Ethnic differences in ventricular hypertrabeculation on cardiac MRI in elite football players

Luijkx, Tim; Zaidi, Abbas; Rienks, Rienk; Senden, P. J.; Sharma, Sanjay; Hellemondt, F. J. van; Buckens, Constantinus F.; Mali, Willem P.Th.M.; Velthuis, BK

doi:10.1007/s12471-012-0305-7

Cited by 39 publications

(27 citation statements)

References 29 publications

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“…Interethnic differences were best measured in the entire cohort and attenuated to some extent in the reference groups where subgrouping led to under representation of specific ethnic or racial subgroups. The association between African background and increased trabeculation has been previously reported (2,6,19,20), but fractal analysis additionally shows a positive and negative association, respectively, between Hispanic and Chinese American participants with trabeculation.…”

Section: Regional Patterns and Reference Values For LV Trabeculationsupporting

confidence: 55%

“…; and manuscript editing, G.C., F.Z., V.M., S.E.P., P.B., N.K.B., W.J.M., P.M.E., J.A.C.L., D.A.B., J.C.M. A bnormal trabecular patterns of the ventricular myocardium coexist with established cardiac disease (1)(2)(3)(4)(5), and a spectrum of so-called normal trabeculation with interethnic differences has also been observed in healthy hearts (2,6). Because of this large variability, trabecular phenotypes are hard to measure, but the recently described (3) fractal method applied to cardiac magnetic resonance (MR) imaging provides a sensitive mathematical solution.…”

Section: Author Contributionsmentioning

confidence: 99%

See 1 more Smart Citation

Fractal Analysis of Myocardial Trabeculations in 2547 Study Participants: Multi-Ethnic Study of Atherosclerosis

Captur¹,

Zemrak²,

Muthurangu³

et al. 2015

Radiology

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).q RSNA, 2015 Purpose:To quantitatively determine the population variation and relationship of left ventricular (LV) trabeculation to LV function, structure, and clinical variables. Materials andMethods:This HIPAA-compliant multicenter study was approved by institutional review boards of participating centers. Results:Included were 2547 participants (mean age, 68.7 years 6 9.1 [standard deviation]; 1211 men). FD MaxApical are in arbitrary units. FD MaxApical reference ranges for BMI 30 kg/m 2 or greater (n = 163), 25 kg/m 2 or greater to less than 30 kg/m 2 (n = 206), and less than 25 kg/m 2 (n = 235) were 1.203 6 0.06 (95% confidence interval: 1.194, 1.212), 1.194 6 0.06 (95% confidence interval: 1.186, 1.202), and 1.169 6 0.05 (95% confidence interval: 1.162, 1.176), respectively. In the entire cohort, adjusted for anthropometrics, trabeculation was higher in African American participants (standardized b [sb] = 0.09; P  .001) and Hispanic participants (sb = 0.05; P = .013) compared with white participants and was also higher in African American participants compared with Chinese American participants (sb = 0.08; P = .01), and this persisted after adjustment for hypertension and LV size. Hypertension (sb = 0.07; P , .001), LV mass (sb = 0.22; P , .001), and wall thickness (sb = 0.27; P , .001) were positively associated with FD MaxApical even after adjustment. In the group with BMIs less than 25 kg/ m 2 , Chinese American participants had less trabeculation than white participants (sb = 20.15; P = .032). Conclusion:Fractal analysis of cardiac MR imaging data measures endocardial complexity, which helps to differentiate normal from abnormal trabecular patterns in healthy versus diseased hearts. Trabeculation is influenced by race and/or ethnicity and, more importantly, by cardiac loading conditions and comorbidities. Clinicians who interpret cine MR imaging data should expect slightly less endocardial complexity in Chinese American patients and more in African American patients, Hispanic patients, hypertensive patients, and those with hypertrophy.q RSNA, 2015

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Section: Regional Patterns and Reference Values For LV Trabeculationsupporting

confidence: 55%

Section: Author Contributionsmentioning

confidence: 99%

Fractal Analysis of Myocardial Trabeculations in 2547 Study Participants: Multi-Ethnic Study of Atherosclerosis

Captur¹,

Zemrak²,

Muthurangu³

et al. 2015

Radiology

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“…19 The same mechanism was also recently proposed to explain the high prevalence of J-point elevation in a population of patients with LV noncompaction cardiomyopathy. 20 An increased LV trabeculation is associated with physical training. In fact, a recent MRI study comparing soccer players of European versus African descent reported a greater degree of myocardial trabeculation in the latter.…”

Section: Discussionmentioning

confidence: 99%

Clinical, Electrocardiographic, Echocardiographic Characteristics and Long-Term Follow-Up of Elite Soccer Players With J-Point Elevation

Biasco

Cristoforetti

Castagno

et al. 2013

Circ: Arrhythmia and Electrophysiology

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Background-J-point elevation is common in athletes; nevertheless, the influence of structural changes associated with the athlete's heart and its prognostic impact are still debated. Our aim was to investigate the prevalence of J-point elevation, the associated clinical, electrocardiographic, and echocardiographic characteristics and its impact on long-term outcome in elite soccer players. Methods and Results-Clinical, electrocardiographic, and cardiopulmonary exercise test data from 332 male professional soccer players were retrospectively analyzed. For 235 (70.7%) athletes echocardiographic data were also available. J-point elevation was defined as an elevation ≥1 mm in ≥2 contiguous leads. Long-term follow-up data were obtained for all athletes, whereas univariate and multivariable analyses were performed to assess the associated characteristics. Overall, 118 (35.6%) athletes showed a J-point elevation ≥1 mm. At multivariable analysis a significant direct association of interventricular septum thickness (odds ratio for 1 SD increase, 1.361; 95% confidence interval, 1.019-1.817; P=0.036) and Sokolow-Lyon index (odds ratio for 1 SD increase, 1.367; 95% confidence interval, 1.026-1.822; P=0.033) and an inverse association of baseline heart rate (odds ratio for 1 SD increase, 0.686; 95% confidence interval, 0.508-0.927; P=0.011) with J-point elevation were observed. During a long-term follow-up (median, 13.3 years; first and third quartiles, 10.1-17.0 years), a low mortality rate was observed, not related to cardiovascular causes. Conclusions-The correlation between J-point elevation and interventricular septum thickness suggests a possible mechanistic role of exercise-induced left ventricular hypertrophy as the basis for J-point elevation. After a long-term follow-up, no cardiac death was observed. (Circ Arrhythm Electrophysiol. 2013;6:1178-1184.)

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“…In the current issue of this journal, Luijkx et al report the prevalence of hypertrabeculation in elite white and black athletes as seen at MRI [7]. They describe a greater degree of LV hypertrabeculation and lower LV and RV ejection fraction in elite black football players vs. white football players, which could be erroneously mistaken for NCCM.…”

mentioning

confidence: 99%

“…Echocardiographic views are operatordependent and off-axis views may affect the morphological assessment of myocardial trabeculations. However, excellent contrast of MRI, as used in the study by Luijkx et al, allows better visualisation of trabeculations, in particular when echocardiography windows are poor [7]. One MRI diagnostic criterion based on an end-diastolic ratio of compacted to noncompacted myocardium >2.3 in long-axis views was used for the diagnosis of NCCM [12].…”

mentioning

confidence: 99%

Noncompaction cardiomyopathy, a frequently overlooked entity (…but beware of over diagnosis!)

Çalışkan¹

2012

Neth Heart J

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Ethnic differences in ventricular hypertrabeculation on cardiac MRI in elite football players

Abstract: A greater degree of LV hypertrabeculation is seen in healthy African athletes, combined with biventricular EF reduction at rest. Recognition of this phenomenon is necessary to avoid misdiagnosis of LVNC.

Cited by 39 publications

References 29 publications

Fractal Analysis of Myocardial Trabeculations in 2547 Study Participants: Multi-Ethnic Study of Atherosclerosis

Fractal Analysis of Myocardial Trabeculations in 2547 Study Participants: Multi-Ethnic Study of Atherosclerosis

Clinical, Electrocardiographic, Echocardiographic Characteristics and Long-Term Follow-Up of Elite Soccer Players With J-Point Elevation

Noncompaction cardiomyopathy, a frequently overlooked entity (…but beware of over diagnosis!)

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