Exercise cardiac magnetic resonance to differentiate athlete’s heart from structural heart disease

Claessen, Guido; Schnell, Frédéric; Bogaert, Jan; Claeys, Mathias; Pattyn, Nele; Buck, Frederik De; Dymarkowski, Steven; Claus, Piet; Carré, François; Cleemput, Johan Van; Gerche, André La; Heidbüchel, Hein

doi:10.1093/ehjci/jey050

Cited by 56 publications

(46 citation statements)

References 34 publications

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“…Our finding that 11.6% of EC and 6.7% of SEC present with reduced EF emphasizes the challenge of differentiating physiological and pathological adaptation in this group. Claessen et al 39 have previously demonstrated that a low EF in this population is simply a function of increased cavity volume, which requires a lower contractile force to produce the necessary stroke volume.…”

Section: Discussionmentioning

confidence: 84%

“…In contrast, E velocity and E’ velocity were both lower in EC (compared to NA), which indicate lower diastolic function. The most likely explanation for these lower values may be a significantly greater reserve volume and lower resting HR in comparison to both SEC and NA, resulting in a decreased need for enhanced relaxation/suction at rest 39 …”

Section: Discussionmentioning

confidence: 99%

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Left ventricular remodeling in elite and sub‐elite road cyclists

Brown

Millar

Somauroo

et al. 2020

Scandinavian Med Sci Sports

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Marked adaptation of left ventricular (LV) structure in endurance athletes is well established. However, previous investigations of functional and mechanical adaptation have been contradictory. A lack of clarity in subjects’ athletic performance level may have contributed to these disparate findings. This study aimed to describe structural, functional, and mechanical characteristics of the cyclists’ LV, based on clearly defined performance levels. Male elite cyclists (EC) (n = 69), sub‐elite cyclists (SEC) (n = 30), and non‐athletes (NA) (n = 46) were comparatively studied using conventional and speckle tracking 2D echocardiography. Dilated eccentric hypertrophy was common in EC (34.7%), but not SEC (3.3%). Chamber concentricity was higher in EC compared to SEC (7.11 ± 1.08 vs 5.85 ± 0.98 g/(mL)2/3, P < .001). Ejection fraction (EF) was lower in EC compared to NA (57 ± 5% vs 59 ± 4%, P < .05), and reduced EF was observed in a greater proportion of EC (11.6%) compared to SEC (6.7%). Global circumferential strain (GCε) was greater in EC (−18.4 ± 2.4%) and SEC (−19.8 ± 2.7%) compared to NA (−17.2 ± 2.6%) (P < .05 and P < .001). Early diastolic filling was lower in EC compared with SEC (0.72 ± 0.14 vs 0.88 ± 0.12 cm/s, P < .001), as were septal E’ (12 ± 2 vs 15 ± 2 cm/s, P < .001) and lateral E’ (18 ± 4 vs 20 ± 4 cm/s, P < .05). The magnitude of LV structural adaptation was far greater in EC compared with SEC. Increased GCε may represent a compensatory mechanism to maintain stroke volume in the presence of increased chamber volume. Decreased E and E’ velocities may be indicative of a considerable functional reserve in EC.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Left ventricular remodeling in elite and sub‐elite road cyclists

Brown

Millar

Somauroo

et al. 2020

Scandinavian Med Sci Sports

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“…In terms of differentiating the athletic heart from cardiomyopathy, when 10 healthy endurance athletes were compared with 9 endurance athletes with subepicardial fibrosis and 5 patients with dilated cardiomyopathy, they demonstrated a significantly greater augmentation of LV ejection fraction (LVEF) during exercise of 14 ± 3%, compared with 4 ± 3% and 5 ± 6% respectively. The endurance athletes with subepicardial fibrosis had similar resting haemodynamics and exercise capacity to the healthy endurance athletes, suggesting that Ex-CMR may be helpful in differentiating healthy endurance athletes from those with fibrosis [63].…”

Section: Athletic Heart Diseasementioning

confidence: 84%

Exercise cardiovascular magnetic resonance: development, current utility and future applications

Craven

Tsao

Gerche

et al. 2020

Journal of Cardiovascular Magnetic Resonance

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Stress cardiac imaging is the current first line investigation for coronary artery disease diagnosis and decision making and an adjunctive tool in a range of non-ischaemic cardiovascular diseases. Exercise cardiovascular magnetic resonance (Ex-CMR) has developed over the past 25 years to combine the superior image qualities of CMR with the preferred method of exercise stress. Presently, numerous exercise methods exist, from performing stress on an adjacent CMR compatible treadmill to in-scanner exercise, most commonly on a supine cycle ergometer. Cardiac conditions studied by Ex-CMR are broad, commonly investigating ischaemic heart disease and congenital heart disease but extending to pulmonary hypertension and diabetic heart disease. This review presents an in-depth assessment of the various Ex-CMR stress methods and the varied pulse sequence approaches, including those specially designed for Ex-CMR. Current and future developments in image acquisition are highlighted, and will likely lead to a much greater clinical use of Ex-CMR across a range of cardiovascular conditions.

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“…Conduction disease such as left bundle branch block or repolarisation abnormalities such as pathological T wave inversions are similarly suggestive of cardiomyopathy. Ventricular arrhythmias, either on ambulatory monitoring or exercise testing as well as functional testing abnormalities including a low peak oxygen consumption (VO 2 ) on cardiopulmonary exercise testing or a failure to increase LVEF by at least 11% on peak exercise imaging [ 61 ] potentially indicate disease. Specific additional imaging parameters including moderate or severe LV systolic impairment, diastolic dysfunction, regional wall motion abnormalities and late gadolinium enhancement on CMR have also been proposed as discriminatory features favouring pathology.…”

Section: Management Of Athletes With Excessive Trabeculationmentioning

confidence: 99%

Left Ventricular Trabeculations in Athletes: Epiphenomenon or Phenotype of Disease?

Abela

D’Silva

2018

Curr Treat Options Cardio Med

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Purpose of reviewExcessive trabeculation attracting a diagnosis of left ventricular noncompaction cardiomyopathy (LVNC) has been reported in ostensibly healthy athletes. This review aims to explain why this occurs and whether this represents a spectrum of athletic physiological remodelling or unmasking of occult cardiomyopathy.Recent findingsGenetic studies have yet to identify a dominant mutation associated with the LVNC phenotype and reported gene mutations overlap with many distinct cardiomyopathies and ion channel disorders, implying that the phenotype is shared across different genetic conditions. Large contemporary cohort studies indicate that current LVNC imaging criteria are oversensitive and not predictive of adverse clinical outcomes.SummaryThe majority of excessive LV trabeculation, as assessed by current quantification methods, is not due to cardiomyopathy but forms part of the normal continuum in health with potential contributions from cardiac remodelling processes. The study of rare, severe LVNC phenotypes may yield insights into an underlying molecular pathogenesis but in the absence of a universally accepted definition, contamination with aetiologically distinct conditions expressing a similar phenotype will remain an issue. Automated, objective quantification of trabeculation will help to define the normal distribution using big data without the constraint of wide interobserver variation.

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Exercise cardiac magnetic resonance to differentiate athlete’s heart from structural heart disease

Abstract: Functional cardiac evaluation during exercise is a promising tool in differentiating healthy athletes with borderline LVEF from those with an underlying cardiomyopathy. Excellent exercise capacity does not exclude significant LV damage.

Cited by 56 publications

References 34 publications

Left ventricular remodeling in elite and sub‐elite road cyclists

Left ventricular remodeling in elite and sub‐elite road cyclists

Exercise cardiovascular magnetic resonance: development, current utility and future applications

Left Ventricular Trabeculations in Athletes: Epiphenomenon or Phenotype of Disease?

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