Cardiac MRI findings to differentiate athlete's heart from hypertrophic (HCM), arrhythmogenic right ventricular (ARVC) and dilated (DCM) cardiomyopathy

Abstract

To provide clinically relevant criteria for differentiation between the athlete’s heart and similar appearing hypertrophic (HCM), dilated (DCM), and arrhythmogenic right-ventricular cardiomyopathy (ARVC) in MRI. 40 top-level athletes were prospectively examined with cardiac MR (CMR) in two university centres and compared to retrospectively recruited patients diagnosed with HCM (n = 14), ARVC (n = 18), and DCM (n = 48). Analysed MR imaging parameters in the whole study cohort included morphology, functional parameters and late gadolinium enhancement (LGE). Mean left-ventricular enddiastolic volume index (LVEDVI) was high in athletes (105 ml/m2) but significantly lower compared to DCM (132 ml/m2; p = 0.001). Mean LV ejection fraction (EF) was 61% in athletes, below normal in 7 (18%) athletes vs. EF 29% in DCM, below normal in 46 (96%) patients (p < 0.0001). Mean RV-EF was 54% in athletes vs. 60% in HCM, 46% in ARVC, and 41% in DCM (p < 0.0001). Mean interventricular myocardial thickness was 10 mm in athletes vs. 12 mm in HCM (p = 0.0005), 9 mm in ARVC, and 9 mm in DCM. LGE was present in 1 (5%) athlete, 8 (57%) HCM, 10 (56%) ARVC, and 21 (44%) DCM patients (p < 0.0001). Healthy athletes’ hearts are characterized by both hypertrophy and dilation, low EF of both ventricles at rest, and increased interventricular septal thickness with a low prevalence of LGE. Differentiation of athlete’s heart from other non-ischemic cardiomyopathies in MRI can be challenging due to a significant overlap of characteristics also seen in HCM, ARVC, and DCM.

A case report of profound atrioventricular block in an endurance athlete: how far do you go?

“…The presence of chamber dilatation, systolic dysfunction, and/or fibrosis on CMR will all help ascertain the likelihood of pathology in athletes presenting in the grey zone. 9 , 10 Using athlete-specific reference ranges may also help decrease the false positive rates, potentially resulting in a misdiagnosis in an otherwise young healthy athletic individual. 11 …”

Increased Expression of N2BA Titin Corresponds to More Compliant Myofibrils in Athlete’s Heart

“…An athlete's heart adapts to regular exercise and results in morphological and functional changes of the cardiovascular system [1][2][3]. The importance of this phenomenon is underlined by the increasing number of professional athletes and the demand for physical fitness in the general population [28]. It is differentiated from cardiomyopathies and is considered to be a reversible, physiological condition of the heart [28,29].…”

“…The importance of this phenomenon is underlined by the increasing number of professional athletes and the demand for physical fitness in the general population [28]. It is differentiated from cardiomyopathies and is considered to be a reversible, physiological condition of the heart [28,29]. It has been extensively documented that aerobic exercise induces atrial and ventricular hypertrophy [1,3,4,30].…”

The Dysfunctional Right Ventricle in Dilated Cardiomyopathies: Looking from the Right Point of View

“…Furthermore, a reduced TAPSE/sPAP predicted CRT non-responders, but it did not predict survival at four years in a study on HF patients by Braganca et al [ 87 ]. TAPSE/sPAP was associated with lower survival and the need for LVAD implantation or cardiac transplant in different HFrEF cohorts [ 18 , 88 , 89 , 90 , 91 ]. In a study on DCM patients, five non-invasive echocardiographic surrogates of RVAC were evaluated as potential rehospitalization predictors (TAPSE/sPAP, RVLS/sPAP, RVFWLS/sPAP, 3D RVEF/sPAP, 3D RV SV/ESV).…”