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Role of the electrocardiogram in differentiating genetically determined dilated cardiomyopathy from athlete's heart

Denise Zaffalon1, Efstathios Papatheodorou2, Ahmed Merghani2

  • 1Cardiovascular Department, Azienda Sanitaria Giuliano-Isontina, University of Trieste, Trieste, Italy.

European Journal of Clinical Investigation
|July 18, 2022
PubMed

Insights

The electrocardiogram (ECG) can help distinguish dilated cardiomyopathy (DCM) from physiological cardiac remodelling in athletes. While often abnormal in DCM patients, the ECG is typically normal in athletes, showing specific abnormalities like low voltages and T-wave inversion in DCM.

Area of Science:

  • Cardiology
  • Sports Medicine
  • Medical Diagnostics

Background:

  • Physiological cardiac remodelling in athletes can mimic dilated cardiomyopathy (DCM).
  • Distinguishing between athlete's heart and pathological conditions like DCM is clinically important.

Purpose of the Study:

  • To evaluate the electrocardiogram (ECG) for its effectiveness in differentiating physiological cardiac remodelling in athletes from dilated cardiomyopathy (DCM).

Main Methods:

  • Compared ECG findings in 30 DCM patients with pathogenic variants to 30 elite athletes with significant left ventricular (LV) remodelling.
  • Defined significant LV remodelling as LV end-diastolic diameter >62 mm and/or LV ejection fraction between 45-50%.

Main Results:

  • ECG abnormalities were found in 73% of DCM patients, most commonly low voltages and lateral T-wave inversion (TWI).
  • Only two athletes had abnormal ECGs (LBBB, atrial flutter).
  • ECG sensitivity, specificity, and accuracy for differentiating DCM were 73%, 93%, and 83%, respectively.

Conclusions:

  • The ECG is frequently abnormal in DCM patients with pathogenic variants.
  • ECG is typically normal in athletes with significant LV dilatation or systolic dysfunction.
  • Low limb lead voltages and lateral TWI are key ECG indicators differentiating DCM from athlete's heart.
Abstract

Keywords:
athlete's heartdilated cardiomyopathyelectrocardiogram

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