Potential role of an athlete-focused echocardiogram in sports eligibility

Table 5 Main echo findings of cardiovascular pathologies in athletes

Pathology	What to assess? (echo view)	Cut-off mm (mean mm)	If pathological, what to assess? (echo view)	Cut-off mm (mean mm)
HCM	LV Max end-diastolic wall thickness	M white 15 (10); M Afro-American 16 (11.5); F white 11; F Afro-American 13 (9.5); M/F adolescent 16 (12)	LV wall thickness distribution	Asymmetric (HCM)
			LV end diastolic diameter (A4C)	M 70 (55); F 66 (49); Adolescent 60 (51)
			LV mass/BSA	M 117 mm/m2 (83 mm/m2); F 143 mm/m2 (101 mm/m2)
			LVOT obstruction
			E/A (A4C)	1.3 (1.93)
DCM	LV end diastolic diameter (PLAX)	M 70 (50); F 66 (49); Adolescent 60 (51)	EF (A4C)	55% (64%)
LVNC	LV trabeculation	NC/C layer ratio > 2.0 in systole	EF (A4C)	55% (64%)
			Thickness of compact layer in systole	8
			E/A (A4C)	1.3 (1.93)
ARVC	RVOT/BSA (PSAX)	> 21 mm/m2	RV inflow (A4C)/ LV end diastolic diameter (PLAX)	> 0.9
	RVOVT/BSA (PLAX)	> 19 mm/m2	RV wall motion abnormalities
			RV FAC	33%
Aortic dilatation	Aortic valve max dimension (PLAX)	M 40 (32); F 34 (28)	Other congenital defects (BAV)
	Ascending aorta dimension (PLAX)		Aortic regurgitation
Mitral prolapse	Mitral prolapse (PLAX)	Abnormal systolic bulging of leaflets > 2 mm toward LA	Mitral regurgitation
			PAPS (A4C)	40 mmHg (24 mmHg)
			Pulmonary veins flow	Reverse
			EF (A4C)	55% (64%)
			LV mass/BSA	M 117 mm/m2 (83 mm/m2); F 143 mm/m2 (101 mm/m2)
			LAVI	M 36 mm/m2 (28 mm/m2); F 33 mm/m2 (26.5 mm/m2)
AOCA	Coronary arteries origin (PSAX)
BAV	Aortic morphology (PSAX)		Aortic stenosis
			Aortic regurgitation
			Aortic root max dimension (PLAX)	M 40 (32); F 34 (28)
			Other congenital defects (coarctation of the aorta, interrupted aortic arch, patent ductus arteriosus, coronary anomaly or hypoplastic left heart, as well as Williams or Turner syndrome)
ASD	ASD		RV dimension (A4C)	Basal RV: M 55 (43.5), F 49 (39); Medial RV: M 47 (34), F 43 (32); Longitudinal RV: M 109 (89), F 100 (82)
			RA area/BSA (A4C)	M 28 mm/m2 (19.5 mm/m2); F 24 mm/m2 (15.5 mm/m2)
			PAPS (A4C)	40 mmHg (24 mmHg)
VSD	VSD		LV mass/BSA (PLAX)	M 117 mm/m2 (83 mm/m2); F 143 mm/m2 (101 mm/m2)
			PAPS (A4C)	40 mmHg (24 mmHg)
			Aortic regurgitation
			Other congenital defects (aneurysm of Valsalva sinus, ToF, TGA, DCRV)
PDA	PDA (PSAX)		LA/Aortic root ratio	≥ 1.4
			LV mass/BSA (PLAX)	M 117 mm/m2 (83 mm/m2); F 143 mm/m2 (101 mm/m2)
			PAPS (A4C)	40 mmHg (24 mmHg)
			Pulmonary artery size (PSAX)
			RV dimension (A4C)	Basal RV: M 55 (43.5), F 49 (39); Medial RV: M 47 (34), F 43 (32); Longitudinal RV: M 109 (89), F 100 (82)
			RA area/BSA (A4C)	M 28 mm/m2 (19.5 mm/m2); F 24 mm/m2 (15.5 mm/m2)
			Other congenital defects (COA, pulmonary atresia)
COA	COA (PSAX)		Aortic stenosis
			Mitral stenosis
			LV mass/BSA (PSAX)	M 117 mm/m2 (83 mm/m2); F 143 mm/m2 (101 mm/m2)
			EF (A4C)	55% (64%)
			Other congenital defects (BAV, ascending aortic aneurysm)
Myocarditis	EF (A4C)	55% (64%)
	LV wall motion abnormalities
	Pericardial effusion
	Increased LV wall thickness
Pericarditis	Pericardial effusion
Kawasaki disease	Coronary artery abnormalities
	EF (A4C)	55% (64%)
	LV wall motion abnormalities
	Mitral regurgitation
	Aortic regurgitation
	Pericardial effusion

PLAX: Parasternal long axis view; PSAX: Parasternal short axis view; A4C: Apical 4 chambers view; HCM: Hypertrophic cardiomyopathy; DCM: Dilated cardiomyopathy; LVNC: Left ventricle non compaction; ARVC: Arrhythmogenic right ventricular cardiomyopathy; BAV: Bicuspid aortic valve; AOCA: Anomalous origin of coronary arteries; ASD: Atrial septum defects; VSD: Ventricular septal defects; PDA: Patent ductus arteriosus; CoA: Aortic coarctation; M: Male; F: Female; LV: Left ventricle; BSA: Body surface area; EF: Ejection fraction; LVOT: Left ventricle outflow tract; NC/C: Non-compact/compact; RVOT: Right ventricle outflow tract; RV: Right ventricle; FAC: Fractional area charge; PAPS: Pulmonary artery systolic pressure; LAVI: Left atrium ventricle index; RA: Right atrium; ToF: Tetralogy of fallot; TgA: Transposition of great arteries; DCRV: Double-chambered right ventricle.