Advanced cardiac imaging in athlete’s heart: unravelling the grey zone between physiologic adaptation and pathology

Anna Palmisano, Fatemeh Darvizeh, Giulia Cundari, Giuseppe Rovere, Giovanni Ferrandino, Valeria Nicoletti, Francesco Cilia, Silvia De Vizio, Roberto Palumbo, Antonio Esposito, Marco Francone

Research output: Contribution to journalReview articlepeer-review


Over the last decades, interest toward athlete’s heart has progressively increased, leading to improve the knowledge on exercise-induced heart modifications. Sport may act as a trigger for life-threatening arrhythmias in patients with structural or electrical abnormalities, hence requiring to improve the diagnostic capability to differentiate physiological from pathological remodeling. Pathological alterations are often subtle at the initial stages; therefore, the challenge is to promptly identify athletes at risk of sudden cardiac death during the pre-participation screening protocols. Advanced imaging modalities such as coronary computed tomography angiography (CCTA) and cardiac magnetic resonance (CMR) can non-invasively depict coronary vessels and provide a deep morpho-functional and structural characterization of the myocardium, in order to rule out pathological life threatening alterations, which may overlap with athletes’ heart remodeling. The purpose of the present narrative review is to provide an overview of most frequent diagnostic challenges, defining the boundaries between athlete's heart remodeling and pathological structural alteration with a focus on the role and importance of CCTA and CMR.

Original languageEnglish
Pages (from-to)1518-1531
Number of pages14
JournalRadiologia Medica
Issue number12
Publication statusPublished - Dec 2021


  • Athlete’s heart
  • Cardiac computed tomography
  • Cardiac magnetic resonance
  • Cardiomyopathy
  • Sudden cardiac death

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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