Multimodality imaging in athlete’s heart

When athlete’s heart occurs with its most marked expression, its features may overlap with those of some structural cardiac diseases, including cardiomyopathies, valvular diseases, aortopathies, myocarditis, and coronary artery anomalies. Identifying the underlying cardiac pathology is essential to reduce the potential for sudden cardiac death. A broad spectrum of imaging modalities can be used to discriminate between extreme physiology and structural cardiac disease during the athlete’s cardiovascular evaluation. For this purpose, a practical step-by-step approach is recommended, based on the use of first-line screening tools (personal and family history, physical examination, and resting ECG), and, if needed, second- and third-line diagnostic modalities (exercise testing and cardiopulmonary exercise testing, rest and exercise echocardiography, cardiac magnetic resonance, cardiac computed tomography, and nuclear imaging).