Unveiling the Athlete’s Heart: Hemodynamic Echocardiography Perspectives for Sport-Specific Cardiac Risk Stratification

Introduction: Intensive training leads to physiological cardiac remodeling known as “athlete’s heart,” varying with the type and intensity of sport. Transthoracic echocardiography (TTE) enables noninvasive assessment of these adaptations, helping to differentiate normal changes from pathologies linked to sudden cardiac death. Methods: This cross-sectional study included 120 national-level athletes (aged 18–35 years) from athletics, gymnastics, martial arts, football, and aquatic sports. All had ≥5 years of structured training and ≥10 h/week of activity. Doppler TTE assessed the parameters including the left ventricular internal diameter in diastole (LViDd), heart rate (HR), systemic vascular resistance (SVR), cardiac output (CO), cardiac index (CI), ejection fraction (EF), tricuspid annular plane systolic excursion (TAPSE), mean pulmonary artery pressure (mPAP), and left ventricular remodeling patterns. Statistical significance was set at P < 0.05. Results: The LViDd, HR, SVR, CO, and CI differed significantly among the groups. Football and athletics athletes had larger LViDd (4.50–4.65 cm) and lower HRs (57.4–63.9 bpm), compared with athletes of other sports. Martial arts and aquatic sports athletes showed higher CO and CI, compared with athletes of other sports. Gymnasts showed the highest SVR. The EF, TAPSE, and mPAP were preserved across groups. Concentric remodelling dominated (55%), with eccentric hypertrophy being exclusive to athletics (45.8%) and concentric hypertrophy being common in football athletes (52.2%). Conclusions: Cardiac adaptations vary according to sport and may mimic pathological changes. Recognizing these patterns can guide the interpretation of TTE findings and improve the risk stratification of athletes. Further research is required to support these tailored screening approaches.