RT Journal Article
SR Electronic
T1 Differentiation between athlete’s heart and dilated cardiomyopathy in athletic individuals
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1059
OP 1065
DO 10.1136/heartjnl-2019-316147
VO 106
IS 14
A1 Lynne Martina Millar
A1 Zephryn Fanton
A1 Gherardo Finocchiaro
A1 Gabriel Sanchez-Fernandez
A1 Harshil Dhutia
A1 Aneil Malhotra
A1 Ahmed Merghani
A1 Michael Papadakis
A1 Elijah R Behr
A1 Nick Bunce
A1 David Oxborough
A1 Matthew Reed
A1 Jamie O'Driscoll
A1 Maria Teresa Tome Esteban
A1 Andrew D'Silva
A1 Gerry Carr-White
A1 Jessica Webb
A1 Rajan Sharma
A1 Sanjay Sharma
YR 2020
UL http://heart.bmj.com/content/106/14/1059.abstract
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.