Sports-specific adaptations and differentiation of the athlete's heart

Although the sports-specific adaptations and differentiation of an athlete' s heart (AH) were first described 100 years ago, the condition is still an area of active debate. In clinical practice, there is often an obvious lack of basic knowledge concerning the prerequisites and well established exten t of the structural and functional characteristics of an AH. Some misunders tandings arise from the somewhat misleading term 'athlete's heart' because not every athlete, even if he or she is training and competing at a very hi gh level, develops an enlarged heart. Such a condition can only be expected after years of quantitative and qualitative demanding aerobic endurance tr aining. Although the correlation with competitive performance of endurance events i s rather low in trained athletes, the relationship between heart dimensions and ergometric performance represents an important criterion for different iation between physiological and pathological cardiac enlargement. The asse ssment of measures exceeding the usual clinical limits, especially concerni ng volume-dependent echocardiographic parameters, also requires considerati on of the strong influence of anthropometric data. The existence of a concentric left ventricular hypertrophy (LVH) in strengt h-rained athletes is still a topic of debate in the literature, but is reje cted by most recent well-conducted trials. In our review, only bodybuilders using anabolic steroids exhibited a distinctly higher hypertrophic index c ompared with all other groups of endurance or strength athletes. Current unsolved issues in clinical sports medicine concern the early detec tion of myocardial complications in athletes exercising during infectious d iseases, and the eligibility for competitive sport in cases of borderline L VH.