Resumen:
Se sabe que los atletas competitivos experimentan adaptaciones fisiológicas para satisfacer las demandas del entrenamiento riguroso, lo que puede imitar condiciones patológicas, llevando a una superposición entre los cambios fisiológicos normales y las anormalidades cardíacas potencialmente mortales. La muerte súbita cardíaca (MSC) en atletas es un evento raro pero devastador, lo que subraya la necesidad de una detección temprana de anormalidades cardíacas para prevenir tales tragedias. Esta revisión destaca el papel fundamental de las técnicas avanzadas de imágenes cardíacas, específicamente la resonancia magnética cardíaca (RMC) y la angiografía por tomografía computarizada coronaria (CCTA), en la prevención de la MSC en atletas competitivos. La RMC y la CCTA ofrecen evaluaciones no invasivas y completas de la morfología y función cardíaca, proporcionando valiosos conocimientos sobre el corazón del atleta. Se presentarán diversas adaptaciones fisiológicas observadas en los corazones de los atletas, incluyendo la hipertrofia del ventrículo izquierdo y la dilatación del ventrículo derecho, que pueden confundirse con condiciones patológicas. El concepto de "zona gris" subraya la importancia de las imágenes avanzadas para distinguir entre cambios cardíacos normales y potencialmente anormales. Para condiciones patológicas específicas relacionadas con la MSC en atletas, la RMC ayuda en el diagnóstico preciso al diferenciar características del tejido y evaluar los patrones de realce tardío con gadolinio (LGE). Además, la RMC desempeña un papel crítico en la identificación de anomalías de las arterias coronarias, miocarditis y enfermedad arterial coronaria en atletas mayores de 35 años, permitiendo una intervención y tratamiento tempranos. También se discutirán los nuevos criterios de Padua, que incorporan la caracterización del tejido y nuevos criterios de ECG para diagnosticar más precisamente la cardiomiopatía arritmogénica. Los esfuerzos colaborativos entre especialistas en medicina deportiva, cardiólogos y radiólogos son esenciales para establecer protocolos estandarizados para el uso responsable de imágenes, mejorando en última instancia la seguridad y el bienestar de los atletas competitivos.

Abstract:
Competitive athletes are known to undergo physiological adaptations to meet the demands of rigorous training which can mimic pathological conditions, leading to an overlap between normal physiological changes and potentially life-threatening cardiac abnormalities. Sudden cardiac death (SCD) in athletes is a rare but devastating event, underscoring the need for early detection of cardiac abnormalities to prevent such tragedies. This review highlights the pivotal role of advanced cardiac imaging techniques, specifically cardiac magnetic resonance imaging (CMR) and coronary computed tomography angiography (CCTA), in the prevention of SCD in competitive athletes. CMR and CCTA offer non-invasive, comprehensive assessments of cardiac morphology and function, providing valuable insights into the athlete’s heart. Various physiological adaptations observed in athletes’ hearts will be presented, including left ventricular hypertrophy and right ventricular dilation, which can be mistaken for pathological conditions. The “grey zone” concept underscores the importance of advanced imaging in distinguishing between normal and potentially abnormal cardiac changes. For specific pathological conditions linked to SCD in athletes, CMR aids in accurate diagnosis by differentiating tissue characteristics and assessing late gadolinium enhancement (LGE) patterns. Additionally, CMR plays a critical role in identifying coronary artery anomalies, myocarditis, and coronary artery disease in athletes over 35 years old, enabling early intervention and treatment. The new Padua criteria will also be discussed, which incorporate tissue characterization and novel ECG criteria to diagnose arrhythmogenic cardiomyopathy more accurately. Collaborative efforts between sports medicine specialists, cardiologists, and radiologists are essential in establishing standardized protocols for responsible imaging use, ultimately enhancing the safety and well-being of competitive athletes.

Abstract:
Competitive athletes are known to undergo physiological adaptations to meet the demands of rigorous training which can mimic pathological conditions, leading to an overlap between normal physiological changes and potentially life-threatening cardiac abnormalities. Sudden cardiac death (SCD) in athletes is a rare but devastating event, underscoring the need for early detection of cardiac abnormalities to prevent such tragedies. This review highlights the pivotal role of advanced cardiac imaging techniques, specifically cardiac magnetic resonance imaging (CMR) and coronary computed tomography angiography (CCTA), in the prevention of SCD in competitive athletes. CMR and CCTA offer non-invasive, comprehensive assessments of cardiac morphology and function, providing valuable insights into the athlete’s heart. Various physiological adaptations observed in athletes’ hearts will be presented, including left ventricular hypertrophy and right ventricular dilation, which can be mistaken for pathological conditions. The “grey zone” concept underscores the importance of advanced imaging in distinguishing between normal and potentially abnormal cardiac changes. For specific pathological conditions linked to SCD in athletes, CMR aids in accurate diagnosis by differentiating tissue characteristics and assessing late gadolinium enhancement (LGE) patterns. Additionally, CMR plays a critical role in identifying coronary artery anomalies, myocarditis, and coronary artery disease in athletes over 35 years old, enabling early intervention and treatment. The new Padua criteria will also be discussed, which incorporate tissue characterization and novel ECG criteria to diagnose arrhythmogenic cardiomyopathy more accurately. Collaborative efforts between sports medicine specialists, cardiologists, and radiologists are essential in establishing standardized protocols for responsible imaging use, ultimately enhancing the safety and well-being of competitive athletes.