Cardiac Disease in Young Trained Athletes

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Abstract
In young competitive athletes,1 the differential diagnosis between nonpathological changes in cardiac morphology associated with training (commonly referred to as “athlete’s heart”)2 3 4 and certain cardiac diseases with the potential for sudden death is an important and not uncommon clinical problem. Such crucial diagnostic distinctions most frequently involve hypertrophic cardiomyopathy (HCM), which is the most common cause of sudden death in young competitive athletes.5 6 7 Our awareness of this issue, as well as the parallel consideration of preparticipation athletic screening,8 9 has been heightened by several recent high-visibility catastrophies involving elite basketball players who died suddenly and unexpectedly from cardiovascular disease.10 11 12 The distinction between athlete’s heart and cardiac disease has particularly important implications, because identification of cardiovascular disease in an athlete may be the basis for disqualification from competition in an effort to minimize risk.13 By the same token, the improper diagnosis of cardiac disease in an athlete may lead to unnecessary withdrawal from athletics, thereby depriving that individual of the varied benefits of sport. Consequently, interest in the application of noninvasive techniques that may aid in making such a diagnostic distinction and in planning subsequent clinical strategies has increased. Because this issue has not been examined in a comprehensive fashion, it is of value to assimilate the available data to develop a practical approach for the decision-making process directed toward the identification of cardiovascular disease in athletes. While the entity of athlete’s heart has been recognized for over 100 years,2 3 4 only in the past two decades has the application of echocardiography and other noninvasive imaging techniques permitted definition with some precision of the alterations in cardiac dimensions associated with athletic conditioning.14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 …