Abstract des Autors

Morphologic cardiac changes associated with athletic conditioning have been recognized for a long time, although uncertainty remains regarding the limits of physiological changes and criteria for differentiation of athlete's heart from hypertrophic or dilated cardiomyopathy. Among athletes, determinants of cardiac morphologic changes include body size, age and gender, as well as the type of sport training, with those engaged in endurance disciplines generally showing the greatest increase in left ventricular cavity dimension and wall thickness. In a small proportion of elite athletes (2%), primarily male rowers and canoeists, left ventricular wall thickening may exceed normal limits (>/=13, and up to 16 mm), often resembling hypertrophic cardiomyopathy and raising the issue of differential diagnosis between physiological and pathological hypertrophy. Diagnostic criteria in favour of physiological hypertrophy are the limited magnitude (</=16 mm) and symmetric districution of mild left ventricular wall thickening, as well as substantial reduction in wall thickness (>/=2 mm) after a few weeks of detraining. In addition, physiological left ventricular wall thickening is associated with an enlarged (>/=55 mm) left ventricular cavity and usually normal left atrium dimension (<40 mm). Abnormalities of left ventricular filling are consistently absent in athletes with physiological hypertrophy, but common in patients with hypertrophic cardiomyopathy. Finally, the future possibility of sreening athletes with the suspicion of hypertrophic cardiomyopathy to identify disease-causing gene mutations, will offer the potential of distinguishing these two entities, independent of their often confounding morphologic features. In a sizeable proportion of elite athletes (12%), absolute left ventricular cavity enlargement may be substantial (>/=60 mm), raising the differential diagnosis of athlete's heart and idiopathic dilated cardiomyopathy. Physiological left ventricular cavity enlargement is usually associated with a large body size and training in intensive aerobic disciplines, primariliy cross-country skiing, cycling and rowing. Morphologic criteria in favour of physiological cavity enlargement are normal or mildly thickened left ventricular wall, conserved relative wall thickness, and most importantly normal global left ventricular systolic function and the absence of wall motion abnormalities. Verf.-Referat