Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Aug 26, 2021; 13(8): 271-297
Published online Aug 26, 2021. doi: 10.4330/wjc.v13.i8.271
Potential role of an athlete-focused echocardiogram in sports eligibility
Stefano Palermi, Alessandro Serio, Marco Vecchiato, Felice Sirico, Francesco Gambardella, Fabrizio Ricci, Franco Iodice, Juri Radmilovic, Vincenzo Russo, Antonello D'Andrea
Stefano Palermi, Alessandro Serio, Felice Sirico, Francesco Gambardella, Public Health Department, University of Naples Federico II, Naples 80131, Italy
Marco Vecchiato, Sport and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Padova 35128, Italy
Fabrizio Ricci, Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University of Chieti-Pescara, Chieti 66100, Italy
Fabrizio Ricci, Department of Clinical Sciences, Faculty of Medicine, Lund University, Clinical Research Center, Malmö 21428, Sweden
Fabrizio Ricci, Casa di Cura Villa Serena, Pescara 65013, Italy
Franco Iodice, Vincenzo Russo, Antonello D'Andrea, Unit of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Naples 80131, Italy
Juri Radmilovic, Antonello D'Andrea, Unit of Cardiology and Intensive Coronary Care, “Umberto I” Hospital, Nocera Inferiore 84014, Italy
Author contributions: Palermi S, Serio A, Vecchiato M, Sirico F and Gambardella F wrote the paper; Ricci F, Iodice F, Radmilovic J and D’Andrea A reviewed and approved the final manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Antonello D’Andrea, MD, PhD, Professor, Chief Doctor, Unit of Cardiology and Intensive Care, “Umberto I” Hospital, Viale San Francesco, Nocera Inferiore 84014, Italy. antonellodandrea@libero.it
Received: February 25, 2021
Peer-review started: February 25, 2021
First decision: April 26, 2021
Revised: April 27, 2021
Accepted: July 14, 2021
Article in press: July 14, 2021
Published online: August 26, 2021
Abstract

Sudden cardiac death (SCD) of an athlete is a rare but tragic event and sport activity might play a trigger role in athletes with underlying structural or electrical heart diseases. Preparticipation screenings (PPs) have been conceived for the potential to prevent SCD in young athletes by early identification of cardiac diseases. The European Society of Cardiology protocol for PPs includes history collection, physical examination and baseline electrocardiogram, while further examinations are reserved to individuals with abnormalities at first-line evaluation. Nevertheless, transthoracic echocardiography has been hypothesized to have a primary role in the PPs. This review aims to describe how to approach an athlete-focused echocardiogram, highlighting what is crucial to focus on for the different diseases (cardiomyopathies, valvulopathies, congenital heart disease, myocarditis and pericarditis) and when is needed to pay attention to overlap diagnostic zone (“grey zone”) with the athlete's heart. Once properly tested, focused echocardiography by sports medicine physicians may become standard practice in larger screening practices, potentially available during first-line evaluation.

Keywords: Echocardiogram, Athletes, Sport eligibility, Pre-participation screening, Sudden cardiac death, Sport cardiology

Core Tip: Echocardiography is a helping tool in detecting several cardiovascular (CV) conditions afflicting athletes. As physicians become more experienced with sonography, focused echocardiography by sports medicine physicians may become standard practice in larger screening practices. This technique could help to detect some hidden CV condition and to distinguish between physiological and pathological adaptation to physical activity, assisting in sport eligibility process. In this review we aimed at describing athlete-focused echocardiogram that could be an effective time and cost-saving first line evaluation in granting sport eligibility to athletes.