ECHO 2013 / Echo and the Athlete’s heart
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Exercise echo to exclude cardiomyopathy
La Gerche, A. et al. J Am Coll Cardiol Img 2009;2:350-363
18 yo athlete with vasovagal syncope LVEF 50%
peak lateral e’= 21 cm/s
peak medial e’= 10cm/s peak S velocity=10cm/s
Doppler indices of myocardial function
•Increased Sm and Em in athletes compared to hypertensive and HCM patients.
•Vinereanu, AJC 2001;88:53-8;
D’Andrea, JASE 2003;16:154-161; Cardim, JASE 2003;16:223-32; Saghir, JASE 2007;20:151-7
Utility of CMR
28 yo athlete with borderline dilated LV and LVEF
50% by echo
courtesy S. Wolff
RV enlargement
•Physiologic balanced and parallel RV and LV enlargement with training
•Especially in endurance athletes (soccer, track).
•Confirmed in multiple CMR studies
•Distinguish from ARVD
Scharag et al, JACC 2002; 40:1856 Scharf et al. AHJ 2010; 159:911-918 Hauser et al. AHJ 1985; 109: 1038
Left atrial enlargement
•Up to 24% elite athletes have LA >40mm in PSL view 
•Increased afib incidence has also been reported in athletes, but not strongly related to LAE (many)
Pelliccia, et al. Circulation(2010), 122:698-706.
Aortic root dilatation in 2317 highly trained athletes
Aortic root >40mm (males)
>34mm(females) uncommon
and mandates close surveillance