A cardiac MRI model incorporating the left ventricular end-diastolic volume to mass ratio accurately distinguished hypertrophic cardiomyopathy from physiological hypertrophy (AUC 0.995).
Cross-Sectional (n=779)
Does the cardiac MRI-derived LV EDV to EDM ratio accurately differentiate hypertrophic cardiomyopathy from physiological left ventricular hypertrophy in athletes?
The cardiac MRI-derived LV EDV to EDM ratio provides high diagnostic accuracy in differentiating hypertrophic cardiomyopathy from physiological athlete's heart, even in borderline cases.
Effect estimate: AUC 0.995
BACKGROUND: Differentiating physiological left ventricular hypertrophy (LVH) in athletes from pathological hypertrophic cardiomyopathy (HCM) can be challenging. This study assesses the ability of cardiac MRI (CMR) to distinguish between physiological LVH (so-called athlete's heart) and HCM. METHODS: 45 patients with HCM (71% men and 20% athletic) and 734 healthy control participants (60% men and 75% athletic) underwent CMR. Quantitative ventricular parameters were used for multivariate logistic regression with age, gender, sport status and left ventricular (LV) end-diastolic volume (EDV) to ED ventricular wall mass (EDM) ratio as covariates. A second model added the LV EDV : right ventricular (RV) EDV ratio. The performance of the model was subsequently tested. RESULTS: LV EDM was greater in patients with HCM (74 g/m2) compared with healthy athletes/non-athletes (53/41 g/m2), while LV EDV was largest in athletes (114 ml/m2) as compared with non-athletes (94 ml/m2) and patients with HCM (88 ml/m2). The LV EDV : EDM ratio was significantly lower in patients with HCM compared with healthy controls and athletes (1.30/2.39/2.25, p<0.05). The LV EDV : RV EDV ratio was significantly greater in patients with HCM (1.10) than in healthy participants (non-athletes/athletes 0.94/0.93). The regression model resulted in high sensitivity and specificity levels in all and borderline-LVH participants (as defined by septal wall thickness). Corresponding areas under the receiver operator characteristic (ROC) curves were 0.995 (all participants) and 0.992 (borderline-LVH participants only). Adding the LV EDV : RV EDV ratio yielded no additional improvement. CONCLUSIONS: 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.
Luijkx et al. (Fri,) conducted a cross-sectional in Hypertrophic cardiomyopathy vs physiological left ventricular hypertrophy (n=779). Cardiac MRI (LV EDV to EDM ratio) was evaluated on Diagnostic accuracy of the regression model for distinguishing HCM from physiological LVH (AUC 0.995). A cardiac MRI model incorporating the left ventricular end-diastolic volume to mass ratio accurately distinguished hypertrophic cardiomyopathy from physiological hypertrophy (AUC 0.995).