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Oxborough D, George K, Cooper R, Bhatia R, Ramcharan T, Zaidi A, Gati S, Prakash K, Rakhit D, Robinson S, Stuart G, Forster J, Ackrill M, Augustine D, Malhotra A, Papadakis M, Castelletti S, Pettemerides V, Ring L, Kenny A, Baggish A, Sharma S. Echocardiography in the cardiac assessment of young athletes: a 2025 guideline from the British Society of Echocardiography (endorsed by Cardiac Risk in the Young). Echo Res Pract 2025; 12:7. [PMID: 40083035 PMCID: PMC11907977 DOI: 10.1186/s44156-025-00069-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2024] [Accepted: 01/14/2025] [Indexed: 03/16/2025] Open
Abstract
Sudden cardiac death in a young physically active individual or athlete is a rare but tragic event. Pre-participation screening and follow-up investigations are utilised to reduce the risk and occurrence of these events. Echocardiography plays a key role in the cardiac diagnostic pathway and aims to identify underlying inherited or congenital structural cardiac conditions. In 2013 the British Society of Echocardiography and Cardiac Risk in the Young produced a joint guidance document to support echocardiographers in this setting. The document was subsequently updated in 2018, and it is now timely to provide a further update to the guideline drawing on the advances in our knowledge alongside the developments in ultrasound technology within this nuanced area of sports cardiology.
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Affiliation(s)
- David Oxborough
- Research Institute for Sport and Exercise Sciences and the Liverpool Centre for Cardiovascular Science at Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK.
| | - Keith George
- Research Institute for Sport and Exercise Sciences and the Liverpool Centre for Cardiovascular Science at Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
| | - Robert Cooper
- Research Institute for Sport and Exercise Sciences and the Liverpool Centre for Cardiovascular Science at Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Raghav Bhatia
- Hull University Teaching Hospitals NHS Trust, Kingston‑Upon‑Hull, UK
- Cardiovascular Clinical Academic Group and Cardiology Research Centre, St. George's, University of London, London, UK
| | - Tristan Ramcharan
- Heart Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Sabiha Gati
- Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Keerthi Prakash
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Dhrubo Rakhit
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Shaun Robinson
- Research Institute for Sport and Exercise Sciences and the Liverpool Centre for Cardiovascular Science at Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool, L3 3AF, UK
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Jan Forster
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Aneil Malhotra
- Institute of Sport, Manchester Metropolitan University, Manchester, UK
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group and Cardiology Research Centre, St. George's, University of London, London, UK
| | - Silvia Castelletti
- Cardiology Department, IRCCS Istituto Auxologico Italiano, 20149, Milan, Italy
| | | | - Liam Ring
- West Suffolk Hospital NHS Trust, Bury St Edmonds, UK
| | | | - Aaron Baggish
- Institut Des Sciences du Sport, Universite de Lausanne, Lausanne, Switzerland
| | - Sanjay Sharma
- Cardiovascular Clinical Academic Group and Cardiology Research Centre, St. George's, University of London, London, UK
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Palermi S, Sperlongano S, Mandoli GE, Pastore MC, Lisi M, Benfari G, Ilardi F, Malagoli A, Russo V, Ciampi Q, Cameli M, D’Andrea A. Exercise Stress Echocardiography in Athletes: Applications, Methodology, and Challenges. J Clin Med 2023; 12:7678. [PMID: 38137747 PMCID: PMC10743501 DOI: 10.3390/jcm12247678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/23/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
This comprehensive review explores the role of exercise stress echocardiography (ESE) in assessing cardiovascular health in athletes. Athletes often exhibit cardiovascular adaptations because of rigorous physical training, making the differentiation between physiological changes and potential pathological conditions challenging. ESE is a crucial diagnostic tool, offering detailed insights into an athlete's cardiac function, reserve, and possible arrhythmias. This review highlights the methodology of ESE, emphasizing its significance in detecting exercise-induced anomalies and its application in distinguishing between athlete's heart and other cardiovascular diseases. Recent advancements, such as LV global longitudinal strain (GLS) and myocardial work (MW), are introduced as innovative tools for the early detection of latent cardiac dysfunctions. However, the use of ESE also subsumes limitations and possible pitfalls, particularly in interpretation and potential false results, as explained in this article.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy;
| | - Simona Sperlongano
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (S.S.); (V.R.)
| | - Giulia Elena Mandoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (M.L.); (M.C.)
| | - Maria Concetta Pastore
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (M.L.); (M.C.)
| | - Matteo Lisi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (M.L.); (M.C.)
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy;
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy;
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, 41126 Modena, Italy;
| | - Vincenzo Russo
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (S.S.); (V.R.)
| | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, 82100 Benevento, Italy;
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (M.L.); (M.C.)
| | - Antonello D’Andrea
- Department of Cardiology, Umberto I Hospital, 84014 Nocera Inferiore, Italy
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Cardiac Magnetic Resonance Imaging (MRI) Findings in Arrhythmogenic Right Ventricular Dysplasia (ARVD) Compared with Echocardiography. Med Sci (Basel) 2018; 6:medsci6030080. [PMID: 30235879 PMCID: PMC6163444 DOI: 10.3390/medsci6030080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/31/2018] [Accepted: 09/10/2018] [Indexed: 11/17/2022] Open
Abstract
Arrhythmogenic right ventricular dysplasia (ARVD) is an abnormality in the right side of the heart that may lead to sudden death. The study aims to compare cardiac MRI (magnetic resonance imaging findings) with echocardiography in patients with ARVD. For the cross-sectional study, patients with ARVD that were diagnosed using Task Force criteria were included, and their cardiac MRI findings were evaluated. Additionally, the right ventricle was divided into three levels-basal, middle, and apical-and each of them was also subdivided into three secondary segments. Gadolinium enhancement was evaluated in each segment. Overall, 39 patients were studied. Thirty-one patients (81%) were men. The average age of female and male patients was 37.8 ± 4.6 and 32.48 ± 5.8, respectively. The average ejection fraction found was 43 ± 9.4 and 42.8 ± 8.5% by MRI and echocardiography, respectively. Additionally, 46 and 35.8% of the patients had hypokinesia in the right ventricle, found based on MRI and echocardiography, respectively. The right ventricular aneurysm was found in 20.5 and 5.1% of patients based on MRI and echocardiography, respectively. The cardiac MRI managed to diagnose some cases which echocardiography was not able to detect. Thus, MRI plays an important role in presenting diagnostic data for the management of patients with ARVD and also making the diagnosis in suspicious patients definitive.
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