Differentiation between athlete’s heart and dilated cardiomyopathy in athletic individuals
Key result
Exercise echocardiography distinguishes grey-zone athletes from DCM patients by revealing LVEF increases in ~96%.
- null
- 95% CI null
- P<0.0001
- n=84
Why the study?
Distinguishing early dilated cardiomyopathy from physiological left ventricular dilatation with left ventricular ejection fraction <55% in athletes (grey zone) is challenging.
Does a cascade of investigations, including exercise stress echocardiography, differentiate between physiological LV dilatation in athletes and early dilated cardiomyopathy?
Comparison
Cascade of investigations across DCM patients, grey-zone athletes, and athlete controls
Authors
Discussion
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Implication
May aid differentiation of grey-zone LV dilatation on exercise echo; leaves open prospective validation before practice change.
Study Design
Type
Cohort (n=84)
Multicenter
No
Structured PICO
Does a cascade of investigations, including exercise stress echocardiography, differentiate between physiological LV dilatation in athletes and early dilated cardiomyopathy?
P
Population
84 asymptomatic active males, including 35 with non-ischaemic dilated cardiomyopathy (DCM), 25 athletes in the 'grey zone' (LV enlargement and LVEF <55% exercising ≥8 hours/week), and 24 healthy athlete controls with normal LV geometry and LVEF.
I
Intervention
A cascade of investigations including NT-proBNP measurement, 12-lead ECG, Holter monitoring, cardiovascular magnetic resonance (CMR), and exercise stress echocardiography.
C
Comparator
Comparison of diagnostic findings between grey-zone athletes and patients with DCM.
O
Outcome
Differentiation between physiological left ventricular dilatation (grey-zone athletes) and early dilated cardiomyopathy (DCM).surrogate
Main Result
Effect estimate: null (95% CI null)
Absolute Event Rate: 17.7% vs 13.1%
p-value: p=<0.0001
Exercise stress echocardiography, specifically the inability to increase LVEF >11% or achieve a peak LVEF >63%, provides the greatest discriminatory value in differentiating physiological LV dilatation in athletes from early dilated cardiomyopathy.
Limitations
- Study participants were predominantly Caucasian and exclusively male, affecting generalizability.
- Relatively small sample size limits result applicability.
- The algorithm was derived and assessed in the same cohort; further validation is required.
- Small sample size requiring validation in larger studies
Cite This Study
Millar et al. (2020) conducted a cohort in Dilated cardiomyopathy and athlete’s heart differentiation (n=84). Exercise echocardiography vs. Control athletes was evaluated on Change in left ventricular ejection fraction (LVEF) from baseline to peak exercise (null, 95% CI null, p=<0.0001). Exercise echocardiography showed that 96% of grey-zone athletes increased LVEF by >11% from baseline to peak exercise compared to only 23% of DCM patients (p<0.0001).