
- Weiner RB, Hutter Jr AM, Wang F, et al. The impact of endurance exercise training on left ventricular torsion. JACC Cardiovasc Imaging. 2010;3(10):1001–9. CrossRef
- Baggish AL, Yared K, Weiner RB, et al. Differences in cardiac parameters among elite rowers and subelite rowers. Med Sci Sports Exerc. 2010;42(6):1215–20.
- Caso P, D'Andrea A, Galderisi M, et al. Pulsed Doppler tissue imaging in endurance athletes: relation between left ventricular preload and myocardial regional diastolic function. Am J Cardiol. 2000;85(9):1131–6. CrossRef
- • D’Andrea A, Cocchia R, Riegler L, et al. Left ventricular myocardial velocities and deformation indexes in top-level athletes. J Am Soc Echocardiogr. 2010;23(12):1281–8. This article describes the full spectrum of systolic and diastolic myocardial velocities and deformation indexes in a large population of competitive athletes. CrossRef
- Lester SJ, Tajik AJ, Nishimura RA, et al. Unlocking the mysteries of diastolic function: deciphering the Rosetta Stone 10 years later. J Am Coll Cardiol. 2008;51(7):679–89. CrossRef
- • Maron BJ. Distinguishing hypertrophic cardiomyopathy from athlete's heart physiological remodelling: clinical significance, diagnostic strategies and implications for preparticipation screening. Br J Sports Med. 2009;43(9):649–56. This article discusses non-invasive strategies that are useful in distinguishing the benign consequences of athletic training from pathological left ventricular hypertrophy with the potential for sudden cardiac death. CrossRef
- Pelliccia A, Maron BJ, Spataro A, et al. The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. N Engl J Med. 1991;324(5):295–301. CrossRef
- Sharma S, Maron BJ, Whyte G, et al. Physiologic limits of left ventricular hypertrophy in elite junior athletes: relevance to differential diagnosis of athlete's heart and hypertrophic cardiomyopathy. J Am Coll Cardiol. 2002;40(8):1431–6. CrossRef
- Klues HG, Schiffers A, Maron BJ. Phenotypic spectrum and patterns of left ventricular hypertrophy in hypertrophic cardiomyopathy: morphologic observations and significance as assessed by two-dimensional echocardiography in 600 patients. J Am Coll Cardiol. 1995;26(7):1699–708. CrossRef
- Maron BJ, Spirito P, Green KJ, et al. Noninvasive assessment of left ventricular diastolic function by pulsed Doppler echocardiography in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. 1987;10(4):733–42. CrossRef
- Lewis JF, Spirito P, Pelliccia A, Maron BJ. Usefulness of Doppler echocardiographic assessment of diastolic filling in distinguishing "athlete's heart" from hypertrophic cardiomyopathy. Br Heart J. 1992;68(3):296–300. CrossRef
- Derumeaux G, Douillet R, Troniou A, et al. Distinguishing between physiologic hypertrophy in athletes and primary hypertrophic cardiomyopathies. Importance of tissue color Doppler. Arch Mal Coeur Vaiss. 1999;92(2):201–10.
- Vinereanu D, Florescu N, Sculthorpe N, et al. Differentiation between pathologic and physiologic left ventricular hypertrophy by tissue Doppler assessment of long-axis function in patients with hypertrophic cardiomyopathy or systemic hypertension and in athletes. Am J Cardiol. 2001;88(1):53–8. CrossRef
- Wang J, Buergler JM, Veerasamy K, et al. Delayed untwisting: the mechanistic link between dynamic obstruction and exercise tolerance in patients with hypertrophic obstructive cardiomyopathy. J Am Coll Cardiol. 2009;54(14):1326–34. CrossRef
- •• Maron MS, Maron BJ, Harrigan C, et al. Hypertrophic cardiomyopathy phenotype revisited after 50 years with cardiovascular magnetic resonance. J Am Coll Cardiol. 2009;54(3):220–8. This article describes the emerging role of cardiac magnetic resonance imaging in the in the contemporary evaluation of patients with hypertrophic cardiomyopathy. CrossRef
- Adabag AS, Maron BJ, Appelbaum E, et al. Occurrence and frequency of arrhythmias in hypertrophic cardiomyopathy in relation to delayed enhancement on cardiovascular magnetic resonance. J Am Coll Cardiol. 2008;51(14):1369–74. CrossRef
- Maron BJ, Pelliccia A, Spataro A, Granata M. Reduction in left ventricular wall thickness after deconditioning in highly trained Olympic athletes. Br Heart J. 1993;69(2):125–8. CrossRef
- Pelliccia A, Maron BJ, De Luca R, et al. Remodeling of left ventricular hypertrophy in elite athletes after long-term deconditioning. Circulation. 2002;105(8):944–9. CrossRef
- • Weiner RB, Wang F, Berkstresser B, et al. Regression of "gray-zone" exercise induced concentric left ventricular hypertrophy during prescribed detraining. J Am Coll Cardiol 2012; In press. This article describes the extent and time course of left ventricular hypertrophy regression in strength trained athletes who underwent 6 months of presrcibed detraining. J Am Coll Cardiol. 2012;59(22):1992–4.
- Sharma S, Elliott PM, Whyte G, et al. Utility of metabolic exercise testing in distinguishing hypertrophic cardiomyopathy from physiologic left ventricular hypertrophy in athletes. J Am Coll Cardiol. 2000;36(3):864–70. CrossRef
- Hauser AM, Dressendorfer RH, Vos M. H et al. Symmetric cardiac enlargement in highly trained endurance athletes: a two-dimensional echocardiographic study Am Heart J. 1985;109(5 Pt 1):1038–44.
- Henriksen E, Landelius J, Wesslen L, et al. Echocardiographic right and left ventricular measurements in male elite endurance athletes. Eur Heart J. 1996;17(7):1121–8. CrossRef
- Scharhag J, Schneider G, Urhausen A, et al. Athlete's heart: right and left ventricular mass and function in male endurance athletes and untrained individuals determined by magnetic resonance imaging. Journal of the American College of Cardiology. 2002;40(10):1856–63. CrossRef
- Scharf M, Brem MH, Wilhelm MS, et al. Cardiac magnetic resonance assessment of left and right ventricular morphologic and functional adaptations in professional soccer players. Am Heart J. 2010;159(5):911–8. CrossRef
- •• Marcus FI, McKenna WJ, Sherrill D, et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the task force criteria. Circulation. 2010;121(13):1533–41. The article presents the Task Force Criteria for the diagnosis of arrhythmogenic right ventricular cardiomyopathy in an effort to improve the diagnosis and management of this condition. CrossRef
- • La Gerche A, Burns AT, D'Hooge J, et al. Exercise strain rate imaging demonstrates normal right ventricular contractile reserve and clarifies ambiguous resting measures in endurance athletes. J Am Soc Echocardiogr. 2012;25(3):253–62 e1. This article shows that lower resting basal right ventricular strain in endurance athletes may represent physiologic change, as opposed to subclinical myocardial damage, given that contracile reserve was comparable between athletes and non-athletes. CrossRef
- •• Oxborough D, Sharma S, Shave R, et al. The Right Ventricle of the Endurance Athlete: The Relationship between Morphology and Deformation. J Am Soc Echocardiogr 2011. The article shows that RV chamber dimensions are larger in endurance athletes than those described by "normal ranges" and that functional assessment of the right ventricle may aid in differential diagnosis.
- La Gerche A, Burns AT, Mooney DJ, et al. Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes. Eur Heart J. 2011;epub December 6, 2011.
- Assessing the Athlete’s Heart
Current Cardiovascular Imaging Reports
Volume 5, Issue 6 , pp 393-402
- Cover Date
- Print ISSN
- Online ISSN
- Current Science Inc.
- Additional Links
- Athlete’s heart
- Exercise physiology
- Gray zone
- Author Affiliations
- 1. Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
- 2. Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit St, Boston, MA, 02114, USA