Keywords
Athletes
Sudden death
Diagnosis
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Abstract
Objective: Identify the differences between physiological and pathological cardiac changes resulting from high-intensity physical exercise performed by athletes. Methods: A systematic review was conducted using observational analyses that investigate cardiac alterations in athletes, through searches in the Virtual Health Library (BVS), Scientific Electronic Library Online (SciELO), and National Library of Medicine (PubMed) databases. Results: 10 scientific articles were selected, involving healthy athletes, athletes with heart disease, healthy non-athletes, and non-athletes with heart disease, which studied the differentiation of the athlete's heart from structural heart diseases. When assessing methodological quality using the ROBINS-E scale, the selected articles showed low or moderate risk. Conclusions: This review identified that Hypertrophic Cardiomyopathy (HCM) is one of the main causes of sudden cardiac death among athletes, complicating the distinction between normal adaptations and cardiac pathologies. Cardiac magnetic resonance imaging (MRI) is essential to overcome these limitations and assess adaptations based on the type of exercise. Analysis of myocardial deformation and end-diastolic volume helps to differentiate pathological conditions from “athlete's heart”.
References
AL-KHATIB SM, et al. AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary. Circulation, 2018; 138(13): 8-39.
ARAÚJO MK, et al. Physical Training In Athletes: Analysis Of Cardiac Autonomic Modulation. Revista Brasileira de Medicina do Esporte, 2021; 27(1): 36-41.
BAZAN SGZ, et al. Cardiomiopatia Hipertrófica – Revisão. Arquivos Brasileiros de Cardiologia, 2020; 115(5): 927-935.
BJERRING AW, et al. The developing athlete’s heart: a cohort study in young athletes transitioning through adolescence. European Journal of Preventive Cardiology, 2019; 26(18).
COLOMBO CSSS e FRANCISCO RC. O Coração de Atleta na Mulher. Revista da Sociedade de Cardiologia do Estado de São Paulo, 2014; 24(1): 66-70.
CORRADO D, et al. 12-lead ECG in the athlete: physiological versus pathological abnormalities. British Journal of Sports Medicine, 2009; 43(9): 669-676.
CZIMBALMOS C, et al. Cardiac magnetic resonance based deformation imaging: role of feature tracking in athletes with suspected arrhythmogenic right ventricular cardiomyopathy. The International Journal of Cardiovascular Imaging, 2018; 35(3): 529-538.
DAMINELLO E, et al. Evaluation of Strain Parameters by Three Dimensional Speckle Tracking Echocardiography in Competitive Athletes. Arquivos Brasileiros de Cardiologia, 2017; 30(3): 92-97.
DANIELIAN A e SHAH A. Differentiating Physiology from Pathology: The Gray Zones of the Athlete's Heart. Clinics in Sports Medicine, 2022; 41(3): 425-440.
DORES H, et al. Myocardial deformation and volume of exercise: a new overlap between pathology and athlete’s heart? The international journal of cardiovascular imaging, 2018; 34(12): 1869-1875.
ERZ G, et al. Correlation between ECG abnormalities and cardiac parameters in highly trained asymptomatic male endurance athletes: evaluation using cardiac magnetic resonance imaging. The International Journal of Cardiovascular Imaging, 2012; 29(2): 325-334.
FRANÇA JLM, et al. Morte súbita cardíaca: o perfil da prevenção nos clubes de futebol do estado do Piauí. Revista Brasileira de Ciência e Movimento, 2015; 23(3): 151-160.
GATI S, et al. Exercise-induced left ventricular hypertrabeculation: physiological adaptation or cardiomyopathy? British Journal of Sports Medicine, 2019; 53(6): 354-355.
GRAZIOLI G, et al. Differentiating hypertrophic cardiomyopathy from athlete’s heart: An electrocardiographic and echocardiographic approach. Journal of electrocardiology, 2016; 49(4): 539-544.
GÜLAN U, et al. A comparative study on the analysis of hemodynamics in the athlete’s heart. Scientific reports, 2022; 12(1).
KLEINNIBBELINK G, et al. Exercise Training Induces Left- but not Right-sided Cardiac Remodelling in Olympic Rowers. International Journal of Sports Medicine, 2021; 43(2): 151-160.
KÜBLER J, et al. Cardiac MRI findings to differentiate athlete’s heart from hypertrophic (HCM), arrhythmogenic right ventricular (ARVC) and dilated (DCM) cardiomyopathy. The International Journal of Cardiovascular Imaging, 2021; 37(8): 2501-2515.
LEAL RCC. Adaptações Fisiológicas no Coração do Desportista: Até que ponto serão benéficas? 2022; 66.
MACEIRA AM, et al. Reference ventricular dimensions and function parameters by cardiovascular magnetic resonance in highly trained Caucasian athletes. Journal of Cardiovascular Magnetic Resonance, 2023; 25(12): 1-9.
MAŁEK LA, et al. Diagnostic Yield of Cardiac Magnetic Resonance in Athletes with and without Features of the Athlete’s Heart and Suspected Structural Heart Disease. International journal of environmental research and public health/International journal of environmental research and public health, 2022; 19(8): 4829.
MALTÊS S e LOPES LR. Novas perspectivas no tratamento farmacológico da miocardiopatia hipertrófica. Revista Portuguesa de Cardiologia, 2020; 39(2): 99-109.
MANÇO ACF, et al. Detecção de hipertrofia ventricular esquerda fisiológica em atletas judocas através do eco-doppler. Revista Brasileira de Prescrição e Fisiologia do Exercício, 2011; 2(9): 342-352.
MARTINEZ MW, et al. Exercise-Induced Cardiovascular Adaptations and Approach to Exercise and Cardiovascular Disease: JACC State-of-the-Art Review. Journal of the American College of Cardiology, 2021; 78(14): 1453-1470.
PALMISANO A, et al. Advanced cardiac imaging in athlete’s heart: unravelling the grey zone between physiologic adaptation and pathology. La radiologia medica, 2021; 126(12): 1518-1531.
PEDRO RL. Análise do Impacto do Treinamento Aeróbico de Resistência Versus Anaeróbico de Força na Fisiologia e Morfologia Cardíaca de Atletas de Alto Rendimento Através da Ecocardiografia com Speckle Tracking. Dissertação - Universidade Tecnológica Federal do Paraná, 2022; 40.
RICH BSE e HAVENS SA. The Athletic Heart Syndrome. Current Sports Medicine Reports, 2004; 3(2): 84-88.
SCHMID T, et al. Sports, Myocarditis and COVID-19: Diagnostics, Prevention and Return-to-Play Strategies. International Journal of Sports Medicine, 2022; 43(13): 1097-1105.
SCHNELL F, et al. Mechanical Dispersion by Strain Echocardiography: A Novel Tool to Diagnose Hypertrophic Cardiomyopathy in Athletes. Journal of the American Society of Echocardiography, 2017; 30(3): 251-261.
SHARMA S, et al, Exercise and the heart: the good, the bad, and the ugly. European Heart Journal, 2015; 36(23): 1445-1453.
WERENITZKY J, et al. Cambios estructurales y funcionales del ventrículo derecho en deportistas de alto rendimiento evaluados por ecocardiografía con strain por speckle tracking. Insuficiencia Cardiaca, 2016; 11(3): 109-114.
ZAFFALON D, et al. Role of the electrocardiogram in differentiating genetically determined dilated cardiomyopathy from athlete’s heart. European Journal of Clinical Investigation, 2022; 52(10).