[Echocardiography in athletes]

Echocardiography of athletes focuses on the left ventricle: in many cases, the interpretation is difficult, showing features of either dilated of hypertrophic cardiomyopathy. Accurate analysis requires careful recording of the left ventricle in the fundamental mode. Diagnostic errors by excess are common: overestimation of the chamber size (inadequate incidence), overestimation of wall thickness (failure to recognise right ventricular bands or false tendons). The body size of the individual must be considered when interpreting the chamber dimensions. The diastolic left ventricular dimension is often < 60 mm but it may attain 70 mm. In these cases, left ventricular function must be accurately determined and shown to be normal, which may prove difficult as the resting left ventricular ejection fraction is physiologically lower in trained athletes. The use of stress echo (exercise left ventricular ejection fraction) and Doppler tissue imaging (left ventricular filling) are often indispensable. Left ventricular wall thickness is rarely > 13 mm. a situation where the possibility of hypertrophic cardiomyopathy has to be assessed. Left atrial dilatation is inconstant and aortic root dilatation is very unusual. The right heart chambers are usually globally dilated and the inferior vena cava may seem abnormally dilated.