{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T07:18:36Z","timestamp":1793085516783,"version":"4.5.0"},"reference-count":175,"publisher":"Oxford University Press (OUP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The term \u2018athlete's heart\u2019 refers to a clinical picture characterized by a slow heart rate and enlargement of the heart. A multi-modality imaging approach to the athlete's heart aims to differentiate physiological changes due to intensive training in the athlete's heart from serious cardiac diseases with similar morphological features. Imaging assessment of the athlete's heart should begin with a thorough echocardiographic examination. Left ventricular (LV) wall thickness by echocardiography can contribute to the distinction between athlete's LV hypertrophy and hypertrophic cardiomyopathy (HCM). LV end-diastolic diameter becomes larger (&amp;gt;55 mm) than the normal limits only in end-stage HCM patients when the LV ejection fraction is &amp;lt;50%. Patients with HCM also show early impairment of LV diastolic function, whereas athletes have normal diastolic function. When echocardiography cannot provide a clear differential diagnosis, cardiac magnetic resonance (CMR) imaging should be performed. With CMR, accurate morphological and functional assessment can be made. Tissue characterization by late gadolinium enhancement may show a distinctive, non-ischaemic pattern in HCM and a variety of other myocardial conditions such as idiopathic dilated cardiomyopathy or myocarditis. The work-up of athletes with suspected coronary artery disease should start with an exercise ECG. In athletes with inconclusive exercise ECG results, exercise stress echocardiography should be considered. Nuclear cardiology techniques, coronary cardiac tomography (CCT) and\/or CMR may be performed in selected cases. Owing to radiation exposure and the young age of most athletes, the use of CCT and nuclear cardiology techniques should be restricted to athletes with unclear stress echocardiography or CMR.<\/jats:p>","DOI":"10.1093\/ehjci\/jeu323","type":"journal-article","created":{"date-parts":[[2015,2,14]],"date-time":"2015-02-14T20:09:02Z","timestamp":1423944542000},"page":"353-353r","source":"Crossref","is-referenced-by-count":222,"title":["The multi-modality cardiac imaging approach to the Athlete's heart: an expert consensus of the European Association of Cardiovascular Imaging"],"prefix":"10.1093","volume":"16","author":[{"given":"Maurizio","family":"Galderisi","sequence":"first","affiliation":[{"name":"1 Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuno","family":"Cardim","sequence":"additional","affiliation":[{"name":"Cardiac Imaging Department, Hospital Da Luz, Lisbon 2 ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonello","family":"D'Andrea","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Second University of Naples, AORN dei Colli, Monaldi Hospital, Naples 3 , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Bruder","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth Hospital Essen, Essen 4 ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Cosyns","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Universtair Ziekenhuis Brussel, Centrum Voor Hart-en Vaatziekten and CHIREC, Brussels 5 ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Davin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Interventional and Cardiovascular Imaging, University of Liege Hospital, Liege 6 ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erwan","family":"Donal","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Pontchaillou \u2013 University Medical Center, Rennes 7 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thor","family":"Edvardsen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Center of Cardiologic Innovation, Oslo University Hospital & University of Oslo, Oslo 8 ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Freitas","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Fernando Fonseca, Amadora 9 ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilbert","family":"Habib","sequence":"additional","affiliation":[{"name":"Cardiology Department, APHM, La Timone Hospital and Aix-Marseille Universit\u00e8, Marseille 10 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Kitsiou","sequence":"additional","affiliation":[{"name":"Cardiology Department, Sismanoglio Hospital, Athens 11 ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Plein","sequence":"additional","affiliation":[{"name":"Multidisciplinary Cardiovascular Research Center & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds 12 ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen E.","family":"Petersen","sequence":"additional","affiliation":[{"name":"13 NIHR Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Queen Mary University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan A.","family":"Popescu","sequence":"additional","affiliation":[{"name":"University of Medicine and Pharmacy \u201cCarol Davila\u201d - Euroecolab, Institute of Cardiovascular Diseases \u201cProf. Dr. C. 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Iliescu\u201d, Bucharest, Romania 14"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Schroeder","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Alb-Fils-Kliniken Goeppingen, Germany 15"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christof","family":"Burgstahler","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine, Internal Medicine V, University of Tuebingen, Tuebingen, Germany 16"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrizio","family":"Lancellotti","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Liege Hospital, GICA Cardiovascular Sciences, Heart Valve Clinic, CHU Sart Tilman, Liege, Belgium 17"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Document Reviewers:","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Sicari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denisa","family":"Muraru","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Lombardi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raluca","family":"Dulgheru","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre La","family":"Gerche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2015,2,14]]},"reference":[{"key":"2026080919285666500_JEU323C1","doi-asserted-by":"crossref","first-page":"23","DOI":"10.7326\/0003-4819-130-1-199901050-00005","article-title":"Physiologic left ventricular cavity dilatation in elite athletes","volume":"130","author":"Pelliccia","year":"1999","journal-title":"Ann Intern Med"},{"key":"2026080919285666500_JEU323C2","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1056\/NEJM199101313240504","article-title":"The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes","volume":"32","author":"Pelliccia","year":"1991","journal-title":"N Engl J Med"},{"key":"2026080919285666500_JEU323C3","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/j.jacc.2004.02.057","article-title":"Serial left ventricular adaptations in world-class professional cyclists: implications for disease screening and follow-up","volume":"44","author":"Abergel","year":"2004","journal-title":"J Am Coll Cardiol"},{"key":"2026080919285666500_JEU323C4","first-page":"44","article-title":"Relationship between maximal oxygen uptake and left ventricular function in exercise","volume":"44","author":"Wolfe","year":"1978","journal-title":"J Appl Physiol Respir Environ Exerc Physiol"},{"key":"2026080919285666500_JEU323C5","doi-asserted-by":"crossref","first-page":"521","DOI":"10.7326\/0003-4819-82-4-521","article-title":"Comparative left ventricular dimensions in trained athletes","volume":"82","author":"Morganroth","year":"1975","journal-title":"Ann Intern Med"},{"key":"2026080919285666500_JEU323C6","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1016\/S0735-1097(02)02270-2","article-title":"Physiologic limits of left ventricular hypertrophy in elite junior athletes: relevance to differential diagnosis of athlete's heart and hypertrophic cardiomyopathy","volume":"40","author":"Sharma","year":"2002","journal-title":"J Am Coll Cardiol"},{"key":"2026080919285666500_JEU323C7","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1161\/01.CIR.101.3.336","article-title":"The athlete's heart. 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