Table 3 Extended athlete’s heart echocardiographic protocol

PSAX (Aortic Valve Level)

(1) Identify coronary ostia. The left and right ostia usually originate from their respective aortic sinuses

(2) Ensure origin is at sinus level

(3) Identify proximal courses and aim to exclude aberrant vessel, especially malignant course between great vessels (aorta and pulmonary artery)

PSAX (Basal LV Level)

LV wall thicknesses should be measured from the maximum dimension at end diastole from:

(1) Anterior septum

(2) Inferior septum

(3) Posterior/Inferolateral wall

(4) Lateral/Anterolateral wall

PSAX (Mid LV Level)

LV wall thicknesses should be measured from the maximum dimension at end diastole from:

(1) Anterior septum

(2) Inferior septum

(3) Posterior/Inferolateral wall

(4) Lateral/Anterolateral wall

PSAX (Mid to apical LV level)

(1) Excess LV trabeculation is a common finding in athletes

(2) LV hypertrabeculation is more prevalent in black athletes

(3) Red-flags—thinned compacted layer <5 mm and regional wall motion abnormality in the region of excess trabeculation.

Further imaging is advised to exclude LV hypertrabeculation/cardiomyopathy

AP4CH, AP2CH and AP3CH for GLS

Provide GLS where possible. Bear in mind the technical limitations including image quality, foreshortening and maintaining frame-rates as high as possible up to 90 frames per second