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June 27, 2025Heart Failure ReviewsOpen Access

Strain echo and CMR differentiate physiological athlete's heart from underlying cardiomyopathies in the gray zone.

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Why the study?

Differentiating athlete's heart in the gray zone from early-stage cardiomyopathies is challenging, and recent advances in echocardiography and CMR make the selection of imaging method and timing complicated.

Design

Review

Key result

Advanced cardiovascular imaging techniques, including strain echocardiography and cardiac magnetic resonance, provide essential diagnostic parameters to differentiate physiological athlete's heart from underlying cardiomyopathies in the gray zone.

Authors

EPEfstathios D. PagoureliasSOStyliani OuzouniPSPanagiotis Salmatzidis

Discussion

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Overview

May aid gray-zone differentiation in athletes; leaves open prospective validation of imaging algorithms before screening adoption.

Structured PICO

P
Population
Athletes presenting with cardiac remodeling in the "gray zone" requiring differentiation from cardiomyopathies (HCM, DCM, ARVC)
I
Intervention
Cardiovascular imaging (advanced echocardiography and cardiovascular magnetic resonance)

This review provides comprehensive imaging algorithms using contemporary echocardiography and CMR to differentiate athlete's heart from cardiomyopathies in the gray zone.

Limitations

  • Lack of globally accepted normal values for right ventricular strain in athletes
  • Limited sensitivity of diagnostic criteria for hypertrabeculated phenotype

Cite This Study

Pagourelias et al. (2025) conducted a review in Athlete's heart and cardiomyopathies (HCM, DCM, ARVC). Cardiovascular imaging (Echocardiography and CMR) was evaluated. Advanced cardiovascular imaging techniques, including strain echocardiography and cardiac magnetic resonance, provide essential diagnostic parameters to differentiate physiological athlete's heart from underlying cardiomyopathies in the gray zone.

synapsesocial.com/papers/6a1ea77b00756c160baf1eb4https://doi.org/10.1007/s10741-025-10541-y
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