A Novel Diagnostic Score Integrating Atrial Dimensions to Differentiate between the Athlete’s Heart and Arrhythmogenic Right Ventricular Cardiomyopathy

Abstract

Objective: The 2010 Task Force Criteria (TFC) have not been tested to differentiate ARVC from the athlete’s heart. Moreover, some criteria are not available (myocardial biopsy, genetic testing, morphology of ventricular tachycardia) or subject to interobserver variability (right ventricular regional wall motion abnormalities) in clinical practice. We hypothesized that atrial dimensions are useful and robust to differentiate between both entities and proposed a new diagnostic score based upon readily available parameters including echocardiographic atrial dimensions. Methods: In this observational study, 21 patients with definite ARVC were matched for age, gender and body mass index to 42 athletes. Based on ROC analysis, the following parameters were included in the score: indexed right/left atrial volumes ratio (RAVI/LAVI ratio), NT-proBNP, RVOT measurements (PLAX and PSAX BSA-corrected), tricuspid annular motion (TAM), precordial TWI and depolarization abnormalities according to TFC. Results: ARVC patients had a higher RAVI/LAVI ratio (1.76 ± 1.5 vs. 0.87 ± 0.2, p < 0.001), lower right ventricular function (fac: 29 ± 10.1 vs. 42.2 ± 5%, p < 0.001; TAM: 19.8 ± 5.4 vs. 23.8 ± 3.8 mm, p = 0.001) and higher serum NT-proBNP levels (345 ± 612 vs. 48 ± 57 ng/L, p < 0.001). Our score showed a good performance, which is comparable to the 2010 TFC using those parameters, which are available in routine clinical practice (AUC93%, p < 0.001 (95%CI 0.874–0.995) vs. AUC97%, p < 0.001 (95%CI 0.93–1.00). A score of 6/12 points yielded a specificity of 91% and an improved sensitivity of 67% for ARVC diagnosis as compared to a sensitivity of 41% for the abovementioned readily available 2010 TFC. Conclusions: ARVC patients present with significantly larger RA compared to athletes, resulting in a greater RAVI/LAVI ratio. Our novel diagnostic score includes readily available clinical parameters and has a high diagnostic accuracy to differentiate between ARVC and the athlete’s heart.

Undiagnosed cardiomyopathy: An incidental finding in a recreational soccer player—A case report and literature review

“…This is usually out of proportion to LV remodelling and an athlete's sports and exercise history. RV:LV (inflow vs. inflow) (≤0.9), RVOT1:RV1 (outflow vs. inflow) (<1), and RAVI:LAVI (<1) ratios can be used to provide insight into physiological or balanced remodelling and ARVC 20–25 . In this case, these measurements suggested unbalanced RV remodelling.…”

Normative values of non-invasively assessed RV function and pulmonary circulation coupling for pre-participation screening derived from 497 male elite athletes

“…In any individual, cardiac adaptations to exercise are influenced by several factors including training mode, intensity, duration and volume [1,3,19,[23][24][25][26]. Cardiac remodeling of the right ventricle in athletes was intensively investigated [6,10,[26][27][28][29][30][31][32] and different echocardiographic approaches were proposed to identify pathological changes [1,3,33]. However, so far, accepted reference values for athletes exist mainly for morphological echocardiographic measurements as highlighted in recent meta-analyses [28,32].…”

Multimodality Imaging in Arrhythmogenic Right Ventricular Cardiomyopathy

“…97 However, the right atrium is often disproportionately affected in patients with ARVC, and a recent study has utilized this feature by designing a scoring system that incorporates the ratio of RA to LA volume to distinguish athlete's heart from ARVC. 98 The spectrum of clinical and diagnostic overlap between ARVC and other diseases underscores the importance of reader familiarity with imaging findings of overlap diagnoses and why findings by multimodality imaging must be integrated into clinical context. Table 3 summarizes the characteristic findings of overlap diagnoses by multimodality imaging.…”