The Role of Cardiac Magnetic Resonance Imaging in Distinguishing the Athlete's Heart From Hypertrophic Cardiomyopathy–A Brief Literature Review

All structural and functional alterations the heart experiences due to intense sports training are collectively called the “athlete's heart” (AH). One of the main diagnostic dilemmas of today's sports cardiology is the so-called “gray zone”—the structural and functional overlap between the physiological adaptation of the AH and the pathological process of cardiomyopathy. The importance of accurate differentiation between these two entities cannot be highlighted enough—it is estimated that half of the cases of sudden cardiac death in young athletes aged 19–29 are caused by cardiomyopathies, primarily hypertrophic cardiomyopathy (HCM). In the last few years, cardiac magnetic resonance imaging (MRI) has positioned itself as the gold standard for diagnosing structural heart disease, emphasizing the role of the cardiac imaging expert. This brief literature review provides the cardiac MRI findings and techniques that aid in distinguishing the AH from the most common cardiomyopathy—HCM. We will discuss the contributions, as well as current challenges and limitations of each technique, hoping to assist imaging experts and clinicians in solving one of the biggest dilemmas of sports cardiology.