Echocardiographic Findings in Endurance Athletes with Hypertrophic Non-Obstructive Cardiomyopathy (HNCM) Compared to Non-Athletes with HNCM and to Physiological Hypertrophy (Athlete's Heart)

Abstract

Hypertrophic non-obstructive cardiomyopathy (HNCM) is one of the most frequent causes of sudden cardiac death in young athletes. Since the clinical findings in HNCM patients may be inconspicuous and the ECG changes found in endurance athletes may be similar to those of HNCM patients, echocardiography, as a non-invasive procedure, seems to take on an important role in differential diagnostics. To prove this hypothesis, conventional echocardiographic parameters were compared in three groups with confirmed diagnosis: Group I: HNCM (n = 9) without sports activity; Group II: HNCM (n = 9) with regular, intensive endurance training (3-5 hours/week). The diagnosis was invasively confirmed in both groups. Group III: healthy subjects (n = 9) with physiological hypertrophy and regular endurance training (3-6 hours/week). In the presence of HNCM, endurance sports activity appears to offset the reduction in the left ventricle and enlargement of the left atrium. The wall thickness of the septum and posterior wall do not differ in the two HNCM groups, but show a significant difference to the healthy athletes. The enddiastolic diameter, the absolute septum and posterior wall thickness and the ratio of septum+posterior wall/enddiastolic diameter can be taken as the most important differential diagnostic criterium in physiological hypertrophy, but not the ratio between septum/posterior wall. It is concluded that conventional echocardiographic examination can be considered a valuable non-invasive method for differentiating HNCM from athlete's heart, even in patients with HNCM who participate in endurance sports. However, a reliable diagnosis may not be possible in individual cases.

Echocardiographic deformation imaging reveals preserved regional systolic function in endurance athletes with left ventricular hypertrophy

“…However, the typical morphological alterations after long-term sports activities are only observed in approximately 50% of athletes 2. The changes in ventricular morphology vary from individual to individual, ranging from the appearance of a “normal” non-athletic heart to an athletes' heart, which could closely resemble HCM 6 10 20…”

Molecular Mechanisms Underlying Cardiac Adaptation to Exercise

“…Therefore, it is generally accepted that the growth of the heart due to exercise is from the collective increase in cardiac myocyte cell size and not from an increase in cardiac cell number. Along with an increase in cardiac mass, the heart undergoes changes in cardiac morphology that are dependent on the type of exercise training (Blomqvist and Saltin, 1983; Dickhuth et al, 1994; Fagard, 2003; Scheuer and Tipton, 1977; Teske et al, 2010). Physiologic cardiac growth, or more appropriately, adaptive remodeling (to signify the non-pathologic nature of this type of cardiac growth) can also be categorized as either concentric or eccentric (Figure 1) (Fagard, 1996; Lauschke and Maisch, 2009; Pluim et al, 2000).…”

BNP et NT-proBNP : intérêt dans le suivi médical des sportifs de haut niveau

“…L'apparition de cardiomyopathies non obstructives avec hypertrophie myocardique pathologique peut être d'ordre constitutionnel mais la pratique sportive intense provoque également des hypertrophies myocardiques souvent considérées comme fonctionnelles [6]. La frontière entre limite physiologique et divergence pathologique est parfois difficilement appréciable [2]. Les décès subits et récents sur le terrain de footballeurs internationaux ont interpellé la communauté médico-sportive.…”

“…En dehors de toute autre cause décelée par les vérifications médicolégales post-mortem les hypertrophies myocardiques observées posent question même si l'aspect pathologique n'a pu être affirmé. Les pratiques dopantes peuvent aussi avoir des conséquences perverses sur le tissu myocardique [2]. Les produits à risque employés sont les stéroïdes, le fer injectable nécessaire à l'efficacité des EPO et les hormones ou facteurs de croissance musculaire dont les effets sur la prolifération myocytaire sont difficilement éva-luables.…”

“…Les investigations cardiologiques spécialisées comme l'échocardio-graphie ou l'ECG d'effort avec mesure de la VO2 max néces-sitent un plateau technique spécialisé. L'échocardiographie peut être prise en défaut devant la présence d'une insuffisance cardiaque diastolique mais aussi pour des raisons techniques à cause d'une échogénicité insuffisante [2]. La mesure de la fonctionnalité myocardique n'était pas accessible à la biologie clinique jusqu'à maintenant.…”