Key result
Combined CPET and stress echocardiography may differentiate athlete's heart from arrhythmogenic cardiomyopathy.
Why the study?
Evidence on how to evaluate athletes suspected of having arrhythmogenic cardiomyopathy who do not fulfill diagnostic criteria is scarce, and differentiating physiological adaptation from cardiomyopathy remains challenging.
Combined CPET and stress echocardiography to assess the Qc/VO2 slope may help differentiate physiological athletic adaptation from subclinical arrhythmogenic cardiomyopathy.
Evaluation of athletes with suspected ACM remains uncertain; combined CPET echocardiography requires prospective validation before clinical adoption.
Differentiating physiological adaptation to exercise from cardiomyopathic hearts can be challenging. Specifically, evidence of how to deal with athletes under suspicion of arrhythmogenic cardiomyopathy (ACM) but not fulfilling diagnostic criteria is scarce and necessitates a better understanding of exercise pathophysiology and prospective trials. Upon available literature, we discuss and suggest research on combined stress echocardiography and cardiopulmonary exercise testing (CPET echocardiography) to demonstrate mismatch between cardiac output and metabolic demand. Integrating CPET echocardiography in suspected ACM cases may be feasible and could help to better differentiate physiological adaptation to exercise from cardiomyopathic hearts and may become a valuable adjunct for risk stratification and diagnostic frameworks. Future studies should implement combined CPET and stress echocardiography to differentiate physiological adaptations to exercise from cardiomyopathies in athletes with suspected ACM not fulfilling diagnostic criteria.
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Wernhart et al. (2026) conducted a review in Arrhythmogenic cardiomyopathy. Combined CPET and stress echocardiography was evaluated. Combined CPET and stress echocardiography may help differentiate physiological adaptation from cardiomyopathic hearts in athletes with suspected arrhythmogenic cardiomyopathy.
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