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the correct diagnosis. If HCM is suspected, some criteria should be considered as
the presence of left outflow tract obstruction, systolic anterior movement of mitral
valve, diastolic dysfunction and the family history. For suspected DCM, impaired
or borderline systolic function and a peak oxygen consumption inferior to 50 ml/
min/kg (<120% of the predicted) should be considered to make the differential
diagnosis [ 3 ].
The pattern and the magnitude of LV mass may depend on the nature of thesports [ 3 ] (Fig. 2.3). Sports as cycling, rowing and swimming determine the major
variation of both LV cavity and thickness, whereas athletes participating in ultra-
endurance sport (as thriathlons) paradoxically show more modest alterations in car-
diac dimensions, even if there are very limiting data [ 3 ].
Data assembled in a large populations of trained athletes assessed with multi-variate analysis demonstrated that about 75% of variability in LV cavity size
depends on non-genetic factors such as body size, type of sports, gender and age,
with the BSA as the principal determinant. The remaining 25% of variability is not
completely explained, but maybe genetic factors and the race play an important
role. Because the BSA is the most powerful predictor of LV cavity dimension, the
measures have to be always indexed for BSA. Larger athletes generally show greater
absolute LV cavity and thickness dimension, that normalizes when corrected for
BSA [ 3 ] (Fig. 2.4).
Fig. 2.3 Different models of left ventricular hypertrophy (LVH) secondary to long-term sport
training. Endurance sports are associated with eccentric LVH, while power training usually deter-
mines concentric LVH. However, most of team sports are related with balanced form of LVH, with
consequent right ventricular (RV) enlargement
A. D’Andrea et al.