PT - JOURNAL ARTICLE AU - Millar, Lynne Martina AU - Fanton, Zephryn AU - Finocchiaro, Gherardo AU - Sanchez-Fernandez, Gabriel AU - Dhutia, Harshil AU - Malhotra, Aneil AU - Merghani, Ahmed AU - Papadakis, Michael AU - Behr, Elijah R AU - Bunce, Nick AU - Oxborough, David AU - Reed, Matthew AU - O'Driscoll, Jamie AU - Tome Esteban, Maria Teresa AU - D'Silva, Andrew AU - Carr-White, Gerry AU - Webb, Jessica AU - Sharma, Rajan AU - Sharma, Sanjay TI - Differentiation between athlete’s heart and dilated cardiomyopathy in athletic individuals AID - 10.1136/heartjnl-2019-316147 DP - 2020 Jul 01 TA - Heart PG - 1059--1065 VI - 106 IP - 14 4099 - http://heart.bmj.com/content/106/14/1059.short 4100 - http://heart.bmj.com/content/106/14/1059.full SO - Heart2020 Jul 01; 106 AB - Objective Distinguishing early dilated cardiomyopathy (DCM) from physiological left ventricular (LV) dilatation with LV ejection fraction <55% in athletes (grey zone) is challenging. We evaluated the role of a cascade of investigations to differentiate these two entities.Methods Thirty-five asymptomatic active males with DCM, 25 male athletes in the ‘grey zone’ and 24 male athletes with normal LV ejection fraction underwent N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement, ECG and exercise echocardiography. Grey-zone athletes and patients with DCM underwent cardiovascular magnetic resonance (CMR) and Holter monitoring.Results Larger LV cavity dimensions and lower LV ejection fraction were the only differences between grey-zone and control athletes. None of the grey-zone athletes had abnormal NT-proBNP, increased ectopic burden/complex arrhythmias or pathological late gadolinium enhancement on CMR. These features were also absent in 71%, 71% and 50% of patients with DCM, respectively. 95% of grey-zone athletes and 60% of patients with DCM had normal ECG. During exercise echocardiography, 96% grey-zone athletes increased LV ejection fraction by >11% from baseline to peak exercise compared with 23% of patients with DCM (p<0.0001). Peak LV ejection fraction was >63% in 92% grey-zone athletes compared with 17% patients with DCM (p<0.0001). Failure to increase LV ejection fraction >11% from baseline to peak exercise or achieve a peak LV ejection fraction >63% had sensitivity of 77% and 83%, respectively, and specificity of 96% and 92%, respectively, for predicting DCM.Conclusion Comprehensive assessment using a cascade of routine investigations revealed that exercise stress echocardiography has the greatest discriminatory value in differentiating between grey-zone athletes and asymptomatic patients with DCM. Our findings require validation in larger studies.