Left Ventricular Hypertrophy in Athletes: Differentiating Physiology From Pathology

Area of Science:

• Cardiology
• Sports Medicine
• Physiology

Background:

• Athlete's heart involves cardiac adaptations influenced by age, gender, ethnicity, and training type.
• Distinguishing physiological left ventricular hypertrophy from pathological hypertrophic cardiomyopathy is clinically significant.

Purpose of the Study:

• To review diagnostic challenges in differentiating physiological left ventricular hypertrophy from hypertrophic cardiomyopathy in athletes.
• To discuss mechanisms, history, clinical, and investigational findings aiding pathology identification.

Main Methods:

• Literature review focusing on differentiating cardiac hypertrophy in athletes.
• Analysis of clinical presentation, electrocardiography (ECG), echocardiography, and cardiac magnetic resonance (CMR) findings.

Main Results:

• Physiological left ventricular hypertrophy (LVH) differs from hypertrophic cardiomyopathy (HCM) in LVH pattern, relative wall thickness, ECG changes, and LV cavity size.
• Diastolic echocardiographic parameters and global longitudinal strain show potential in distinguishing physiology from pathology.
• Cardiac MRI, particularly late gadolinium enhancement, T1 mapping, and extracellular volume quantification, offers additive diagnostic value for fibrosis detection.

Conclusions:

• A systematic approach integrating clinical and investigational data is essential for accurate assessment of LVH in athletes.
• Understanding the interplay between exercise adaptation and potential pathology is key to avoiding misdiagnosis.
• Advanced imaging techniques like CMR hold promise for future diagnostic refinement.