Open AccessThe demanding grey zone: Sport indices by cardiac magnetic resonance imaging differentiate hypertrophic cardiomyopathy from athlete’s heart
Author(s) -
Csilla Czimbalmos,
Ibolya Csécs,
Attila Tóth,
Orsolya Kiss,
Ferenc Imre Suhai,
Nóra Sydó,
Zsófia Dohy,
Astrid Apor,
Béla Merkely,
Hajnalka Vágó
Publication year - 2019
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0211624
Subject(s) - hypertrophic cardiomyopathy , cardiology , medicine , left ventricular hypertrophy , muscle hypertrophy , concentric hypertrophy , magnetic resonance imaging , athletes , diastole , cardiomyopathy , pathological , cardiac magnetic resonance imaging , population , ventricular remodeling , heart failure , radiology , blood pressure , physical therapy , environmental health
Background We aimed to characterize gender specific left ventricular hypertrophy using a novel, accurate and less time demanding cardiac magnetic resonance (CMR) quantification method to differentiate physiological hypertrophy and hypertrophic cardiomyopathy based on a large population of highly trained athletes and hypertrophic cardiomyopathy patients. Methods Elite athletes (n = 150,>18 training hours/week), HCM patients (n = 194) and athletes with hypertrophic cardiomyopathy (n = 10) were examined by CMR. CMR based sport indices such as maximal end-diastolic wall thickness to left ventricular end-diastolic volume index ratio (EDWT/LVEDVi) and left ventricular mass to left ventricular end-diastolic volume ratio (LVM/LVEDV) were calculated, established using both conventional and threshold-based quantification method. Results Whereas 47.5% of male athletes, only 4.1% of female athletes were in the grey zone of hypertrophy (EDWT 13-16mm). EDWT/LVEDVi discriminated between physiological and pathological left ventricular hypertrophy with excellent diagnostic accuracy (AUC CQ :0.998, AUC TQ :0.999). Cut-off value for LVM/LVEDV CQ <0.82 mm×m 2 /ml and for EDWT/LVEDVi TQ <1.27 discriminated between physiological and pathological left ventricular hypertrophy with a sensitivity of 77.8% and 89.2%, a specificity of 86.7% and 91.3%, respectively. LVM/LVEDV evaluated using threshold-based quantification performed significantly better than conventional quantification even in the male subgroup with EDWT between 13-16mm (p<0.001). Conclusions Almost 50% of male highly trained athletes can reach EDWT of 13 mm. CMR based sport indices provide an important tool to distinguish hypertrophic cardiomyopathy from athlete’s heart, especially in highly trained athletes in the grey zone of hypertrophy.