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
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Figure 1 Important Domains of Study in Athlete's Heart
Demonstrating the progressive importance of function, exercise studies and tissue characterization and detailing the potential for each imaging modality to progress current understanding. Angio = angiography; CMR = cardiac magnetic resonance; CT = computed tomography; Echo = echocardiography.
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Figure 2 Changes in Morphology and Function in Athlete's Heart
Ranges of values for athletes' hearts are obtained from published studies. Proposed cutoff values for athletes (bold) beyond which pathology may be considered. *IVSd and LVM ranges include black athletes; normal ranges not validated. EF = ejection fraction; IVSd = interventricular septal defect; LA = left atrial; LVEDV = left ventricular end-diastolic volume; LVIDm = left ventricular internal diameter at midventricle; LVM = left ventricular mass; RVEDV = right ventricular end-diastolic volume; RVEF = right ventricular ejection fraction; RVFAC = right ventricular function area change.
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Figure 3 Stress Echocardiography to Exclude a Cardiomyopathy
Exercise can be used to differentiate low systolic function from a myopathic process. Imaging during exercise is critical in athletes and can be achieved using a recumbent ergometer (top panel). End systolic frames at rest (A and B) and peak exercise (C and D) demonstrate excellent augmentation of low-normal resting function.
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Figure 4 A Young Athlete With Hypertrophic Cardiomyopathy
Example of the importance of CMR in diagnosing HCM in a young athlete who presented with aborted sudden cardiac death and in whom echocardiography was not diagnostic. Left ventricular wall thickness of 12 mm was within ranges accepted for his athletic training (A and B). Mitral inflow and early diastolic annular motion were normal (C and D). The concentric nature of the hypertrophy was atypical for an athlete (E = diastole, F = systole) resulting in intracavity obstruction (blue arrow). T1-weighted images after the administration of gadolinium contrast (G and H) demonstrate apical scarring (red arrows).
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Figure 5 An Athlete With Ventricular Tachycardia and an Abnormal Right Ventricle
Cardiovascular magnetic resonance study of an elite triathlete after sustained ventricular tachycardia. Cine images in diastole (A) and systole (B) demonstrate an enlarged right ventricle (RV) with reduced systolic function. Note also the septal shift in diastole suggesting significant volume loading. T1-weighted (late gadolinium enhancement) images (C and D) demonstrate increased signal (arrows) of uncertain significance given the spatial resolution constraints within the thin walled RV. A RV focus was identified on electrophysiology studies, which correlated with fibrosis on biopsy.
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