Sporcularda Ekokardiyografik Değerlendirme
Özet
Sporcu çocuk kalbi, aktif fiziksel egzersiz yapan çocukların kalbinde görülen adaptif değişikliklerdir. Bulgular, yapılan sporun türüne, yaş, cinsiyet ve toplumlara göre farklılık gösterir. Bu fizyolojik değişikliklerin patolojik kalp hastalıklarının erken evresinden ayrımının yapılması, genç sporculardaki ani kardiyak ölüm riskini azaltmak açısından önemlidir. Bu yazıda sporcu çocuk kalbindeki fizyolojik değişiklikler ve bunların ekokardiyografik görüntüleme ile patolojik durumlardan ayrımı anlatılacaktır.
Referanslar
Pieles GE, Oberhoffer R. The Assessment of the Paediatric Athlete. J Cardiovasc Transl Res. 2020 Jun;13(3):306-312. doi: 10.1007/s12265-020-10005-8.
Maron BJ, Shirani J, Poliac LC, et al. Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles. JAMA. 1996 Jul 17;276(3):199-204.
Maron BJ, Haas TS, Murphy CJ, et al. Incidence and causes of sudden death in U.S. college athletes. J Am Coll Cardiol. 2014 Apr 29;63(16):1636-43. doi: 10.1016/j.jacc.2014.01.041.
Harmon KG, Zigman M, Drezner JA. The effectiveness of screening history, physical exam, and ECG to detect potentially lethal cardiac disorders in athletes: a systematic review/meta-analysis. J Electrocardiol. 2015 May-Jun;48(3):329-38. doi: 10.1016/j.jelectrocard.2015.02.001.
Pelliccia A, Caselli S, Sharma S, et al. Internal reviewers for EAPC and EACVI. European Association of Preventive Cardiology (EAPC) and European Association of Cardiovascular Imaging (EACVI) joint position statement: recommendations for the indication and interpretation of cardiovascular imaging in the evaluation of the athlete's heart. Eur Heart J. 2018 Jun 1;39(21):1949-1969. doi: 10.1093/eurheartj/ehx532.
Maron BJ, Olivotto I. Chapter 66: Hypertrophic cardiomyopathy. In: Mann DK, Zipes DR, Libby P, Bonow RO, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier; 2014:1574–1588
Gersh BJ, Maron BJ, Bonow RO, et al. American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; American Association for Thoracic Surgery; American Society of Echocardiography; American Society of Nuclear Cardiology; Heart Failure Society of America; Heart Rhythm Society; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011 Dec 13;124(24):2761-96. doi: 10.1161/CIR.0b013e318223e230.
Grazioli G, Merino B, Montserrat S, et al. Usefulness of echocardiography in preparticipation screening of competitive athletes. Rev Esp Cardiol (Engl Ed). 2014 Sep;67(9):701-5. doi: 10.1016/j.rec.2013.11.023.
Evangelista A, Flachskampf F, Lancellotti P, et al. European Association of Echocardiography. European Association of Echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies. Eur J Echocardiogr. 2008 Jul;9(4):438-48. doi: 10.1093/ejechocard/jen174.
Albaeni A, Davis JW, Ahmad M. Echocardiographic evaluation of the Athlete's heart. Echocardiography. 2021 Jun;38(6):1002-1016. doi: 10.1111/echo.15066.
Levine BD, Baggish AL, Kovacs RJ, Link MS, Maron MS, Mitchell JH; American Heart Association Electrocardiography and Arrhythmias Committee of Council on Clinical Cardiology, Council on Cardiovascular Disease in Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and American College of Cardiology. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 1: Classification of Sports: Dynamic, Static, and Impact: A Scientific Statement From the American Heart Association and American College of Cardiology. Circulation. 2015 Dec 1;132(22):e262-6. doi: 10.1161/CIR.0000000000000237.
Cavarretta E, Maffessanti F, Sperandii F, et al. Reference values of left heart echocardiographic dimensions and mass in male peri-pubertal athletes. Eur J Prev Cardiol. 2018 Jul;25(11):1204-1215. doi: 10.1177/2047487318776084.
Popple E, George K, Somauroo J, et al. Right ventricular structure and function in senior and academy elite footballers. Scand J Med Sci Sports. 2018 Dec;28(12):2617-2624. doi: 10.1111/sms.13272.
Cantinotti M, Koestenberger M, Santoro G, et al. Normal basic 2D echocardiographic values to screen and follow up the athlete's heart from juniors to adults: What is known and what is missing. A critical review. Eur J Prev Cardiol. 2020 Aug;27(12):1294-1306. doi: 10.1177/2047487319862060.
Lai WW, Geva T, Shirali GS, et al. Task Force of the Pediatric Council of the American Society of Echocardiography; Pediatric Council of the American Society of Echocardiography. Guidelines and standards for performance of a pediatric echocardiogram: a report from the Task Force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiogr. 2006 Dec;19(12):1413-30. doi: 10.1016/j.echo.2006.09.001.
Lopez L, Colan S, Stylianou M, et al. Pediatric Heart Network Investigators. Relationship of Echocardiographic Z Scores Adjusted for Body Surface Area to Age, Sex, Race, and Ethnicity: The Pediatric Heart Network Normal Echocardiogram Database. Circ Cardiovasc Imaging. 2017 Nov;10(11):e006979. doi: 10.1161/CIRCIMAGING.117.006979.
Sharma S, Maron BJ, Whyte G, et al. Physiologic limits of left ventricular hypertrophy in elite junior athletes: relevance to differential diagnosis of athlete's heart and hypertrophic cardiomyopathy. J Am Coll Cardiol. 2002 Oct 16;40(8):1431-6. doi: 10.1016/s0735-1097(02)02270-2.
Weiner RB, Wang F, Isaacs SK, et al. Blood pressure and left ventricular hypertrophy during American-style football participation. Circulation. 2013 Jul 30;128(5):524-31. doi: 10.1161/CIRCULATIONAHA.113.003522.
Finocchiaro G, Dhutia H, D'Silva A, et al. Effect of Sex and Sporting Discipline on LV Adaptation to Exercise. JACC Cardiovasc Imaging. 2017 Sep;10(9):965-972. doi: 10.1016/j.jcmg.2016.08.011.
Utomi V, Oxborough D, Whyte GP, et al. Systematic review and meta-analysis of training mode, imaging modality and body size influences on the morphology and function of the male athlete's heart. Heart. 2013 Dec;99(23):1727-33. doi: 10.1136/heartjnl-2012-303465.
McClean G, Riding NR, Ardern CL, et al. Electrical and structural adaptations of the paediatric athlete's heart: a systematic review with meta-analysis. Br J Sports Med. 2018 Feb;52(4):230. doi: 10.1136/bjsports-2016-097052.
Boraita A, Sánchez-Testal MV, Diaz-Gonzalez L, et al. Apparent Ventricular Dysfunction in Elite Young Athletes: Another Form of Cardiac Adaptation of the Athlete's Heart. J Am Soc Echocardiogr. 2019 Aug;32(8):987-996. doi: 10.1016/j.echo.2019.03.017.
Di Paolo FM, Schmied C, Zerguini YA, et al. The athlete's heart in adolescent Africans: an electrocardiographic and echocardiographic study. J Am Coll Cardiol. 2012 Mar 13;59(11):1029-36. doi: 10.1016/j.jacc.2011.12.008.
Caselli S, Di Paolo FM, Pisicchio C, Pandian NG, Pelliccia A. Patterns of left ventricular diastolic function in Olympic athletes. J Am Soc Echocardiogr. 2015 Feb;28(2):236-44. doi: 10.1016/j.echo.2014.09.013.
D'Andrea A, Riegler L, Golia E, et al. Range of right heart measurements in top-level athletes: the training impact. Int J Cardiol. 2013 Mar 20;164(1):48-57. doi: 10.1016/j.ijcard.2011.06.058.
Zaidi A, Ghani S, Sharma R, et al. Physiological right ventricular adaptation in elite athletes of African and Afro-Caribbean origin. Circulation. 2013 Apr 30;127(17):1783-92. doi: 10.1161/CIRCULATIONAHA.112.000270.
Christou GA, O'Driscoll JM. The impact of demographic, anthropometric and athletic characteristics on left atrial size in athletes. Clin Cardiol. 2020 Aug;43(8):834-842. doi: 10.1002/clc.23368.
Riding NR, Salah O, Sharma S, et al. ECG and morphologic adaptations in Arabic athletes: are the European Society of Cardiology's recommendations for the interpretation of the 12-lead ECG appropriate for this ethnicity? Br J Sports Med. 2014;48(15):1138-1143.
Gabrielli L, Enríquez A, Córdova S, et al. Assessment of left atrial function in hypertrophic cardiomyopathy and athlete's heart: a left atrial myocardial deformation study. Echocardiography. 2012 Sep;29(8):943-9. doi: 10.1111/j.1540-8175.2012.01719.x.
Boraita A, Heras ME, Morales F, et al. Reference Values of Aortic Root in Male and Female White Elite Athletes According to Sport. Circ Cardiovasc Imaging. 2016 Oct;9(10):e005292. doi: 10.1161/CIRCIMAGING.116.005292.
Pelliccia A, Di Paolo FM, Quattrini FM. Aortic root dilatation in athletic population. Prog Cardiovasc Dis. 2012 Mar-Apr;54(5):432-7. doi: 10.1016/j.pcad.2012.01.004.
Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015 Jan;28(1):1-39.e14. doi: 10.1016/j.echo.2014.10.003.
Maron BJ, Olivotto I, Spirito P, et al. Epidemiology of hypertrophic cardiomyopathy-related death: revisited in a large non-referral-based patient population. Circulation. 2000 Aug 22;102(8):858-64. doi: 10.1161/01.cir.102.8.858.
Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006. Circulation. 2009 Mar 3;119(8):1085-92. doi: 10.1161/CIRCULATIONAHA.108.804617.
Lipshultz SE, Law YM, Asante-Korang A, et al. Cardiomyopathy in Children: Classification and Diagnosis: A Scientific Statement From the American Heart Association. Circulation. 2019 Jul 2;140(1):e9-e68. doi: 10.1161/CIR.0000000000000682.
Maron BJ, Pelliccia A. The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death. Circulation. 2006 Oct 10;114(15):1633-44. doi: 10.1161/CIRCULATIONAHA.106.613562.
Sheikh N, Papadakis M, Schnell F, et al. Clinical Profile of Athletes With Hypertrophic Cardiomyopathy. Circ Cardiovasc Imaging. 2015 Jul;8(7):e003454. doi: 10.1161/CIRCIMAGING.114.003454.
Abulí M, de la Garza MS, Sitges M. Differentiating Athlete's Heart from Left Ventricle Cardiomyopathies. J Cardiovasc Transl Res. 2020 Jun;13(3):265-273. doi: 10.1007/s12265-020-10021-8.
Pelliccia A, Culasso F, Di Paolo FM, Maron BJ. Physiologic left ventricular cavity dilatation in elite athletes. Ann Intern Med. 1999 Jan 5;130(1):23-31. doi: 10.7326/0003-4819-130-1-199901050-00005.
Abergel E, Chatellier G, Hagege AA, et al. Serial left ventricular adaptations in world-class professional cyclists: implications for disease screening and follow-up. J Am Coll Cardiol. 2004 Jul 7;44(1):144-9. doi: 10.1016/j.jacc.2004.02.057.
Millar LM, Fanton Z, Finocchiaro G, et al. Differentiation between athlete's heart and dilated cardiomyopathy in athletic individuals. Heart. 2020 Jul;106(14):1059-1065. doi: 10.1136/heartjnl-2019-316147.
Maron BJ, Udelson JE, Bonow RO, et al. American Heart Association Electrocardiography and Arrhythmias Committee of Council on Clinical Cardiology, Council on Cardiovascular Disease in Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and American College of Cardiology. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 3: Hypertrophic Cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy and Other Cardiomyopathies, and Myocarditis: A Scientific Statement From the American Heart Association and American College of Cardiology. Circulation. 2015 Dec 1;132(22):e273-80. doi: 10.1161/CIR.0000000000000239.
Gati S, Chandra N, Bennett RL, et al. Increased left ventricular trabeculation in highly trained athletes: do we need more stringent criteria for the diagnosis of left ventricular non-compaction in athletes? Heart. 2013 Mar;99(6):401-8. doi: 10.1136/heartjnl-2012-303418.
Coris EE, Moran BK, De Cuba R, Farrar T, Curtis AB. Left Ventricular Non-Compaction in Athletes: To Play or Not to Play. Sports Med. 2016 Sep;46(9):1249-59. doi: 10.1007/s40279-016-0512-2.
Bauce B, Frigo G, Benini G, et al. Differences and similarities between arrhythmogenic right ventricular cardiomyopathy and athlete's heart adaptations. Br J Sports Med. 2010 Feb;44(2):148-54. doi: 10.1136/bjsm.2007.042853.
Marcus FI, McKenna WJ, Sherrill D, et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the Task Force Criteria. Eur Heart J. 2010 Apr;31(7):806-14. doi: 10.1093/eurheartj/ehq025.
Lancellotti P, Pellikka PA, Budts W, et al. The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging. 2016 Nov;17(11):1191-1229. doi: 10.1093/ehjci/jew190.
D'Andrea A, Sperlongano S, Russo V, et al. The Role of Multimodality Imaging in Athlete's Heart Diagnosis: Current Status and Future Directions. J Clin Med. 2021 Oct 31;10(21):5126. doi: 10.3390/jcm10215126.
Afonso L, Kondur A, Simegn M, et al. Two-dimensional strain profiles in patients with physiological and pathological hypertrophy and preserved left ventricular systolic function: a comparative analyses. BMJ Open. 2012 Aug 17;2(4):e001390. doi: 10.1136/bmjopen-2012-001390.
Caselli S, Montesanti D, Autore C, et al. Patterns of left ventricular longitudinal strain and strain rate in Olympic athletes. J Am Soc Echocardiogr. 2015 Feb;28(2):245-53. doi: 10.1016/j.echo.2014.10.010.
Simsek Z, Hakan Tas M, Degirmenci H, et al. Speckle tracking echocardiographic analysis of left ventricular systolic and diastolic functions of young elite athletes with eccentric and concentric type of cardiac remodeling. Echocardiography. 2013 Nov;30(10):1202-8. doi: 10.1111/echo.12263.
Gabrielli L, Enríquez A, Córdova S, Yáñez F, Godoy I, Corbalán R. Assessment of left atrial function in hypertrophic cardiomyopathy and athlete's heart: a left atrial myocardial deformation study. Echocardiography. 2012 Sep;29(8):943-9. doi: 10.1111/j.1540-8175.2012.01719.x.
Roşca M, Popescu BA, Beladan CC, et al. Left atrial dysfunction as a correlate of heart failure symptoms in hypertrophic cardiomyopathy. J Am Soc Echocardiogr. 2010 Oct;23(10):1090-8. doi: 10.1016/j.echo.2010.07.016.
Esposito R, Galderisi M, Schiano-Lomoriello V, et al. Nonsymmetric myocardial contribution to supranormal right ventricular function in the athlete's heart: combined assessment by speckle tracking and real time three-dimensional echocardiography. Echocardiography. 2014 Sep;31(8):996-1004. doi: 10.1111/echo.12499.
Mele D, Smarrazzo V, Pedrizzetti G, et al. Intracardiac Flow Analysis: Techniques and Potential Clinical Applications. J Am Soc Echocardiogr. 2019 Mar;32(3):319-332. doi: 10.1016/j.echo.2018.10.018.
Referanslar
Pieles GE, Oberhoffer R. The Assessment of the Paediatric Athlete. J Cardiovasc Transl Res. 2020 Jun;13(3):306-312. doi: 10.1007/s12265-020-10005-8.
Maron BJ, Shirani J, Poliac LC, et al. Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles. JAMA. 1996 Jul 17;276(3):199-204.
Maron BJ, Haas TS, Murphy CJ, et al. Incidence and causes of sudden death in U.S. college athletes. J Am Coll Cardiol. 2014 Apr 29;63(16):1636-43. doi: 10.1016/j.jacc.2014.01.041.
Harmon KG, Zigman M, Drezner JA. The effectiveness of screening history, physical exam, and ECG to detect potentially lethal cardiac disorders in athletes: a systematic review/meta-analysis. J Electrocardiol. 2015 May-Jun;48(3):329-38. doi: 10.1016/j.jelectrocard.2015.02.001.
Pelliccia A, Caselli S, Sharma S, et al. Internal reviewers for EAPC and EACVI. European Association of Preventive Cardiology (EAPC) and European Association of Cardiovascular Imaging (EACVI) joint position statement: recommendations for the indication and interpretation of cardiovascular imaging in the evaluation of the athlete's heart. Eur Heart J. 2018 Jun 1;39(21):1949-1969. doi: 10.1093/eurheartj/ehx532.
Maron BJ, Olivotto I. Chapter 66: Hypertrophic cardiomyopathy. In: Mann DK, Zipes DR, Libby P, Bonow RO, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier; 2014:1574–1588
Gersh BJ, Maron BJ, Bonow RO, et al. American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; American Association for Thoracic Surgery; American Society of Echocardiography; American Society of Nuclear Cardiology; Heart Failure Society of America; Heart Rhythm Society; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011 Dec 13;124(24):2761-96. doi: 10.1161/CIR.0b013e318223e230.
Grazioli G, Merino B, Montserrat S, et al. Usefulness of echocardiography in preparticipation screening of competitive athletes. Rev Esp Cardiol (Engl Ed). 2014 Sep;67(9):701-5. doi: 10.1016/j.rec.2013.11.023.
Evangelista A, Flachskampf F, Lancellotti P, et al. European Association of Echocardiography. European Association of Echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies. Eur J Echocardiogr. 2008 Jul;9(4):438-48. doi: 10.1093/ejechocard/jen174.
Albaeni A, Davis JW, Ahmad M. Echocardiographic evaluation of the Athlete's heart. Echocardiography. 2021 Jun;38(6):1002-1016. doi: 10.1111/echo.15066.
Levine BD, Baggish AL, Kovacs RJ, Link MS, Maron MS, Mitchell JH; American Heart Association Electrocardiography and Arrhythmias Committee of Council on Clinical Cardiology, Council on Cardiovascular Disease in Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and American College of Cardiology. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 1: Classification of Sports: Dynamic, Static, and Impact: A Scientific Statement From the American Heart Association and American College of Cardiology. Circulation. 2015 Dec 1;132(22):e262-6. doi: 10.1161/CIR.0000000000000237.
Cavarretta E, Maffessanti F, Sperandii F, et al. Reference values of left heart echocardiographic dimensions and mass in male peri-pubertal athletes. Eur J Prev Cardiol. 2018 Jul;25(11):1204-1215. doi: 10.1177/2047487318776084.
Popple E, George K, Somauroo J, et al. Right ventricular structure and function in senior and academy elite footballers. Scand J Med Sci Sports. 2018 Dec;28(12):2617-2624. doi: 10.1111/sms.13272.
Cantinotti M, Koestenberger M, Santoro G, et al. Normal basic 2D echocardiographic values to screen and follow up the athlete's heart from juniors to adults: What is known and what is missing. A critical review. Eur J Prev Cardiol. 2020 Aug;27(12):1294-1306. doi: 10.1177/2047487319862060.
Lai WW, Geva T, Shirali GS, et al. Task Force of the Pediatric Council of the American Society of Echocardiography; Pediatric Council of the American Society of Echocardiography. Guidelines and standards for performance of a pediatric echocardiogram: a report from the Task Force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiogr. 2006 Dec;19(12):1413-30. doi: 10.1016/j.echo.2006.09.001.
Lopez L, Colan S, Stylianou M, et al. Pediatric Heart Network Investigators. Relationship of Echocardiographic Z Scores Adjusted for Body Surface Area to Age, Sex, Race, and Ethnicity: The Pediatric Heart Network Normal Echocardiogram Database. Circ Cardiovasc Imaging. 2017 Nov;10(11):e006979. doi: 10.1161/CIRCIMAGING.117.006979.
Sharma S, Maron BJ, Whyte G, et al. Physiologic limits of left ventricular hypertrophy in elite junior athletes: relevance to differential diagnosis of athlete's heart and hypertrophic cardiomyopathy. J Am Coll Cardiol. 2002 Oct 16;40(8):1431-6. doi: 10.1016/s0735-1097(02)02270-2.
Weiner RB, Wang F, Isaacs SK, et al. Blood pressure and left ventricular hypertrophy during American-style football participation. Circulation. 2013 Jul 30;128(5):524-31. doi: 10.1161/CIRCULATIONAHA.113.003522.
Finocchiaro G, Dhutia H, D'Silva A, et al. Effect of Sex and Sporting Discipline on LV Adaptation to Exercise. JACC Cardiovasc Imaging. 2017 Sep;10(9):965-972. doi: 10.1016/j.jcmg.2016.08.011.
Utomi V, Oxborough D, Whyte GP, et al. Systematic review and meta-analysis of training mode, imaging modality and body size influences on the morphology and function of the male athlete's heart. Heart. 2013 Dec;99(23):1727-33. doi: 10.1136/heartjnl-2012-303465.
McClean G, Riding NR, Ardern CL, et al. Electrical and structural adaptations of the paediatric athlete's heart: a systematic review with meta-analysis. Br J Sports Med. 2018 Feb;52(4):230. doi: 10.1136/bjsports-2016-097052.
Boraita A, Sánchez-Testal MV, Diaz-Gonzalez L, et al. Apparent Ventricular Dysfunction in Elite Young Athletes: Another Form of Cardiac Adaptation of the Athlete's Heart. J Am Soc Echocardiogr. 2019 Aug;32(8):987-996. doi: 10.1016/j.echo.2019.03.017.
Di Paolo FM, Schmied C, Zerguini YA, et al. The athlete's heart in adolescent Africans: an electrocardiographic and echocardiographic study. J Am Coll Cardiol. 2012 Mar 13;59(11):1029-36. doi: 10.1016/j.jacc.2011.12.008.
Caselli S, Di Paolo FM, Pisicchio C, Pandian NG, Pelliccia A. Patterns of left ventricular diastolic function in Olympic athletes. J Am Soc Echocardiogr. 2015 Feb;28(2):236-44. doi: 10.1016/j.echo.2014.09.013.
D'Andrea A, Riegler L, Golia E, et al. Range of right heart measurements in top-level athletes: the training impact. Int J Cardiol. 2013 Mar 20;164(1):48-57. doi: 10.1016/j.ijcard.2011.06.058.
Zaidi A, Ghani S, Sharma R, et al. Physiological right ventricular adaptation in elite athletes of African and Afro-Caribbean origin. Circulation. 2013 Apr 30;127(17):1783-92. doi: 10.1161/CIRCULATIONAHA.112.000270.
Christou GA, O'Driscoll JM. The impact of demographic, anthropometric and athletic characteristics on left atrial size in athletes. Clin Cardiol. 2020 Aug;43(8):834-842. doi: 10.1002/clc.23368.
Riding NR, Salah O, Sharma S, et al. ECG and morphologic adaptations in Arabic athletes: are the European Society of Cardiology's recommendations for the interpretation of the 12-lead ECG appropriate for this ethnicity? Br J Sports Med. 2014;48(15):1138-1143.
Gabrielli L, Enríquez A, Córdova S, et al. Assessment of left atrial function in hypertrophic cardiomyopathy and athlete's heart: a left atrial myocardial deformation study. Echocardiography. 2012 Sep;29(8):943-9. doi: 10.1111/j.1540-8175.2012.01719.x.
Boraita A, Heras ME, Morales F, et al. Reference Values of Aortic Root in Male and Female White Elite Athletes According to Sport. Circ Cardiovasc Imaging. 2016 Oct;9(10):e005292. doi: 10.1161/CIRCIMAGING.116.005292.
Pelliccia A, Di Paolo FM, Quattrini FM. Aortic root dilatation in athletic population. Prog Cardiovasc Dis. 2012 Mar-Apr;54(5):432-7. doi: 10.1016/j.pcad.2012.01.004.
Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015 Jan;28(1):1-39.e14. doi: 10.1016/j.echo.2014.10.003.
Maron BJ, Olivotto I, Spirito P, et al. Epidemiology of hypertrophic cardiomyopathy-related death: revisited in a large non-referral-based patient population. Circulation. 2000 Aug 22;102(8):858-64. doi: 10.1161/01.cir.102.8.858.
Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006. Circulation. 2009 Mar 3;119(8):1085-92. doi: 10.1161/CIRCULATIONAHA.108.804617.
Lipshultz SE, Law YM, Asante-Korang A, et al. Cardiomyopathy in Children: Classification and Diagnosis: A Scientific Statement From the American Heart Association. Circulation. 2019 Jul 2;140(1):e9-e68. doi: 10.1161/CIR.0000000000000682.
Maron BJ, Pelliccia A. The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death. Circulation. 2006 Oct 10;114(15):1633-44. doi: 10.1161/CIRCULATIONAHA.106.613562.
Sheikh N, Papadakis M, Schnell F, et al. Clinical Profile of Athletes With Hypertrophic Cardiomyopathy. Circ Cardiovasc Imaging. 2015 Jul;8(7):e003454. doi: 10.1161/CIRCIMAGING.114.003454.
Abulí M, de la Garza MS, Sitges M. Differentiating Athlete's Heart from Left Ventricle Cardiomyopathies. J Cardiovasc Transl Res. 2020 Jun;13(3):265-273. doi: 10.1007/s12265-020-10021-8.
Pelliccia A, Culasso F, Di Paolo FM, Maron BJ. Physiologic left ventricular cavity dilatation in elite athletes. Ann Intern Med. 1999 Jan 5;130(1):23-31. doi: 10.7326/0003-4819-130-1-199901050-00005.
Abergel E, Chatellier G, Hagege AA, et al. Serial left ventricular adaptations in world-class professional cyclists: implications for disease screening and follow-up. J Am Coll Cardiol. 2004 Jul 7;44(1):144-9. doi: 10.1016/j.jacc.2004.02.057.
Millar LM, Fanton Z, Finocchiaro G, et al. Differentiation between athlete's heart and dilated cardiomyopathy in athletic individuals. Heart. 2020 Jul;106(14):1059-1065. doi: 10.1136/heartjnl-2019-316147.
Maron BJ, Udelson JE, Bonow RO, et al. American Heart Association Electrocardiography and Arrhythmias Committee of Council on Clinical Cardiology, Council on Cardiovascular Disease in Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and American College of Cardiology. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 3: Hypertrophic Cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy and Other Cardiomyopathies, and Myocarditis: A Scientific Statement From the American Heart Association and American College of Cardiology. Circulation. 2015 Dec 1;132(22):e273-80. doi: 10.1161/CIR.0000000000000239.
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