Authors' Reply to Kindermann et al.'s Comment on: "Athlete's Heart: Diagnostic Challenges and Future Perspectives".

Abstract

We thank Prof. Wilfried Kindermann and colleagues for their interest in our publication [1] and for the important comments raised in their letter [2]. They understandably underscore the importance of a step-wise approach to cardiovascular assessment of athletes, where the diagnostic work-up needs to be tailored according to the pre-test probability of disease and the clinical context, namely the pre-participation screening of asymptomatic competitive or leisure athletes, and the assessment of athletes reporting specific symptoms, a positive family history, and an abnormal physical examination and/or abnormal resting 12-lead electrocardiogram (ECG) [3]. It should be noted that exercise-induced cardiac remodeling presents a spectrum of adaptations that overlaps with pathological changes seen in inherited or acquired cardiomyopathies. It is up to the clinician to decide where this boundary may be for each individual on the basis of a diagnostic continuum encompassing both resting and stress clinical investigations (Fig. 1 in the review article [1]).