Over the years, the spectrum of competitive and recreational athletes has significantly expanded, including various age groups, diverse sex distribution and ethnic origin. Consequently, while the statements regarding athlete screening outcomes and cardiac remodeling may be qualitatively correct, there is a need for new data and evidence on cardiac adaptation that accurately represent the changing spectrum of sports participants. New diagnostic modalities may be helpful in discriminating adaptation from pathology, particularly using CMR. In this thesis, we aimed to update and extensively discuss the benefits and harms (downsides) of athlete screening in the growing groups of competitive athletes with changing compositions. This is covered in two sections: the first describing the General introduction 15 available evidence of current athlete screening and the second providing new data on cardiac remodeling, as observed with CMR in special groups of world-class athletes involved in extreme exercise. In Chapter 2, we evaluated the available evidence for athlete screening in a systematic review, and focused on the methodological quality, quality of evidence and efficacy of athlete screening to detect HRCC. To further improve the interpretation of athlete screening test results, we evaluated in Chapter 3 whether the ECG criteria based on young athletes (=35 years) could be used in master athletes (>35 years) as well. In Chapter 4, we summarized the available data on electrocardiographic and morphological cardiac remodeling in competitive female athletes to study the adaptation of the female heart to the high exercise demands. In Chapter 5, we compared the morphological EICR characteristics of track cyclists with road cyclists and explored whether this comparison may be used to test a classical hypothesis of EICR - power exercise induces increased ventricular wall thickness and mass, and endurance exercise induces ventricular dilatation. Thereafter, in Chapter 6, we analyzed the dynamics of cardiac remodeling in elite rowers in a 9-month period between the World Cup championships and the Olympic Games. In the general discussion in Chapter 7, the findings of the previous chapters are integrated to search for an optimal balance between the intended beneficial effects of cardiovascular screening and the unintended effects of screening (including potential harm) for the various groups of athletes.
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