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Athlete's Heart: The Potential for Multimodality Imaging to Address the Critical Remaining Questions

Andre La Gerche, MBBS, FRACP^_*, Andrew J. Taylor, MBBS, FRACP, PhD, David L. Prior, MBBS, FRACP, PhD^_*,_*

^_* St Vincent's Hospital and University of Melbourne, Melbourne, Australia
Alfred Hospital and Baker IDI Heart and Diabetes Institute, Melbourne, Australia

^_* Reprint requests and correspondence: Dr. David L. Prior, Cardiac Investigation Unit, St. Vincent's Hospital, P.O. Box 2900, Fitzroy, VIC 3065, Australia (Email: david.prior{at}svhm.org.au).

Moderate exercise is a powerful therapy in the treatment and prevention of cardiac disease, but intense habitual exercise leads to cardiac adaptations for which the prognostic benefits are less clear. The athlete's heart syndrome refers to the morphological and electrical remodeling which occurs to varying extents dependent upon the sporting discipline. Its accurate differentiation from pathological entities is critical. This review describes the role multi-modality imaging serves in determining the limitations and consequences of intense exercise. Tissue characterization and imaging studies during exercise are emphasized as important future directions of inquiry with the potential to address remaining controversies.

Key Words: athlete's heart • cardiac structure • cardiac function • myocardial injury

Abbreviations and Acronyms   CMR = cardiac magnetic resonance   HCM = hypertrophic cardiomyopathy   LA = left atrial   LV = left ventricle   LVEF = left ventricular ejection fraction   LVH = left ventricular hypertrophy   PET = position emission tomography   RV = right ventricle   SPECT = single-photon emission computed tomography   TDI = tissue Doppler imaging