IMR Press / RCM / Volume 23 / Issue 4 / DOI: 10.31083/j.rcm2304129
Open Access Systematic Review
Cardiac Structure and Function in Junior Athletes: A Systematic Review of Echocardiographic Studies
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1 Institute of Preventive Pediatrics, TUM Department of Sport and Health Sciences, Technical University of Munich, 80992 Munich, Germany
2 Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University of Munich, 80636 Munich, Germany
*Correspondence: (Heidi Weberruß)
Academic Editors: Vincenzo Russo, Saverio Muscoli and Giuseppe Mascia
Rev. Cardiovasc. Med. 2022, 23(4), 129;
Submitted: 10 January 2022 | Revised: 9 February 2022 | Accepted: 17 February 2022 | Published: 7 April 2022
(This article belongs to the Special Issue Sudden Cardiac Death in Special Population)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: In young athletes, the level of competitiveness in sports is increasing, as well as frequency and intensity of exercise training. Adaptations of the cardiac system to this increased workload imposed by exercise has not yet been studied sufficiently. In adults, studies point towards a shift from the functional athlete’s heart towards pathological cardiac remodelling, with ventricular arrythmia and impaired cardiac function, that is exercise-related. This systematic review investigates cardiac adaptations to exercise in junior athletes compared to inactive controls. Methods: Three electronic databases (PubMed/Medline, ScienceDirect and Web of Science) were searched for studies assessing 2-dimensional transthoracic echocardiography (2D TTE) and 2-dimensional speckle tracking echocardiography (2D STE) parameters in junior athletes, aged 7–19 years, compared to inactive controls. Data was screened and extracted by two reviewers; study quality and risk of bias was assessed by three reviewers. Results: Eight out of 1460 studies met all inclusion criteria, with all studies reporting results on 2D TTE and six studies reporting results on 2D STE parameters in 540 (51 girls) junior athletes and 270 (18 girls) controls. There is evidence for structural cardiac adaptations of the left ventricle and both atria in junior athletes. Results regarding left ventricular function are controversial with a tendency to improved function in dynamic exercising athletes. Left ventricular mass and relative wall thickness point towards higher values in static exercising athletes. Conclusions: Cardiac adaptations to exercise occur in children and adolescents. These adaptations are more pronounced in structural left ventricular parameters. Functional parameters are preserved or slightly improved in junior athletes but not impaired by exercise.

athlete's heart
junior athletes
2D transthoracic echocardiography
2D speckle tracking echocardiography
cardiac remodelling
Fig. 1.
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