The Heart of an Athlete: Black, White, and Shades of Grey with No Gold Standard
The heart of the athlete has intrigued cardiologists since the original description of increased cardiac dimensions in elite Nordic skiers over a century ago1. Athletes exhibit structural and electrical cardiac abnormalities that mimic findings associated with cardiovascular disease2. Some early observers regarded the heart of a conditioned athlete as weakened due to strenuous training and thereby subject to progressive deterioration in function3. Structural findings include chamber enlargement and ventricular hypertrophy2,3. Electrical abnormalities include increased QRS voltage, abnormal Q waves, and T-wave inversions2,3. Currently the athlete's heart is regarded as a benign increase in cardiac mass with circulatory and morphologic alterations in response to athletic training2,3. Contemporary evidence supports the notion that this represents adaptive physiology not preclinical disease2,3. Despite considerable advances in diagnostic tests, significant challenges remain in differentiating the athlete's heart from some types of cardiac disease2-4. Electrocardiographic (ECG) and morphologic changes found in athletes can mimic findings of hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy (ARVC) and other cardiovascular diseases2-4. The absence of a definitive diagnostic test or gold standard for many cardiovascular commonly results in diagnostic uncertainty2-4.
- right ventricle echocardiography
- right ventricular dyssynchrony
- arrhythmogenic right ventricular cardiomyopathy
- Received March 25, 2013.
- Accepted March 27, 2013.