Why the study?
The increasing number of individuals engaging in sports requires refined diagnostic strategies to distinguish physiological cardiac remodelling from pathology in athletes.
This European consensus statement establishes a harmonized, multimodality imaging framework for evaluating athletes to accurately differentiate physiological adaptation from potentially dangerous cardiac pathology without unnecessary sport restriction.
Refines athlete risk stratification with multimodality imaging; extends prior recommendations via the first dedicated consensus framework.
The number of individuals engaging in sports continues to rise, and identifying those with cardiac substrates associated with increased risk of exercise-related adverse events is crucial. Athlete evaluation requires a refined diagnostic strategy to distinguish physiological cardiac remodelling from pathology. This joint European Association of Preventive Cardiology/European Association of Cardiovascular Imaging consensus provides a multimodality approach for advanced cardiovascular imaging in sports cardiology. Cardiovascular magnetic resonance, cardiac computed tomography, and nuclear imaging each offer complementary insights into cardiac structure, function, coronary anatomy, tissue characterization, perfusion, and inflammation. When integrated with clinical data and first-line tests, they improve diagnostic precision and risk stratification in scenarios frequently encountered in athletes, including ventricular arrhythmias, cardiomyopathies, congenital coronary anomalies, inflammatory myocardial disease, and coronary artery disease. Standardized protocols tailored to age, training, and clinical indication are essential to ensure reliability and avoid misinterpreting physiological adaptation as disease. The consensus emphasizes responsible reporting, considering performance and legal implications of diagnoses, and recommends second-line imaging when justified. Functional imaging, for ischaemia or inflammation, is central in guiding return-to-play decisions. Persistent evidence gaps include limited normative datasets across athletic subgroups and uncertain significance of subtle tissue abnormalities. Overall, this consensus supports harmonized, safe, and judicious multimodality imaging to protect athletes while preventing unnecessary sport restriction.
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Maestrini et al. (2026) conducted a review in Cardiovascular evaluation in athletes. Advanced cardiovascular imaging (Cardiovascular magnetic resonance, cardiac CT, and nuclear imaging) was evaluated. Advanced cardiovascular imaging using CMR, cardiac CT, and nuclear imaging improves diagnostic precision and risk stratification for athletes, aiding in safe return-to-play decisions.
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