Assessment of Left Ventricular Hypertrophy in a Trained Athlete: Differential Diagnosis of Physiologic Athlete's Heart From Pathologic Hypertrophy
Section snippets
Historical perspectives
The concept that the cardiovascular system of trained athletes differs structurally and functionally from that of untrained, normal individuals is remarkably more than 100 years old.1 Henschen1 is credited with the first description in 1899, using only a basic physical examination with careful percussion to recognize enlargement of the heart due to athletic activity in cross-country skiers. Henschen1 concluded that both dilatation and hypertrophy were present in trained athletes, involving the
Type of sport
Morphologic cardiac changes in athletes have been attributed primarily to the type of sport and, specifically, to the hemodynamic overload induced by various conditioning programs3, 4, 5, 6, 7, 8, 9 (Fig 1). Specifically, endurance sports (ie, cycling, cross-country skiing, and rowing) are associated with a predominant volume overload, whereas power disciplines (ie, weight and power lifting, shot put, and discus) are associated with a predominant pressure overload. In our experience, elite
Left ventricular remodeling
Responses of individual athletes to systematic conditioning are not uniform. Training induces some evidence of cardiac remodeling in about one half of trained athletes, consisting of alterations in ventricular chamber dimensions, namely, increased LV and right ventricular and left atrial cavity size (and volume), associated with normal systolic and diastolic function (Fig 3A-C). However, there is a considerable overlap in cardiac dimensions between a trained athlete population and age- and
Athlete's heart and cardiovascular disease
Because of the potentially adverse consequences of underlying cardiovascular disease in young athletes, considerable attention has focused on the clinical distinction of physiologically based athlete's heart from a variety of structural heart diseases.20, 21 This differential diagnosis has critical implications for dedicated athletes (and their physicians) because cardiovascular disease, namely, cardiomyopathies, may represent the basis for disqualification from competitive sports as a strategy
Statement of Conflict of Interest
All authors declare that there are no conflicts of interest.
Disclosure
Dr Barry J. Maron is a consultant for Gene Dx.
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Statement of Conflict of Interest: see page 395.