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Remodelling of the left ventricle in athlete’s heart: a three dimensional echocardiographic and magnetic resonance imaging study
  1. S De Castro1,
  2. A Pelliccia2,
  3. S Caselli1,
  4. E D Angelantonio3,
  5. F Papetti1,
  6. E Cavarretta1,
  7. I Carbone4,
  8. M Francone4,
  9. R Passariello4,
  10. N G Pandian5,
  11. F Fedele1
  1. 1Department of Cardiovascular and Respiratory Sciences, La Sapienza University of Rome, Rome, Italy
  2. 2National Institute of Sports Medicine, Rome, Italy
  3. 3Department of Internal Medicine, La Sapienza University of Rome, Rome, Italy
  4. 4Department of Radiology, La Sapienza University of Rome, Rome, Italy
  5. 5New England Medical Center, Tufts University, Boston, Massachusetts, USA
  1. Correspondence to:
    Dr Stefano De Castro
    Department of Cardiovascular and Respiratory Sciences, “La Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; stefano.decastro{at}

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Intensive long term athletic training is associated with morphological cardiac changes, which have extensively been described as “athlete’s heart”. These changes are considered to be physiological adaptations to increased haemodynamic overload induced by chronic and intensive exercise.1,2

For many years, morphological assessment of athlete’s heart and its differentiation from pathological cardiac conditions have been based on two dimensional and M mode echocardiography. The formulas used with these methods are based on geometric assumptions and are possible causes of inaccuracy.

The objective of our study was, therefore, to validate and assess the pattern of left ventricular (LV) remodelling in a population of highly trained athletes by using three different techniques—conventional two dimensional echocardiography, three dimensional echocardiography, and magnetic resonance imaging (MRI)—and to explore the potential advantages and limitations of these techniques.


Thirty subjects were studied: 18 male top level athletes, who were members of the Italian Olympic rowing team (> 3 consecutive years’ long term exercise), and 12 untrained sedentary male subjects. All subjects signed an informed consent form.

Each patient underwent two dimensional echocardiography (Sonos 5500; Philips). LV mass was calculated by the Devereux formula, and LV volumes and ejection fraction (EF) were calculated by the modified Simpson’s rule. Three dimensional echocardiography was performed with a Philips Sonos 7500 equipped with the X-Matrix probe (2–4 MHz). Images were acquired by the “full volume” technique, which consists of a wide angle three dimensional pyramid built on four smaller …

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