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In most cases, athletic cardiac remodeling presents mild characteristics that are easily distinguishable from pathologic entities. However, common inherited cardiomyopathies such as hypertrophic, dilated, or arrhythmogenic may also affect athletes or athletic individuals, while athlete\u2019s heart in a more pronounced form (frequently called \u201cgray\u201d zone) should be distinguished from early stages of the above-mentioned cardiomyopathies. Based on these assumptions, cardiovascular imaging remains the key process that should be applied to accurately differentiate between normal and abnormal phenotypes, facilitating thus pre-participation screening along with early detection and handling of underlying cardiomyopathies. Recent advances in both echocardiography and cardiovascular magnetic resonance offer new diagnostic potentials, making, however, \u201cmethod\u201d and \u201ctime\u201d selection rather complicated. The aim of this review is to provide a short and comprehensive guide for differentiating athlete\u2019s heart in the gray zone from cardiomyopathies, encompassing all contemporary tools of imaging modalities into easily applicable and hierarchically appropriate algorithms.<\/jats:p>","DOI":"10.1007\/s10741-025-10541-y","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T04:25:30Z","timestamp":1750998330000},"page":"1215-1224","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A concise guide of contemporary cardiovascular imaging practices to differentiate athlete\u2019s heart in the gray zone"],"prefix":"10.1007","volume":"30","author":[{"given":"Efstathios D.","family":"Pagourelias","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Styliani","family":"Ouzouni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Panagiotis","family":"Salmatzidis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theocharis","family":"Sargiannidis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleni","family":"Tsiouli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitrios","family":"Ntelios","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evangelia","family":"Kouidi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vasileios P.","family":"Vassilikos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,6,27]]},"reference":[{"key":"10541_CR1","unstructured":"Carbone A, D\u2019Andrea (2023) Cardiac dysfunction and athlete\u2019s heart: new insights into pathophysiology and treatment, European Society of Cardiology. 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