Key result
Area-length echocardiography yields ~9% higher LV mass than the linear method in elite rugby athletes.
Why the study?
Recommendations suggest linear methods for echocardiographic LV mass in athletes, but comparisons with the area-length method and their impact on 2-tier and 4-tier geometry classifications in elite rugby league athletes were unestablished.
Does the area-length method compared to the linear method alter the calculated LV mass and geometry classification in elite rugby football league athletes?
Cross-Sectional (n=220)
No
Does the area-length method compared to the linear method alter the calculated LV mass and geometry classification in elite rugby football league athletes?
The area-length method yields significantly higher LV mass estimates than the linear method in elite rugby athletes, leading to a higher prevalence of eccentric hypertrophy classification.
Answers are grounded in this paper and cite their sources.
Findings should not yet change echocardiographic method choice in athletes; leaves open need for outcome-linked validation studies.
Background: Recommendations for the echocardiographic assessment of left ventricular (LV) mass in the athlete suggest the use of the linear method using a two-tiered classification system (2TC). The aims of this study were to compare the linear method and the area-length (A-L) method for LV mass in elite rugby football league (RFL) athletes and to establish how any differences impact the classification of LV geometry using 2TC and four-tier (4TC) classification systems. Methods: Two hundred and twenty (220) male RFL athletes aged 25 ± 5 (14-34 years) were recruited. All athletes underwent echocardiography and LV mass was calculated by the American Society of Echocardiography (ASE) corrected Linear equation (2D) and the A-L method. Left ventricular mass Index (LVMi) was used with relative wall thickness to determine geometry in the 2TC and with concentricity and LV end diastolic volume index for the 4TC. Method specific recommended cut-offs were utilised. Normal LV geometry was demonstrated in 98.2% and 80% of athletes whilst eccentric hypertrophy in 1.4% and 19.5% for linear and A-L respectively. Both methods provided 0.5% as having concentric remodelling and 0% as having concentric hypertrophy. Allocation to the 4TC resulted in 97% and 80% with normal geometry, 0% and 8.6% with eccentric dilated hypertrophy, 0% and 7.7% with eccentric non-dilated hypertrophy, 1.4% and 0.5% with concentric remodelling and 1.4% and 3% with concentric non-dilated hypertrophy for linear and A-L methods respectively. No participants had concentric dilated hypertrophy from either methods. Conclusion: The linear and A-L method for calculation of LV mass in RFL athletes are not interchangeable with significantly higher values obtained using A-L method impacting on geometry classification. More athletes present with eccentric hypertrophy using 2TC and eccentric dilated/non-dilated using 4TC. Further studies should be aimed at establishing the association of A-L methods of LV mass and application of the 4TC to the multi-factorial demographics of the athlete.
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McGregor-Cheers et al. (2023) conducted a cross-sectional in Elite rugby football league athletes (n=220). Area-length (A-L) echocardiographic method vs. Linear echocardiographic method was evaluated on Absolute left ventricular mass (g) (p=<0.0001). The area-length echocardiographic method yielded significantly higher absolute left ventricular mass (197 g) compared to the linear method (181 g; p<0.0001) in elite male rugby football league athletes.
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