Echocardiography in sports cardiology: LV remodeling in athletes' heart — Questions to be answered

An enhanced risk of undesirable events has been described in individuals who take part in mainly high intensity physical activities. Underlying cardiac disorders are the most common cause of sudden death during sports activities. Left ventricular remodeling is associated with a long-term athletic training. Echocardiography is an easy, non-invasive and efficient way to the precise distinction between these exercise-induced changes, called “physiological” hypertrophy, that revert after detraining, and those of cardiac disorders or “pathological” hypertrophy. The identification of a cardiac disease in an athlete usually leads to his disqualification in an attempt to reduce the risk. On the other hand, a false diagnosis of a cardiac disease in an athlete may also lead to disqualification, thus depriving him of the various benefits from sports participation. Pronounced left ventricular dilatation and hypertrophy should always be suspected for underlying cardiac disease. Physiological left ventricular remodeling is associated with normal systolic and diastolic left ventricle function. Both global and regional left ventricle diastolic function should be evaluated. New echocardiographic techniques (tissue Doppler imaging, strain rate) have revealed “super — diastolic” left ventricle function in athletes, adding the new quality in differential diagnosis od athlete's heart syndrome.