PT  - JOURNAL ARTICLE
AU  - Lynne Martina Millar
AU  - Zephryn Fanton
AU  - Gherardo Finocchiaro
AU  - Gabriel Sanchez-Fernandez
AU  - Harshil Dhutia
AU  - Aneil Malhotra
AU  - Ahmed Merghani
AU  - Michael Papadakis
AU  - Elijah R Behr
AU  - Nick Bunce
AU  - David Oxborough
AU  - Matthew Reed
AU  - Jamie O'Driscoll
AU  - Maria Teresa Tome Esteban
AU  - Andrew D'Silva
AU  - Gerry Carr-White
AU  - Jessica Webb
AU  - Rajan Sharma
AU  - Sanjay Sharma
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.