Revista de Medicina Desportiva (English) September 2018 - Page 25

it is essential to carry out a mul- tiparametric evaluation. The ath- letes who most often present these dubious patterns are male, black race and involved on high intensity static exercise sports. As regards the typical characteristics of heart of athlete identified in the echocardio- gram, it is highlighted the balanced and homogeneous reshaping of all cardiac cavities and the presence of a normal or supernormal diastolic function. In addition to the conventional modalities provided by the tran- sthoracic echocardiogram, new parameters have been developed that can improve the evaluation of the athlete and help differenti- ate between physiological and pathological reshaping, such as the analysis of myocardial deformation. On the other hand, in specific cases of individuals with HC, other echo- cardiography techniques may be useful, such as the stress echocar- diogram to detect the obstruction on the left ventricle exit chamber, the transesophageal echocardiogram for structural characterization, notably the mitral valve, as well as contrast echocardiogram to identify atypical patterns such as apical HC. Despite the importance of this examination in the evaluation of the athlete, the transthoracic echocardi- ogram routinely used on the com- petitive athlete does not present a favorable cost-effectiveness relation- ship. However, this exam is manda- tory and is first-line in evaluating athletes with pathological changes in the EKG or physical evaluation, allowing both the diagnosis and the exclusion of HC. However, there may be HC without phenotypic expression... what should be done? Repeat annually, every two years, the echocardiogram? As already mentioned, the changes of the HC appear as a cascade and the structural phenotype can be manifested only many years after the evidence of other changes, namely in the EKG. The notion of this fact is very relevant, not only to justify more regular surveillance of these individuals, but also because Figure 2 – Echocardiographic images of an athlete with HC (asymmetric septal hypertrophy) sudden death, though often dis- tinctly, may arise at any stage of the development of the disease. The presence of pathologi- cal changes in the EKG without evidence of the HC phenotype in imaging exams (echocardiogram and cardiac MRI) or other changes located in the grey zone does not exclude the disease. These athletes must perform a multiparametric evaluation, encompassing clini- cal variables, personal and family backgrounds, as well as data from other complementary diagnostic exams, such as the 24-hour Holter or stress test. If there are confirmed cases of HC on first-degree family, the genetic study can be carried out to establish the diagnosis. With regard to the transthoracic echocardiogram, although a fixed periodicity is not established, it is suggested that these patients it should be done be annually, always considering the specifics of each patient. patterns of HC, such as apical HC, often not identified by transthoracic echocardiogram, as well as isolated segmental patterns of hypertrophy and the extension to the right ven- tricle. In addition to the ability to evalu- ate cardiac structure and function, several MRI modalities may be useful for the evaluation of patients with cardiomyopathies, among which the late highlight and T1 mapping. Late enhancement is a very important parameter, corresponding to the presence of myocardial fibro- sis, determined after the injection of Gadolinium. Because gadolinium has an extracellular distribution, it Cardiac MRI is now fundamental. We heard about morphological, functional and late-enhancing MRI. What does all this mean? Cardiac RM is considered the exami- nation gold-standard for morphologi- cal and functional cardiac evalua- tion. In the suspicion or presence of confirmed HC, cardiac MRI, besides establishing the diagnosis, is use- ful to detect atypical presentations of the disease, identify additional pré-fenotípics parameters that are associated to a greater likelihood of the disease and provide information with a prognosis impact. Cardiac MRI is critical for the differential diagnosis between HC and other pathological forms of left ventricular hypertrophy. Its diagnostic capac- ity also allows to detect atypical Revista de Medicina Desportiva informa september 2018 · 23