Key result
Integrated athlete CV screening framework combines clinical exam, resting ECG, echocardiography, CPET, and CCTA.
Why the study?
Current cardiovascular pre-participation evaluation in elite athletes focuses on sudden cardiac death prevention but lacks integration with physiological performance assessment.
This conceptual framework proposes integrating traditional pre-participation cardiovascular screening with physiological performance evaluation to optimize both safety and training in elite athletes.
May guide comprehensive athlete screening; leaves open the need for prospective validation before practice change.
Cardiovascular pre-participation evaluation in elite athletes primarily aims to identify cardiovascular conditions associated with sudden cardiac death. Current international recommendations emphasize comprehensive medical history, physical examination, and resting 12-lead electrocardiography (ECG), with additional investigations guided by clini-cal findings and individual risk. However, advances in sports cardiology, cardiovascular imaging, and exercise physiology provide opportunities to integrate cardiovascular risk assessment with physiological performance evaluation. This article proposes a concep-tual, hypothesis-generating framework integrating structural, electrical, and functional cardiovascular assessment in elite athletes. The framework consists of 3 sequential components: comprehensive clinical assessment with resting ECG; transthoracic echo-cardiography for structural evaluation and longitudinal reference; and cardiopulmonary exercise testing (CPET) as an optional complementary investigation. Cardiopulmonary exercise testing may provide information on maximal oxygen uptake, ventilatory thresh-olds, oxygen pulse, ventilatory efficiency, heart rate recovery, and exercise-induced arrhythmias, potentially supporting individualized training prescription and longitudinal physiological monitoring. Cardiac magnetic resonance and coronary computed tomog-raphy angiography (CCTA) may be considered selectively when clinically indicated. A one-time CCTA strategy during an athlete's career is proposed as a research hypothesis requiring prospective assessment of clinical utility and cost-effectiveness. Importantly, CPET and CCTA are not proposed as universal screening requirements. This framework is intended to complement, rather than replace, current evidence-based international recommendations. As the proposed model is based on available literature and expert opinion and has not undergone prospective clinical validation, future multicenter stud-ies are required to determine whether integrated cardiovascular assessment improves risk stratification, athlete safety, clinical decision-making, performance monitoring, and cost-effectiveness.
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Akın Torun (2026) conducted a review in Cardiovascular conditions in elite athletes. Integrated cardiovascular assessment framework vs. Current international recommendations was evaluated. An integrated conceptual framework for cardiovascular assessment in elite athletes proposes combining clinical evaluation, resting ECG, and echocardiography with optional CPET and CCTA.
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