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ORIGINAL PAPER

Possible new options and benefits to detect myocarditis, right ventricular remodeling and coronary anomalies by echocardiography in systematic preparticipation screening of athletes Tom Döbel1   · Stephan Stöbe1 · Robert Percy Marshall2 · Pierre Hepp3 · Sven Fikenzer1 · Kati Fikenzer1 · Sandra Tautenhahn1 · Ulrich Laufs1 · Andreas Hagendorff1 Received: 19 March 2020 / Accepted: 21 May 2020 © The Author(s) 2020

Abstract Exclusion of cardiac abnormalities should be performed at the beginning of the athlete’s career. Myocarditis, right ventricular remodeling and coronary anomalies are well-known causes of life-threatening events of athletes, major cardiovascular events and sudden cardiac death. The feasibility of an extended comprehensive echocardiographic protocol for the detection of structural cardiac abnormalities in athletes should be tested. This standardized protocol of transthoracic echocardiography includes two- and three-dimensional imaging, tissue Doppler imaging, and coronary artery scanning. Post processing was performed for deformation analysis of all compounds including layer strain. During 2017 and 2018, the feasibility of successful image acquisition and post processing analysis was retrospectively analyzed in 54 male elite athletes. In addition, noticeable findings inside the analyzed cohort are described. The extended image acquisition and data analyzing was feasible from 74 to 100%, depending on the used modalities. One case of myocarditis was detected in the present cohort. Coronary anomalies were not found. Right ventricular size and function were within normal ranges. Isovolumetric right ventricular relaxation time showed significant regional differences. One case of hypertrophic cardiomyopathy and two subjects with bicuspid aortic valves were found. Due to the excessive cardiac stress in highly competitive sports, high-quality and precise screening modalities are necessary, especially with respect to acquired cardiac diseases like acute myocarditis and pathological changes of left ventricular and RV geometry. The documented feasibility of the proposed extended protocol underlines the suitability to detect distinct morphological and functional cardiac alterations and documents the potential added value of a comprehensive echocardiography. Keywords  Transthoracic echocardiography · Myocarditis · Sudden cardiac death · Left ventricular remodeling · Cardiac imaging

Introduction

* Tom Döbel [email protected]‑leipzig.de 1



University Hospital Leipzig Department for Internal Medicine Neurology and Dermatology, Department of Cardiology, University Hospital Leipzig, Leipzig, Sachsen, Germany

2



RasenBallsport Leipzig GmbH, Leipzig, Germany

3

Department of Orthopedics, University Hospital Leipzig, Leipzig, Sachsen, Germany



An athlete’s motivation to achieve or exceed performance limit is linked to the disposition to maximum effort during excessive sportive activities. In consequence, the cardiovascular system is exposed to exceptional stress in the context of training