Unravelling the grey zone: cardiac MRI volume to wall mass ratio to differentiate hypertrophic cardiomyopathy and the athlete's heart

Luijkx, Tim; Buckens, Constantinus F.; Zaidi, Abbas; Rienks, Rienk; Mosterd, Arend; Prakken, Niek H J; Dijkman, Barbara; Mali, Willem P.Th.M.; Velthuis, Birgitta K.

doi:10.1136/bjsports-2013-092360

Cited by 16 publications

(10 citation statements)

References 34 publications

(32 reference statements)

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“…Male sex (B=3.17, p<0.001), body mass index (BMi) (B=0.80, p<0.001) and height (B=0.25, p<0.001) were the strongest independent correlates of systolic BP. in the second cohort (n=304, ages [17][18][19][20][21][22][23][24][25][26], systolic BP was an independent correlate of lV mass/volume ratio (B=0.002, p=0.001). lV longitudinal strain was similar across BP categories, while higher BP was associated with slower early diastolic relaxation.…”

Section: Introductionmentioning

confidence: 92%

Blood pressure in athletic preparticipation evaluation and the implication for cardiac remodelling

Hedman

Moneghetti

Christle

et al. 2019

Heart

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ObjectivesTo explore blood pressure (BP) in athletes at preparticipation evaluation (PPE) in the context of recently updated US and European hypertension guidelines, and to determine the relationship between BP and left ventricular (LV) remodelling.MethodsIn this retrospective study, athletes aged 13–35 years who underwent PPE facilitated by the Stanford Sports Cardiology programme were considered. Resting BP was measured in both arms; repeated once if ≥140/90 mm Hg. Athletes with abnormal ECGs or known hypertension were excluded. BP was categorised per US/European hypertension guidelines. In a separate cohort of athletes undergoing routine PPE echocardiography, we explored the relationship between BP and LV remodelling (LV mass, mass/volume ratio, sphericity index) and LV function.ResultsIn cohort 1 (n=2733, 65.5% male), 34.3% of athletes exceeded US hypertension thresholds. Male sex (B=3.17, p<0.001), body mass index (BMI) (B=0.80, p<0.001) and height (B=0.25, p<0.001) were the strongest independent correlates of systolic BP. In the second cohort (n=304, ages 17–26), systolic BP was an independent correlate of LV mass/volume ratio (B=0.002, p=0.001). LV longitudinal strain was similar across BP categories, while higher BP was associated with slower early diastolic relaxation.ConclusionIn a large contemporary cohort of athletes, one-third presented with BP levels above the current US guidelines’ thresholds for hypertension, highlighting that lowering the BP thresholds at PPE warrants careful consideration as well as efforts to standardise measurements. Higher systolic BP was associated with male sex, BMI and height and with LV remodelling and diastolic function, suggesting elevated BP in athletes during PPE may signify a clinically relevant condition.

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Section: Introductionmentioning

confidence: 92%

Blood pressure in athletic preparticipation evaluation and the implication for cardiac remodelling

Hedman

Moneghetti

Christle

et al. 2019

Heart

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“…The increase in LV wall thickness in athletes is an adaptation to increase stroke volume so it has to be accompanied by chamber enlargement. Thus, a LV end-diastolic diameter > 54 mm 41 , an increased LV volume and particularly LV volume/mass ratios by MRI 42 have been proposed to differentiate athlete’s heart from disease 41 .…”

Section: The Left Ventriclementioning

confidence: 99%

Echocardiography in the evaluation of athletes

et al. 2015

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Echocardiography is currently a widely available imaging technique that can provide useful data in the field of sports cardiology particularly in two areas: pre-participation screening and analysis of the cardiac adaptation induced by exercise.The application of pre-participation screening and especially, the type and number of used diagnostic tests remains controversial. Echocardiography has shown though, higher sensitivity and specificity as compared to the ECG, following a protocol adapted to athletes focused on ruling out the causes of sudden death and the most common disorders in this population. It is still a subject of controversy the actual cost of adding it, but depending on the type of sport, echocardiography might be cost-effective if added in the first line of examination.Regarding the evaluation of cardiac adaptation to training in athletes, echocardiography has proved to be useful in the differential diagnosis of diseases that can cause sudden death, analysing both the left ventricle (hypertrophy cardiomyopathy, dilated cardiomyopathy, left ventricle non compaction) and the right ventricle (arrhythmogenic right ventricular cardiomyopathy).The aim of this paper is to review the current knowledge and the clinical practical implications of it on the field of echocardiography when applied in sport cardiology areas.

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“…The HCM is characterized by a disorganized architecture of the myocardial hypertrophied myocytes and cell and fibrillary disruption, which in most cases is expressed by asymmetric hypertrophy [11]. The athlete's heart has an adaptive response to physical training that imposes an intermittent burden of pressure and volume; cardiovascular changes such as increased left ventricular mass is observed only in some individuals [12]. A recent study [4] suggested that LV-EDD below 54 mm showed high sensitivity (94%) but low specificity (21%) for the diagnosis of HCM.…”

Section: Discussionmentioning

confidence: 99%

Differentiating hypertrophic cardiomyopathy from athlete's heart: An electrocardiographic and echocardiographic approach

Grazioli

Usín

Trucco

et al. 2016

Journal of Electrocardiology

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Unravelling the grey zone: cardiac MRI volume to wall mass ratio to differentiate hypertrophic cardiomyopathy and the athlete's heart

Abstract: A model incorporating the LV EDV : EDM ratio can help distinguish HCM from physiological hypertrophy in athletes. This also applies to cases with borderline LVH, which present the greatest diagnostic challenge in clinical practice.

Cited by 16 publications

References 34 publications

Blood pressure in athletic preparticipation evaluation and the implication for cardiac remodelling

Blood pressure in athletic preparticipation evaluation and the implication for cardiac remodelling

Echocardiography in the evaluation of athletes

Differentiating hypertrophic cardiomyopathy from athlete's heart: An electrocardiographic and echocardiographic approach

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