Athlete’s Heart: Diagnostic Challenges and Future Perspectives

Research output: Contribution to journalReview article


Distinguishing between adaptive and maladaptive cardiovascular response to exercise is crucial to prevent the unnecessary termination of an athlete’s career and to minimize the risk of sudden death. This is a challenging task essentially due to the substantial phenotypic overlap between electrical and structural changes seen in the physiological athletic heart remodeling and pathological changes seen in inherited or acquired cardiomyopathies. Stress testing is an ideal tool to discriminate normal from abnormal cardiovascular response by unmasking subtle pathologic responses otherwise undetectable at rest. Treadmill or bicycle electrocardiography, transthoracic echocardiography, and cardiopulmonary exercise testing are common clinical investigations used in sports cardiology, specifically among participants presenting with resting electrocardiographic abnormalities, frequent premature ventricular beats, or non-sustained ventricular arrhythmias. In this setting, as well as in cases of left ventricular hypertrophy or asymptomatic left ventricular dysfunction, stress imaging and myocardial tissue characterization by cardiovascular magnetic resonance show promise. In this review, we aimed to reappraise current diagnostic schemes, screening strategies and novel approaches that may be used to distinguish adaptive remodeling patterns to physical exercise from early phenotypes of inherited or acquired pathological conditions commanding prompt intervention.


  • Carlo De Innocentiis
  • Fabrizio Ricci
  • Mohammed Y. Khanji
  • Nay Aung
  • Claudio Tana
  • Elvira Verrengia
  • Steffen E. Petersen
  • Sabina Gallina
External organisations
  • University of Chieti-Pescara
  • Queen Mary University
  • St Bartholomew's Hospital
  • Parma University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Sport and Fitness Sciences
  • Cardiac and Cardiovascular Systems
Original languageEnglish
Pages (from-to)2463-2477
Number of pages15
JournalSports Medicine
Issue number11
Publication statusPublished - 2018
Publication categoryResearch