Key result
The anti-DSG2 antibody, a biomarker for ARVC, was absent in all 30 middle-aged endurance athletes with right ventricular enlargement, demonstrating 100% specificity in this cohort.
Why the study?
It was unknown whether the anti-DSG2 antibody, a novel ARVC biomarker, is present in endurance athletes with RV enlargement but without clinical ARVC.
Is the anti-DSG2 antibody present in middle-aged endurance athletes with right ventricular enlargement?
Cross-Sectional (n=30)
Researchers were blinded to clinical data during analysis
Is the anti-DSG2 antibody present in middle-aged endurance athletes with right ventricular enlargement?
The absence of the anti-DSG2 biomarker in endurance athletes with RV enlargement suggests that physiological exercise-induced RV remodeling is distinct from pathologic ARVC.
May aid differentiation of exercise-induced RV remodeling from ARVC; leaves open prospective validation in larger athlete cohorts.
BACKGROUND: Right ventricular (RV) enlargement is common in endurance athletes. It is usually considered to be physiological, but it is possible that this remodelling is adverse, manifesting as a variant of arrhythmogenic right ventricular cardiomyopathy (ARVC), termed "exercise-induced ARVC." A novel biomarker (anti-desmoglein-2 [anti-DSG2] antibody) has been shown to indicate ARVC with high sensitivity and specificity and may be an immune response to breakdown of RV desmosomes. It is not known if this antibody is present in endurance athletes with RV enlargement but without clinical ARVC. METHODS: Middle-aged, healthy endurance athletes with RV enlargement on cardiac magnetic resonance imaging had serum tested for the presence of the anti-DSG2 antibody. All athletes also underwent Holter monitoring, a signal-averaged electrocardiogram, and an exercise questionnaire. RESULTS: (women). Athletes demonstrated other characteristics of endurance training, including depolarization abnormalities (abnormal signal-averaged electrocardiogram, 19 of 30) and incomplete right bundle branch block (8 of 30). No athlete met criteria for definite or probable ARVC. None of the athletes tested positive for anti-DSG2 antibody. CONCLUSIONS: Among middle-aged endurance athletes with RV enlargement, the anti-DSG2 antibody, a suggested ARVC biomarker, is absent in all and is highly specific in this cohort (95% confidence interval, 88%-100%). Despite significant RV remodelling, these athletes did not express a previously characterized pathologic biomarker known to be sensitive for ARVC. Physiological exercise remodelling and pathologic ARVC remodelling are likely separate processes.
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Dorian et al. (2021) conducted a cross-sectional in Right ventricular enlargement in endurance athletes (n=30). Endurance exercise with right ventricular enlargement was evaluated on Proportion of athletes with a positive anti-DSG2 test by western blot (100% specificity, 95% CI 88-100). The anti-DSG2 antibody, a biomarker for ARVC, was absent in all 30 middle-aged endurance athletes with right ventricular enlargement, demonstrating 100% specificity in this cohort.
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