Key result
A 10-point score based on echocardiographic and laboratory parameters accurately revealed hypertrophic cardiomyopathy in a gray zone athletic population (AUC 0.958; 95% CI 0.738-1.0; P=0.00005).
Why the study?
Do echocardiographic and laboratory indices differentiate physiologic LVH from mild HCM in athletes?
Cross-Sectional (n=44)
Do echocardiographic and laboratory indices differentiate physiologic LVH from mild HCM in athletes?
Effect estimate: AUC 0.958 (95% CI 0.738-1.0)
p-value: p=0.00005
A combination of specific echocardiographic parameters and resting BNP can accurately differentiate mild hypertrophic cardiomyopathy from physiologic athlete's heart.
Supports differentiation of mild HCM from athlete's heart via combined echo-lab score; leaves open prospective validation before clinical use.
Left ventricular hypertrophy (LVH) with intraventricular septum thickness (IVST) between 1.2 and 1.5 cm in athletes represents a "gray zone" between physiologic adaptation and mild hypertrophic cardiomyopathy (HCM). Various echo and laboratory parameters have been reported till now in the literature to discriminate the "gray zone" entities. Aim of this study was to assess the efficacy of these "classic" parameters in differentiating physiologic LVH in athletes from mild HCM in a highly selected population. Nine highly trained athletes with IVST (1.28 ± 0.07 cm), 9 patients with mild HCM (1.38 ± 0.11 cm), and 26 athletes without LVH (1.06 ± 0.09 cm; P < 0.0005) underwent echocardiographic study, cardiopulmonary treadmill exercise stress test, and brain natriuretic peptide (BNP) measurement before and after exercise. Among all parameters tested, 7 were found to significantly differ between "gray zone" groups. After bootstrapping analysis, it was found that athletes with left ventricular end-diastolic diameter <4.74 cm, mitral deceleration time >200 ms, isovolumic relaxation time >94 ms, tricuspid E/A < 1.63, septum Em < 9.5 cm/sec, relative wall thickness >0.445, and a BNP value at rest >9.84 pg/mL had a greater possibility for having underlying cardiomyopathy. A 10-point score based on these parameters showed accuracy (area under the curve = 0.958 [95%CI: 0.738-1.0; P = 0.00005, standard error = 0.0342]) for revealing HCM in a gray zone athletic population. Differentiation of adaptive LVH versus HCM in a gray zone population could be facilitated by recognition of certain features referring to LV dimensions, diastolic function, and BNP.
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Pagourelias et al. (2012) conducted a cross-sectional in Left ventricular hypertrophy in athletes and mild hypertrophic cardiomyopathy (n=44). 10-point score based on echocardiographic and laboratory parameters was evaluated on Accuracy of the 10-point score for revealing HCM in a gray zone athletic population (AUC 0.958, 95% CI 0.738-1.0, p=0.00005). A 10-point score based on echocardiographic and laboratory parameters accurately revealed hypertrophic cardiomyopathy in a gray zone athletic population (AUC 0.958; 95% CI 0.738-1.0; P=0.00005).
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