Differences and similarities between arrhythmogenic right ventricular cardiomyopathy and athlete’s heart adaptations

Bauce, Barbara; Frigo, Gianfranco; Benini, Giampaolo; Michieli, Pierantonio; Basso, Cristina; Folino, Antonio Franco; Rigato, Ilaria; Mazzotti, Elisa; Daliento, Luciano; Thiene, Gaetano; Nava, Andrea

doi:10.1136/bjsm.2007.042853

Cited by 79 publications

(59 citation statements)

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“…Limited data in white athletes indicate that the RV is subject to the same preload as the LV during exercise and exhibits structural and functional adaptation in synergy with the left side of the heart. 5,6 As such, physiological remodeling of the athlete's RV may mimic changes observed in arrhythmogenic right ventricular cardiomyopathy (ARVC), 7 which is responsible for as many as 22% of SCDs in young athletes in Europe. 3,8 The magnitude of athletic cardiac remodeling is dependent on a variety of demographic and sport-specific variables; large, adult male athletes engaging in endurance sports generally exhibit the greatest dimensions.…”

Section: Editorial See P 1757 Clinical Perspective On P 1792mentioning

confidence: 99%

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Physiological Right Ventricular Adaptation in Elite Athletes of African and Afro-Caribbean Origin

et al. 2013

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Background-Regular, intensive exercise results in physiological biventricular cardiac adaptation. Ethnicity is an established determinant of left ventricular remodeling; black athletes (BAs) exhibit more profound LV hypertrophy than white athletes (WAs). Right ventricular (RV) remodeling has not been characterized in BAs, although the issue is pertinent because BAs commonly exhibit ECG anomalies that resemble arrhythmogenic RV cardiomyopathy. Methods and Results-Between 2006 and 2012, 300 consecutive BAs (n=243 males) from 25 sporting disciplines were evaluated by use of ECG and echocardiography. Results were compared with 375 WAs and 153 sedentary control subjects (n=69 blacks). There were no ethnic differences between RV parameters in control subjects. Both BAs and WAs exhibited greater RV dimensions than control subjects. RV dimensions were marginally smaller in BAs than in WAs (proximal outflow tract, 30.9±5.5 versus 32.8±5.3 mm, P<0.001; longitudinal dimension, 86.6±9.5 versus 89.8±9.6 mm, P<0.001), although only 2.3% of variation was attributable to ethnicity. RV enlargement compatible with diagnostic criteria for arrhythmogenic RV cardiomyopathy was frequently observed (proximal outflow tract ≥32 mm; 45.0% of BAs, 58.5% of WAs). Anterior T-wave inversion was present in 14.3% of BAs versus 3.7% of WAs (P<0.001). Marked RV enlargement with concomitant anterior T-wave inversion was observed in 3.0% of BAs versus 0.3% of WAs (P=0.005). Further investigation did not diagnose arrhythmogenic RV cardiomyopathy in any athlete. Conclusions-Physiological RV enlargement is commonly observed in both black and white athletes. The impact of ethnicity is minimal, which obviates the need for race-specific RV reference values. However, in the context of frequent ECG repolarization anomalies in BAs, the potential for erroneous diagnosis of arrhythmogenic RV cardiomyopathy is considerably greater in this ethnic group. (Circulation. 2013;127:1783-1792.)Key Words: cardiomyopathy ◼ echocardiography ◼ electrocardiographic screening ◼ ethnicity ◼ exercise © 2013 American Heart Association, Inc.Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIRCULATIONAHA.112.000270Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz. Received December 6, 2012; accepted March 4, 2013. From St. George's University of London, London, United Kingdom (A.Z., S. Ghani, R.S., N.S., S. Gati, M.P., S.S.); University Hospital Lewisham, London, United Kingdom (A.Z., S. Ghani, N.S., S. Gati, S.S.); Liverpool John Moores University, Liverpool, United Kingdom (D.O.); and Imperial College Healthcare NHS Trust, London, United Kingdom (V.F.P. [WAs]). 10,11 The influence of ethnicity on athletic RV remodeling has never been characterized, even though healthy BAs frequently reveal ECG repolarization anomalies that resemble those observed in ARVC.12 Furthermore, BAs comprise a growing number of elite sports participants worldwide, and for reasons that remain incompletely under...

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Section: Editorial See P 1757 Clinical Perspective On P 1792mentioning

confidence: 99%

“…The majority of abnormal signal-averaged ECG findings consisted of filtered QRS prolongation (60.0%), a phenomenon that has been reported previously in healthy athletes. 7,29 The above investigations did not result in a diagnosis of ARVC in any athlete. …”

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Physiological Right Ventricular Adaptation in Elite Athletes of African and Afro-Caribbean Origin

et al. 2013

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“…7 These athletes had RV outflow tract enlargement and a reduced RV ejection fraction, and no athlete had T-wave inversion beyond V 1 on the ECG. 7 Thus, none of the athletes met ECG criteria for the diagnosis of ARVC. 7 Data from preparticipation screening of competitive athletes from northeast Italy revealed an incidence of T-wave inversion in subjects >14 years of age of 1.4%.…”

Section: Article See P 1783mentioning

confidence: 99%

“…7 Thus, none of the athletes met ECG criteria for the diagnosis of ARVC. 7 Data from preparticipation screening of competitive athletes from northeast Italy revealed an incidence of T-wave inversion in subjects >14 years of age of 1.4%. 8 In a separate study, 154 African players exhibited a greater incidence of ECG T-wave inversion compared with 62 white competitive soccer players.…”

Section: Article See P 1783mentioning

confidence: 99%

“…[7][8][9] In a study comparing 40 athletes with 40 control subjects and 40 subjects with ARVC, the athletes exhibited significant enlargement of the RV. 7 These athletes had RV outflow tract enlargement and a reduced RV ejection fraction, and no athlete had T-wave inversion beyond V 1 on the ECG. 7 Thus, none of the athletes met ECG criteria for the diagnosis of ARVC.…”

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