Artificial Intelligence in Sports Cardiology: Advancing Cardiovascular Screening and Diagnosis

Sudden cardiac death in athletes, though uncommon, remains a major concern in sports cardiology. Many responsible cardiovascular conditions, including cardiomyopathies, inherited channelopathies, valvular disease, and congenital coronary anomalies, may remain asymptomatic until intense physical exertion. Current pre-participation screening relies on clinical history, physical examination, electrocardiography, and selective cardiac imaging. While effective, these tools are limited by interobserver variability, dependence on specialist expertise, and difficulty distinguishing physiological athletic remodeling from pathological disease. These limitations have prompted growing interest in artificial intelligence (AI) as an adjunct to cardiovascular screening in athletes. This review summarizes current evidence on AI applications in sports cardiology, with a focus on electrocardiography, digital auscultation, transthoracic echocardiography, and selected imaging modalities. AI-enhanced electrocardiographic analysis has demonstrated improved sensitivity compared with traditional criteria for detecting left ventricular hypertrophy, long QT syndrome, including concealed forms, Brugada syndrome, electrolyte abnormalities, and aortic stenosis. Several deep learning models identify disease patterns even when conventional electrocardiographic parameters appear normal, addressing a key limitation of standard screening approaches. AI-assisted digital auscultation improves the detection of pathological murmurs and differentiation from benign flow murmurs, supporting earlier identification of valvular disease. In echocardiography, AI-guided image acquisition and automated analysis improve access, workflow efficiency, and measurement consistency, with diagnostic performance approaching expert interpretation. This review proposes a pragmatic AI-integrated screening framework that complements clinician judgment rather than replacing it. Although promising, limitations remain, including limited athlete-specific training data, false-positive risk related to physiological remodeling, and the need for external validation. When thoughtfully integrated into clinical workflows, AI may enhance early detection of occult cardiac disease and improve cardiovascular risk stratification in athletes.