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