Differentiation between athlete’s heart and dilated cardiomyopathy in athletic individuals
Journal article
Millar, L. M., Fanton, Z., Finnochiaro, G., Sanchez-Fernandez, G., Dhutia, H., Malhotra, A., Merghani, A., Papadakis, M., Behr, E. R., Bunce, N., Oxborough, D., Reed, M., O'Driscoll, J., Tome Esteban, M. T., D'Silva, A., Carr-White, G., Sharma, R. and Sharma, S. 2020. Differentiation between athlete’s heart and dilated cardiomyopathy in athletic individuals. Heart. https://doi.org/10.1136/heartjnl-2019-316147
Authors | Millar, L. M., Fanton, Z., Finnochiaro, G., Sanchez-Fernandez, G., Dhutia, H., Malhotra, A., Merghani, A., Papadakis, M., Behr, E. R., Bunce, N., Oxborough, D., Reed, M., O'Driscoll, J., Tome Esteban, M. T., D'Silva, A., Carr-White, G., Sharma, R. and Sharma, S. |
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Abstract | Background: Distinguishing early dilated cardiomyopathy (DCM) from physiological left ventricular (LV) dilatation with mildly reduced LV ejection fraction (‘grey-zone’) is challenging. We evaluated the role of a cascade of investigations to differentiate these two entities. Methods and Results: Thirty-five asymptomatic active males with DCM, 25 male athletes in the ‘grey-zone’ and 24 male athlete controls with normal LV ejection fraction were investigated with NT-proBNP, electrocardiography (ECG) and exercise echocardiography. ‘Grey-zone’ athletes and DCM patients underwent cardiovascular magnetic resonance and Holter monitoring. Larger LV cavity dimensions and lower LV ejection fraction were the only differences between control and ‘grey-zone’ athletes. None of the ‘grey-zone’ athletes had an abnormal NT-proBNP, increased ectopic burden/complex arrhythmias or pathological late gadolinium enhancement. These features were absent in 71%, 71% and 50% of DCM patients respectively. 95% of ‘grey-zone’ athletes and 60% DCM patients had a normal ECG. During exercise echocardiography, 96% of the ‘grey-zone’ athletes increased LV ejection fraction by >11% from baseline to peak exercise compared with 23% DCM patients. Peak LV ejection fraction was >63% in 92% ‘grey-zone’ athletes compared with 17% DCM patients. Failure to increase LV ejection fraction >11% from baseline to peak exercise or achieve a peak LV ejection fraction >63% had a 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 DCM patients. |
Keywords | Athlete’s heart; Dilated cardiomyopathy; Exercise stress echocardiography |
Year | 2020 |
Journal | Heart |
Publisher | BMJ Publishing Group Ltd & British Cardiovascular Society |
ISSN | 1355-6037 |
Digital Object Identifier (DOI) | https://doi.org/10.1136/heartjnl-2019-316147 |
Official URL | http://dx.doi.org/10.1136/heartjnl-2019-316147 |
Publication dates | |
Online | 27 Apr 2020 |
Publication process dates | |
Accepted | 25 Mar 2020 |
Deposited | 07 May 2020 |
Accepted author manuscript | License |
Output status | Published |
https://repository.canterbury.ac.uk/item/8v2z5/differentiation-between-athlete-s-heart-and-dilated-cardiomyopathy-in-athletic-individuals
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