The multi-modality cardiac imaging approach to the Athlete's heart: an expert consensus of the European Association of Cardiovascular Imaging

Eur Heart J Cardiovasc Imaging. 2015 Apr;16(4):353. doi: 10.1093/ehjci/jeu323.


The term 'athlete's heart' refers to a clinical picture characterized by a slow heart rate and enlargement of the heart. A multi-modality imaging approach to the athlete's heart aims to differentiate physiological changes due to intensive training in the athlete's heart from serious cardiac diseases with similar morphological features. Imaging assessment of the athlete's heart should begin with a thorough echocardiographic examination.Left ventricular (LV) wall thickness by echocardiography can contribute to the distinction between athlete's LV hypertrophy and hypertrophic cardiomyopathy (HCM). LV end-diastolic diameter becomes larger (>55 mm) than the normal limits only in end-stage HCM patients when the LV ejection fraction is <50%. Patients with HCM also show early impairment of LV diastolic function, whereas athletes have normal diastolic function.When echocardiography cannot provide a clear differential diagnosis, cardiac magnetic resonance (CMR) imaging should be performed.With CMR, accurate morphological and functional assessment can be made. Tissue characterization by late gadolinium enhancement may show a distinctive, non-ischaemic pattern in HCM and a variety of other myocardial conditions such as idiopathic dilated cardiomyopathy or myocarditis. The work-up of athletes with suspected coronary artery disease should start with an exercise ECG. In athletes with inconclusive exercise ECG results, exercise stress echocardiography should be considered. Nuclear cardiology techniques, coronary cardiac tomography (CCT) and/or CMR may be performed in selected cases. Owing to radiation exposure and the young age of most athletes, the use of CCT and nuclear cardiology techniques should be restricted to athletes with unclear stress echocardiography or CMR.

MeSH terms

  • Adult
  • Arrhythmogenic Right Ventricular Dysplasia / diagnosis
  • Cardiac Imaging Techniques / methods*
  • Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography
  • Cardiomegaly / diagnosis
  • Cardiomegaly, Exercise-Induced*
  • Cardiomyopathy, Dilated / diagnosis
  • Cardiomyopathy, Hypertrophic / diagnosis
  • Consensus
  • Contrast Media
  • Death, Sudden, Cardiac / prevention & control
  • Echocardiography, Stress* / methods
  • Electrocardiography*
  • European Union
  • Gadolinium
  • Humans
  • Hypertrophy, Left Ventricular / diagnosis*
  • Magnetic Resonance Imaging, Cine*
  • Predictive Value of Tests
  • Sensitivity and Specificity
  • Societies, Medical
  • Technetium Tc 99m Sestamibi
  • Tomography, Emission-Computed, Single-Photon*
  • Tomography, X-Ray Computed* / methods


  • Contrast Media
  • Technetium Tc 99m Sestamibi
  • Gadolinium