Differentiating hypertrophic cardiomyopathy from athlete's heart: An electrocardiographic and echocardiographic...

Area of Science:

• Cardiology
• Diagnostic Imaging
• Electrocardiography

Background:

• Differentiating hypertrophic cardiomyopathy (HCM) from athlete's heart is challenging, especially with mild-moderate left-ventricular hypertrophy.
• Accurate diagnosis is crucial for appropriate patient management and risk stratification.

Purpose of the Study:

• To evaluate the effectiveness of various ECG and echocardiographic parameters in the differential diagnosis of HCM.
• To identify the most reliable criteria for distinguishing HCM from athlete's heart in individuals with borderline left-ventricular hypertrophy.

Main Methods:

• A study involving 75 men divided into three groups: controls (n=30), "gray zone" athletes (n=25), and HCM patients (n=20).
• Assessment of interventricular septum (IVS) thickness, left ventricle end-diastolic diameter (LV-EDD), relative septal thickness (RST), spatial QRS-T angle, and T-wave inversion (TWI).
• Analysis of diagnostic performance using Area Under the Curve (AUC) for individual and combined parameters.

Main Results:

• Relative septal thickness (RST) and spatial QRS-T angle showed significant differences between groups (p<0.01).
• RST > 0.54 demonstrated the highest diagnostic accuracy (AUC=0.92) for HCM.
• Spatial QRS-T angle > 45 (AUC=0.75) and TWI (AUC=0.67) were also significant predictors.
• Combining parameters did not significantly improve diagnostic performance compared to RST alone.

Conclusions:

• Relative septal thickness (RST) > 0.54 is the most effective criterion for differentiating HCM from athlete's heart.
• Spatial QRS-T angle and TWI are useful but less accurate than RST.
• No significant benefit was observed from combining multiple diagnostic parameters for HCM diagnosis in this cohort.