Echocardiography: profiling of the athlete's heart

Cardiovascular physiologic remodeling associated with athleticism may mimic many of the features of genetic and acquired heart disease. The most pervasive dilemma is distinguishing between normal and abnormal physiologic remodeling in an athlete's heart. Imaging examinations, such as magnetic resonance imaging and computed tomography, which focus predominantly on anatomy, and electrocardiography, which monitors electrical components, do not simultaneously evaluate cardiac anatomy and physiology. Despite nonlinear anatomic and electrical remodeling, the athlete's heart retains normal or supernormal myocyte function, whereas a diseased heart has various degrees of pathophysiology. Echocardiography is the only cost-effective, validated imaging modality that is widely available and capable of simultaneously quantifying variable anatomic and physiologic features. Doppler echocardiography substantially redefines the understanding of normal remodeling from preemergent and overt disease.