Revealing the unrevealed: echocardiography for non-ischemic scar tissue detection

a B S T r a c T The detection of myocardial scar tissue profoundly influences athletes care and prognostic categorization. Athletes appear to be at risk of developing fatal arrhythmias when harboring a quiescent cardiac disorder. Early identification of disease in asymptomatic individuals through preparticipation screening is means to prevent these events. We presented a male marathon runner master athlete who came at our department of Sports Medicine for a preparticipation screening. Baseline 12-lead standard electrocardiogram was normal. a maximal cycle ergometer exercise test revealed exercise-induced premature ventricular contractions (pVcs) with uncommon morphology. echocardiography revealed an hyperechogenic zone at mid-basal posterior segments of the left ventricle. Twenty-four-hours ecG holter monitoring, with training session, showed some isolated polymorphic PVCs even during training session. Cardiac magnetic resonance (CMR) confirmed the presence of a non-ischemic left ventricular scar (subepicardial) into the mid-basal segment of the posterior wall. Echocardiography is a first-line, economic, and accessible diagnostic test for athletes and it can be useful, when abnormalities are detected, to indicate further investigations, such as cMr. although nonischemic left ventricular scarring is difficult to detect on echocardiography, this event is sometimes possible and require further investigation when observed.