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Exercise testing in athletes: an adjunct to diagnose arrhythmogenic cardiomyopathy?
Simon Wernhart1,2, Martin Halle1,2, Mark J Haykowsky3,4
1Department for Preventive Sports Medicine and Sports Cardiology, TUM School of Medicine and Health, TUM University Hospital, Technical University of Munich (TUM), Munich, Germany.
Frontiers in Cardiovascular Medicine
|August 4, 2026
Summary
Differentiating exercise adaptation from arrhythmogenic cardiomyopathy (ACM) in athletes is difficult. Combined CPET echocardiography may help distinguish physiological changes from disease, aiding diagnosis and risk stratification in suspected ACM cases.
Area of Science:
- Cardiology
- Sports Medicine
- Exercise Physiology
Background:
- Distinguishing physiological adaptation to exercise from cardiomyopathic hearts is challenging in athletes.
- Limited evidence exists for managing athletes suspected of arrhythmogenic cardiomyopathy (ACM) but not meeting diagnostic criteria.
- Understanding exercise pathophysiology is crucial for accurate diagnosis.
Purpose of the Study:
- To explore the utility of combined stress echocardiography and cardiopulmonary exercise testing (CPET echocardiography) in differentiating physiological adaptation from cardiomyopathies in athletes.
- To suggest research directions for evaluating CPET echocardiography in suspected ACM cases.
Main Methods:
- Literature review and discussion of existing evidence.
- Proposal for prospective trials integrating CPET echocardiography.
- Focus on demonstrating mismatch between cardiac output and metabolic demand.
Main Results:
- CPET echocardiography may reveal a mismatch between cardiac output and metabolic demand, aiding differentiation.
- The combined approach may be feasible for clinical integration in suspected ACM cases.
- Potential for improved risk stratification and diagnostic frameworks.
Conclusions:
- CPET echocardiography shows promise as an adjunct tool for differentiating physiological exercise adaptation from cardiomyopathies in athletes.
- Further prospective studies are needed to validate its role in suspected ACM cases not meeting current diagnostic criteria.
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