Athlete´s Heart vs. hypertrophic cardiomyopathy and markers of myocardial necrosis in football players

Abstract

High-level athletes, such as football players, undergo prolonged and intense training regimens that can lead to adaptive structural and functional changes in the heart. Athlete's heart syndrome is perhaps the most well-known of these alterations exhibiting adaptive responses such as left ventricular hypertrophy, considered benign and without intervention. However, there can be overlap between the adaptations observed in athlete's heart and pathological changes like hypertrophic cardiomyopathy, making it challenging to differentiate between the two. It is important to emphasize that football is characterized by its intermittent nature, utilizing aerobic metabolism, but also involving high-intensity actions that place significant strain on anaerobic metabolism. The present study aims to analyze cardiac structural and functional changes in high-performance football players (after finishing the competitive period and in a pre-competitive rest period) and to compare them with the patients with hypertrophic cardiomyopathy with implantable cardioverter defibrillators (N = 10). We analyzed seven elite football players who competed in the professional Portuguese league. In addition to heart rate and blood pressure measurements, data from electrocardiograms, echocardiograms, and blood samples were collected to assess biomarkers indicative of necrosis or myocardial stress, including high-sensitivity Troponin I. The results suggest that high-performance football players during the competitive phase exhibited elevated markers (nonpathological values) of myocardial necrosis, possibly due to intense physical exertion. However, the elevation of these biomarkers is significantly higher in patients with hypertrophic cardiomyopathy. The measurement of these biomarkers may aid in distinguishing between 'athlete's heart' and hypertrophic cardiomyopathy, particularly in challenging cases of differential diagnosis.