Key result
Strain echo and CMR differentiate physiological athlete's heart from underlying cardiomyopathies in the gray zone.
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.
This review provides comprehensive imaging algorithms using contemporary echocardiography and CMR to differentiate athlete's heart from cardiomyopathies in the gray zone.
Answers are grounded in this paper and cite their sources.
May aid gray-zone differentiation in athletes; leaves open prospective validation of imaging algorithms before screening adoption.
Athlete's heart comprises various structural and functional adaptations, imposed by systematic training and intended to serve the increased needs of the body during exercise. In most cases, athletic cardiac remodeling presents mild characteristics that are easily distinguishable from pathologic entities. However, common inherited cardiomyopathies such as hypertrophic, dilated, or arrhythmogenic may also affect athletes or athletic individuals, while athlete's heart in a more pronounced form (frequently called "gray" zone) should be distinguished from early stages of the above-mentioned cardiomyopathies. Based on these assumptions, cardiovascular imaging remains the key process that should be applied to accurately differentiate between normal and abnormal phenotypes, facilitating thus pre-participation screening along with early detection and handling of underlying cardiomyopathies. Recent advances in both echocardiography and cardiovascular magnetic resonance offer new diagnostic potentials, making, however, "method" and "time" selection rather complicated. The aim of this review is to provide a short and comprehensive guide for differentiating athlete's heart in the gray zone from cardiomyopathies, encompassing all contemporary tools of imaging modalities into easily applicable and hierarchically appropriate algorithms.
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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.
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