Differentiation between athlete's heart and dilated cardiomyopathy in athletic individuals

Lynne Martina Millar; Zephryn Fanton; Gherardo Finocchiaro; Gabriel Sanchez-Fernandez; Harshil Dhutia; Aneil Malhotra; Ahmed Merghani; Michael Papadakis; Elijah R. Behr; Nick Bunce; David Oxborough; Matthew Reed; Jamie O'Driscoll; Maria Teresa Tome Esteban; Andrew D'Silva; Gerry Carr-White; Jessica Webb; Rajan Sharma; Sanjay Sharma

doi:10.1136/heartjnl-2019-316147

Differentiation between athlete's heart and dilated cardiomyopathy in athletic individuals

Lynne Martina Millar, Zephryn Fanton, Gherardo Finocchiaro, Gabriel Sanchez-Fernandez, Harshil Dhutia, Aneil Malhotra, Ahmed Merghani, Michael Papadakis, Elijah R. Behr, Nick Bunce, David Oxborough, Matthew Reed, Jamie O'Driscoll, Maria Teresa Tome Esteban, Andrew D'Silva, Gerry Carr-White, Jessica Webb, Rajan Sharma, Sanjay Sharma^*

^*Corresponding author for this work

Imaging and Biomedical Engineering

Research output: Contribution to journal › Article › peer-review

64 Citations (Scopus)

Abstract

Objective: Distinguishing early dilated cardiomyopathy (DCM) from physiological left ventricular (LV) dilatation with LV ejection fraction <55% in athletes (grey zone) is challenging. We evaluated the role of a cascade of investigations to differentiate these two entities. Methods: Thirty-five asymptomatic active males with DCM, 25 male athletes in the 'grey zone' and 24 male athletes with normal LV ejection fraction underwent N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement, ECG and exercise echocardiography. Grey-zone athletes and patients with DCM underwent cardiovascular magnetic resonance (CMR) and Holter monitoring. Results: Larger LV cavity dimensions and lower LV ejection fraction were the only differences between grey-zone and control athletes. None of the grey-zone athletes had abnormal NT-proBNP, increased ectopic burden/complex arrhythmias or pathological late gadolinium enhancement on CMR. These features were also absent in 71%, 71% and 50% of patients with DCM, respectively. 95% of grey-zone athletes and 60% of patients with DCM had normal ECG. During exercise echocardiography, 96% grey-zone athletes increased LV ejection fraction by >11% from baseline to peak exercise compared with 23% of patients with DCM (p<0.0001). Peak LV ejection fraction was >63% in 92% grey-zone athletes compared with 17% patients with DCM (p<0.0001). Failure to increase LV ejection fraction >11% from baseline to peak exercise or achieve a peak LV ejection fraction >63% had sensitivity of 77% and 83%, respectively, and specificity of 96% and 92%, respectively, for predicting DCM. Conclusion: Comprehensive assessment using a cascade of routine investigations revealed that exercise stress echocardiography has the greatest discriminatory value in differentiating between grey-zone athletes and asymptomatic patients with DCM. Our findings require validation in larger studies.

Original language	English
Journal	Heart
DOIs	https://doi.org/10.1136/heartjnl-2019-316147
Publication status	Accepted/In press - 1 Jan 2020

Keywords

idiopathic dilated cardiomyopathy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1136/heartjnl-2019-316147

Cite this

Millar, L. M., Fanton, Z., Finocchiaro, G., Sanchez-Fernandez, G., Dhutia, H., Malhotra, A., Merghani, A., Papadakis, M., Behr, E. R., Bunce, N., Oxborough, D., Reed, M., O'Driscoll, J., Tome Esteban, M. T., D'Silva, A., Carr-White, G., Webb, J., Sharma, R., & Sharma, S. (Accepted/In press). Differentiation between athlete's heart and dilated cardiomyopathy in athletic individuals. Heart. https://doi.org/10.1136/heartjnl-2019-316147

@article{ec3bf53b47e44e7d9de4611f890c1ab8,

title = "Differentiation between athlete's heart and dilated cardiomyopathy in athletic individuals",

abstract = "Objective: Distinguishing early dilated cardiomyopathy (DCM) from physiological left ventricular (LV) dilatation with LV ejection fraction <55% in athletes (grey zone) is challenging. We evaluated the role of a cascade of investigations to differentiate these two entities. Methods: Thirty-five asymptomatic active males with DCM, 25 male athletes in the 'grey zone' and 24 male athletes with normal LV ejection fraction underwent N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement, ECG and exercise echocardiography. Grey-zone athletes and patients with DCM underwent cardiovascular magnetic resonance (CMR) and Holter monitoring. Results: Larger LV cavity dimensions and lower LV ejection fraction were the only differences between grey-zone and control athletes. None of the grey-zone athletes had abnormal NT-proBNP, increased ectopic burden/complex arrhythmias or pathological late gadolinium enhancement on CMR. These features were also absent in 71%, 71% and 50% of patients with DCM, respectively. 95% of grey-zone athletes and 60% of patients with DCM had normal ECG. During exercise echocardiography, 96% grey-zone athletes increased LV ejection fraction by >11% from baseline to peak exercise compared with 23% of patients with DCM (p<0.0001). Peak LV ejection fraction was >63% in 92% grey-zone athletes compared with 17% patients with DCM (p<0.0001). Failure to increase LV ejection fraction >11% from baseline to peak exercise or achieve a peak LV ejection fraction >63% had sensitivity of 77% and 83%, respectively, and specificity of 96% and 92%, respectively, for predicting DCM. Conclusion: Comprehensive assessment using a cascade of routine investigations revealed that exercise stress echocardiography has the greatest discriminatory value in differentiating between grey-zone athletes and asymptomatic patients with DCM. Our findings require validation in larger studies.",

keywords = "idiopathic dilated cardiomyopathy",

author = "Millar, {Lynne Martina} and Zephryn Fanton and Gherardo Finocchiaro and Gabriel Sanchez-Fernandez and Harshil Dhutia and Aneil Malhotra and Ahmed Merghani and Michael Papadakis and Behr, {Elijah R.} and Nick Bunce and David Oxborough and Matthew Reed and Jamie O'Driscoll and {Tome Esteban}, {Maria Teresa} and Andrew D'Silva and Gerry Carr-White and Jessica Webb and Rajan Sharma and Sanjay Sharma",

year = "2020",

month = jan,

day = "1",

doi = "10.1136/heartjnl-2019-316147",

language = "English",

journal = "Heart",

issn = "1355-6037",

publisher = "BMJ Publishing Group Ltd",

}

Millar, LM, Fanton, Z, Finocchiaro, G, Sanchez-Fernandez, G, Dhutia, H, Malhotra, A, Merghani, A, Papadakis, M, Behr, ER, Bunce, N, Oxborough, D, Reed, M, O'Driscoll, J, Tome Esteban, MT, D'Silva, A, Carr-White, G , Webb, J, Sharma, R & Sharma, S 2020, 'Differentiation between athlete's heart and dilated cardiomyopathy in athletic individuals', Heart. https://doi.org/10.1136/heartjnl-2019-316147

TY - JOUR

T1 - Differentiation between athlete's heart and dilated cardiomyopathy in athletic individuals

AU - Millar, Lynne Martina

AU - Fanton, Zephryn

AU - Finocchiaro, Gherardo

AU - Sanchez-Fernandez, Gabriel

AU - Dhutia, Harshil

AU - Malhotra, Aneil

AU - Merghani, Ahmed

AU - Papadakis, Michael

AU - Behr, Elijah R.

AU - Bunce, Nick

AU - Oxborough, David

AU - Reed, Matthew

AU - O'Driscoll, Jamie

AU - Tome Esteban, Maria Teresa

AU - D'Silva, Andrew

AU - Carr-White, Gerry

AU - Webb, Jessica

AU - Sharma, Rajan

AU - Sharma, Sanjay

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Objective: Distinguishing early dilated cardiomyopathy (DCM) from physiological left ventricular (LV) dilatation with LV ejection fraction <55% in athletes (grey zone) is challenging. We evaluated the role of a cascade of investigations to differentiate these two entities. Methods: Thirty-five asymptomatic active males with DCM, 25 male athletes in the 'grey zone' and 24 male athletes with normal LV ejection fraction underwent N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement, ECG and exercise echocardiography. Grey-zone athletes and patients with DCM underwent cardiovascular magnetic resonance (CMR) and Holter monitoring. Results: Larger LV cavity dimensions and lower LV ejection fraction were the only differences between grey-zone and control athletes. None of the grey-zone athletes had abnormal NT-proBNP, increased ectopic burden/complex arrhythmias or pathological late gadolinium enhancement on CMR. These features were also absent in 71%, 71% and 50% of patients with DCM, respectively. 95% of grey-zone athletes and 60% of patients with DCM had normal ECG. During exercise echocardiography, 96% grey-zone athletes increased LV ejection fraction by >11% from baseline to peak exercise compared with 23% of patients with DCM (p<0.0001). Peak LV ejection fraction was >63% in 92% grey-zone athletes compared with 17% patients with DCM (p<0.0001). Failure to increase LV ejection fraction >11% from baseline to peak exercise or achieve a peak LV ejection fraction >63% had sensitivity of 77% and 83%, respectively, and specificity of 96% and 92%, respectively, for predicting DCM. Conclusion: Comprehensive assessment using a cascade of routine investigations revealed that exercise stress echocardiography has the greatest discriminatory value in differentiating between grey-zone athletes and asymptomatic patients with DCM. Our findings require validation in larger studies.

AB - Objective: Distinguishing early dilated cardiomyopathy (DCM) from physiological left ventricular (LV) dilatation with LV ejection fraction <55% in athletes (grey zone) is challenging. We evaluated the role of a cascade of investigations to differentiate these two entities. Methods: Thirty-five asymptomatic active males with DCM, 25 male athletes in the 'grey zone' and 24 male athletes with normal LV ejection fraction underwent N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement, ECG and exercise echocardiography. Grey-zone athletes and patients with DCM underwent cardiovascular magnetic resonance (CMR) and Holter monitoring. Results: Larger LV cavity dimensions and lower LV ejection fraction were the only differences between grey-zone and control athletes. None of the grey-zone athletes had abnormal NT-proBNP, increased ectopic burden/complex arrhythmias or pathological late gadolinium enhancement on CMR. These features were also absent in 71%, 71% and 50% of patients with DCM, respectively. 95% of grey-zone athletes and 60% of patients with DCM had normal ECG. During exercise echocardiography, 96% grey-zone athletes increased LV ejection fraction by >11% from baseline to peak exercise compared with 23% of patients with DCM (p<0.0001). Peak LV ejection fraction was >63% in 92% grey-zone athletes compared with 17% patients with DCM (p<0.0001). Failure to increase LV ejection fraction >11% from baseline to peak exercise or achieve a peak LV ejection fraction >63% had sensitivity of 77% and 83%, respectively, and specificity of 96% and 92%, respectively, for predicting DCM. Conclusion: Comprehensive assessment using a cascade of routine investigations revealed that exercise stress echocardiography has the greatest discriminatory value in differentiating between grey-zone athletes and asymptomatic patients with DCM. Our findings require validation in larger studies.

KW - idiopathic dilated cardiomyopathy

UR - http://www.scopus.com/inward/record.url?scp=85084069294&partnerID=8YFLogxK

U2 - 10.1136/heartjnl-2019-316147

DO - 10.1136/heartjnl-2019-316147

M3 - Article

AN - SCOPUS:85084069294

SN - 1355-6037

JO - Heart

JF - Heart

ER -

Differentiation between athlete's heart and dilated cardiomyopathy in athletic individuals

Abstract

Keywords

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this