What does this research mean for the field?

Nuclear medicine techniques, including SPECT and PET, offer unique and underutilized capabilities for accurately diagnosing and managing cardiac diseases in athletes by evaluating myocardial perfusion, metabolism, and innervation. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

October 3, 2024Journal of Cardiovascular Development and DiseaseOpen Access

The Role of Nuclear Medicine in the Diagnostic Work-Up of Athletes: An Essential Guide for the Sports Cardiologist

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Why the study?

Differentiating physiological features of the athlete's heart from pathological cardiac disease is challenging, and the role of underutilized nuclear medicine techniques for stress-based functional evaluation required review.

Structured PICO

Population

Athletes with suspected cardiac diseases, including coronary atherosclerosis, congenital coronary anomalies, ventricular arrhythmias, and non-ischemic myocardial scars

Intervention

Nuclear medicine techniques including single photon emission computed tomography (SPECT) and positron emission tomography (PET) using radiotracers such as [99mTc]MIBI, [99mTc]HDP, [18F]FDG, and [123I]MIBG

Nuclear medicine techniques such as SPECT and PET offer unique advantages in the diagnostic work-up of athletes with suspected cardiac diseases, particularly for stress-based functional evaluation.

Implication

May inform athlete cardiac diagnostics; leaves open prospective trials before clinical adoption.

Abstract

Athletes with heart disease are at increased risk of malignant ventricular arrhythmias and sudden cardiac death compared to their sedentary counterparts. When athletes have symptoms or abnormal findings at preparticipation screenings, a precise diagnosis by differentiating physiological features of the athlete's heart from pathological signs of cardiac disease is as important as it is challenging. While traditional imaging methods such as echocardiography, cardiac magnetic resonance, and computed tomography are commonly employed, nuclear medicine offers unique advantages, especially in scenarios requiring stress-based functional evaluation. This article reviews the use of nuclear medicine techniques in the diagnostic work-up of athletes with suspected cardiac diseases by highlighting their ability to investigate myocardial perfusion, metabolism, and innervation. The article discusses the application of single photon emission computed tomography (SPECT) and positron emission tomography (PET) using radiotracers such as [99mTc]MIBI, [99mTc]HDP, [18F]FDG, and [123I]MIBG. Several clinical scenarios are explored, including athletes with coronary atherosclerosis, congenital coronary anomalies, ventricular arrhythmias, and non-ischemic myocardial scars. Radiation concerns are addressed, highlighting that modern SPECT and PET equipment significantly reduces radiation doses, making these techniques safer for young athletes. We conclude that, despite being underutilized, nuclear medicine provides unique opportunities for accurate diagnosis and effective management of cardiac diseases in athletes.