IMR Press / RCM / Volume 24 / Issue 5 / DOI: 10.31083/j.rcm2405151
Open Access Review
Athlete's Heart: A Cardiovascular Step-By-Step Multimodality Approach
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1 Public Health Department, University of Naples Federico II, 80131 Naples, Italy
2 Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
3 Mediterranea Cardiocentro, 80122 Naples, Italy
4 Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
5 Cardiology Department, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy
6 Department of Neuroscience, Imaging and Clinical Sciences, G.d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
7 Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy
8 Division of Cardiology, AORN A Cardarelli Hospital, 80131 Naples, Italy
9 Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
10 Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, 00187 Rome, Italy
11 Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
12 Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
13 Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA 02114, USA
14 Unit of Cardiology and Intensive Coronary Care, Umberto I Hospital, 84014 Salerno, Italy
*Correspondence: (Antonello D'Andrea)
Rev. Cardiovasc. Med. 2023, 24(5), 151;
Submitted: 6 February 2023 | Revised: 16 April 2023 | Accepted: 4 May 2023 | Published: 19 May 2023
(This article belongs to the Special Issue Cardiovascular Diseases in Athletes)
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

“Athlete’s heart” is a spectrum of morphological, functional, and regulatory changes that occur in people who practice regular and long-term intense physical activity. The morphological characteristics of the athlete’s heart may overlap with some structural and electrical cardiac diseases that may predispose to sudden cardiac death, including inherited and acquired cardiomyopathies, aortopathies and channelopathies. Overdiagnosis should be avoided, while an early identification of underlying cardiac life-threatening disorders is essential to reduce the potential for sudden cardiac death. A step-by-step multimodality approach, including a first-line evaluation with personal and family history, clinical evaluation, 12-lead resting electrocardiography (ECG), followed by second and third-line investigations, as appropriate, including exercise testing, resting and exercise echocardiography, 24-hour ECG Holter monitoring, cardiac magnetic resonance, computed tomography, nuclear scintigraphy, or genetic testing, can be determinant to differentiate between extreme physiology adaptations and cardiac pathology. In this context, cardiovascular imaging plays a key role in detecting structural abnormalities in athletes who fall into the grey zone between physiological adaptations and a covert or early phenotype of cardiovascular disease.

athlete's heart
cardiovascular imaging
pre-participation screening
sports activity
sports cardiology
sudden cardiac death
Fig. 1.
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