The athlete's heart: is big beautiful?

Area of Science:

• Cardiology
• Sports Medicine
• Physiology

Background:

• The concept of "athlete's heart" has evolved from early clinical observations to advanced imaging techniques.
• Historically, diagnostic criteria for pathological cardiac enlargement have been revised upwards, recognizing the prevalence of larger hearts in healthy athletes.

Purpose of the Study:

• To trace the historical development of the "athlete's heart" concept.
• To re-evaluate the association between cardiac enlargement and pathological conditions in athletes.
• To assess the validity of current diagnostic criteria and screening methods for cardiac abnormalities in sports participants.

Main Methods:

• Review of historical clinical and radiographic studies.
• Analysis of modern echocardiography and magnetic resonance imaging data.
• Examination of diagnostic criteria for hypertrophic cardiomyopathy and congenital myocardial dystrophy in athletes.

Main Results:

• The prevalence of enlarged hearts in healthy endurance and power sports competitors is higher than previously recognized, leading to revised diagnostic criteria.
• The belief that hypertrophic cardiomyopathy is the most common cause of sports-related death in young adults is based on weak evidence and limited case studies.
• Congenital myocardial dystrophy, while established, is extremely rare and not specific to athletes.

Conclusions:

• Cardiac enlargement in most athletes is a physiological adaptation, not a pathological sign, enhancing athletic performance and promoting longevity.
• Current echocardiographic screening methods for excluding athletes based on heart size appear ineffective and costly.
• Future genetic screening may offer better diagnostic tools, but current exclusion criteria should be reconsidered.