Search

PURPOSE OF REVIEW: The purpose of this review was to highlight the current recommendations, data, and limitations for methods of cardiovascular screening in athletes. RECENT FINDINGS: While the history and physical (H&P) alone remains the cornerstone for preparticipation cardiovascular screening (PPCS) in athletes, the advent of modern electrocardiographic (ECG) screening criteria has drastically increased sensitivity and decreased false positive rates for screening. Advanced imaging techniques remain an important component of secondary testing after an athlete has an abnormal initial screening exam, however, the use of imaging for universal screening has not been rigorously tested to date. Current disqualification guidelines have now begun to emphasize shared decision making between the provider and athlete in situations of clinical equipoise. SUMMARY: All major medical and sporting societies recommend PPCS using a focused medical history and physical examination for all competitive athletes, but there remains controversy about the role of ECG and advanced imaging in PPCS. Future research should focus on the creation of a randomized trial that is powered for mortality that can truly assess the utility of PPCS in athletes.

The number of female athletes participating in sports has increased exponentially over the past century. While cardiac adaptations to exercise have been well described, female athletes have been underrepresented in many prior studies. More recently, important research has embraced gender as an important biologic variable. We will review this work in order to examine how gender influences the impact of exercise on the heart. Exercise-induced cardiac remodeling (EICR) manifests slightly differently in male and female athletes. Specifically, female athletes have fewer signs of EICR on the electrocardiogram than male athletes, though are more likely to have anterior T wave inversions in the absence of cardiac disease. Cardiac enlargement due to exercise follows a different pattern in female versus male athletes, with females having similar chamber size when adjusted for body size but lower left ventricular mass. Recent research also suggests that female masters athletes may be less likely to have excess coronary disease, atrial fibrillation, and myocardial fibrosis, all of which have been posited though not proven to be sequelae of long-term endurance exercise in males. Gender appears to be an important modifier of the relationship between exercise and associated cardiac remodeling. The biological mechanisms underlying gender-based differences in EICR are poorly understood and will be an important area of future research.