Recommendations for cardiovascular evaluation in athletes – a viewpoint

Traditionally, cardiovascular screening has been recommended mostly for competitive athletes younger than 35 years. The perception that only young competitive athletes at top level are at increased risk, has changed in the last years. Theoretically, we advocate a voluntary cardiovascular screening for all athletes who exercise vigorously, independent of their competitive status, and age. Although, this should be based on an individual estimation of the athlete’s risk. Physical examination, medical history and an ECG should be the baseline investigations for all athletes. Ideally, an echocardiography should be performed once at the beginning of the athletic career to rule out congenital coronary and valvular abnormalities-although addition of an echocardiography has not yet been established routinely due to lacking evidence. We advocate to repeat the ECG every 1–2 years in athletes < 30–35 years. For older athletes, we recommend to assess their individual CV risk profile (particularly with inclusion of lipid profile) and their previous training history. Depending on the assessment, further investigations should be implemented such as an exercise stress test and/or Coronary CT scan.