Non invasive morphological and functional evaluation of athletes in sports cardiology

After an introduction that discuss how an adequate modern study of cardiovascular fitness requires simultaneous evaluation of a lot of parameters which provide information both on morphological and functional parameters, the Authors discuss on the enlargement of heart cavities accompanied by upper function which characterizes the 'athlete's heart'. The Authors refer the results of an echocardiographic study on 'top level' athletes at rest and on exercise. They point out how in the evaluation of athletes's heart enlargement the thickness/diameter ratio, calculated by echocardiography, should be replaced by the mass/volume ratio, since thickness is not always a good measure of mass nor diameter of volume and the athlete's heart may change its volume without significant changes in the transverse diameter, as a result of changes in shape, with lengthening predominating over widening. After discuss the morphological data, the Authors discuss the functional, systolic and diastolic data which demonstrate (1) the absence of pathological changes in contractility, (2) that the heart produces a better yield in the athletes: lower myocardial oxygen consumption is accompanied by normal performance at rest and higher fitness during muscular exercise, (3) that the diastolic filling in the athletes takes place almost entirely in the first period of the diastole with little use of the presystolic period. Finally, the Authors discuss the behaviour of modification of cardiac volume, cardiac output, stroke volume and heart rate observed in the athlete during bicycle ergometer exercise compared with the behaviour of modification in a normal subject.