In a study of heart-wall thickness among 947 elite Italian athletes in 1991, eight of the 16 athletes with the thickest heart muscles were medalists in either the Olympics or the world championships. The remaining eight were medalists at other major international events or were Italian champions in their sports—or were both. And a British study in 1984 reported that national-class athletes had significantly greater left ventricular wall thickness and mass than collegiate and recreational athletes. Then again, similar studies elsewhere have found no difference in heart size between world-class and less accomplished athletes.
Finally, there's the elusive mental factor to consider, as Crawford points out in one of his papers on athlete's heart: "Ultimately athletic performance is determined not only by the effects of training on the body but also by the ability to coordinate muscular activity and psychic motivation." Expanding on the idea in an interview, he says, "You could have two guys whose hearts were equivalently trained, but one might be a better athlete than the other for other reasons: He's got better coordination, better reflexes, whatever. Or he just wants it more, you know?"
Of course, now Crawford is talking about the other kind of athlete's heart, the heart full of passion and desire for the game—the heart that will not be denied. One athlete who had such heart was Troy Raunig, 16, of Maple Valley, Wash. Troy was born with a rare disorder of the heart muscle, but he still became an outstanding junior athlete in football, basketball and track. He was over six feet tall by the time he finished eighth grade, and he dreamed of playing basketball in college and even the pros. Then, in the summer of 1994, before his freshman year at Tahoma High in Kent, Wash., where the coaches were eagerly awaiting his arrival, Troy's doctors made a grim discovery. His heart, which had been functioning normally, had become enlarged. Eventually, he was told, he would need a heart transplant. Organized sports were, for him, out of the question.
The next 15 months were not easy. "It was a constant struggle within him, trying to accept reality," says his mother, Patty. One thing that made it difficult was that Troy's condition didn't weaken him or slow him down. "He could still do everything he needed to do," says Patty. One thing he needed to do was play pickup basketball. Though he knew he was taking a serious risk, he loved basketball too much to stop. In December, just a few minutes into a game at the local community center, Troy collapsed and died.
"On one level," his mother says, "I really believe that in time—in his time—he would have accepted the situation and moved forward. But being young, he wasn't quite ready to give the game up." That he might have been ready someday is hinted at in a short story Troy wrote, which his mother found as she was cleaning his room one day. The main character in the story is an NBA player with a heart transplant. The player doesn't feel well on the day of the championship game, but he doesn't say anything because his team needs him. He wins the game with a shot at the buzzer. Then he falls down and dies.
"In the story it said that his wife went on with her life," Patty Raunig recalls, "and she went around schools telling students that sports are not worth your life." It could be that Troy wanted to believe that, but he really wanted to win the big game too. Because he was an athlete. And he had a lot of heart.