Echocardiography in Athletes: the Ever-Evolving Assessment of Physiology Versus Pathology

PURPOSE OF REVIEW: This review article summarizes the established physiologic adaptations seen on echocardiogram in athletes and provides a focus update and perspective on changing diagnostic criteria in several pathologies known to overlap with exercise induced cardiac remodeling. RECENT FINDINGS: There have been recent publications regarding improved diagnostic criteria for apical hypertrophic cardiomyopathy, shift towards "excessive trabeculations" rather than historically termed non-compaction, and expanding knowledge of arrhythmogenic cardiomyopathies. Exercise induced cardiac remodeling can be mistaken for these pathologies, among others. As the evaluation of cardiomyopathies changes with the growing understanding of the pathology, it is important that these updates are compared to the potential physiologic adaptation seen in athletic training. It is imperative for the practicing cardiologist to remain knowledgeable of these evolving guidelines.