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Differentiation of Myocardial Properties in Physiological Athletic Cardiac Remodeling and Mild Hypertrophic
Lars G Klaeboe1, Øyvind H Lie1, Pål H Brekke1
1Precision Health Center for Optimized Cardiac Care (ProCardio), Department of Cardiology, Oslo University Hospital, Rikshospitalet, 0424 Oslo, Norway.
Insights
Distinguishing athlete hearts from hypertrophic cardiomyopathy (HCM) is challenging. Speckle tracking echocardiography (STE) and cardiac magnetic resonance imaging (CMR) show promise, with mechanical dispersion (MD) and native T1-time effectively differentiating the two conditions.
Area of Science:
- Cardiology
- Medical Imaging
- Sports Cardiology
Background:
- Differentiating athlete's heart from hypertrophic cardiomyopathy (HCM) presents a clinical challenge.
- Distinguishing physiological cardiac adaptation in athletes from pathological hypertrophy in HCM is crucial for accurate diagnosis and management.
- Advanced imaging techniques are needed to improve diagnostic accuracy in these overlapping conditions.
Purpose of the Study:
- To evaluate the utility of speckle tracking echocardiography (STE) and cardiac magnetic resonance imaging (CMR) in differentiating athlete's heart from mild HCM.
- To compare mechanical dispersion (MD) assessed by STE and native T1-time and extracellular volume (ECV) assessed by CMR between athletes and HCM patients.
Main Methods:
- Comparison of 30 elite endurance athletes with 20 mild HCM mutation carriers.
- Assessment of mechanical dispersion (MD) using speckle tracking echocardiography (STE).
- Measurement of native T1-time and extracellular volume (ECV) using cardiac magnetic resonance imaging (CMR).
Main Results:
- Mechanical dispersion (MD) was significantly higher in HCM carriers (54 ± 16 ms) compared to athletes (40 ± 11 ms) (p=0.001).
- Athletes exhibited lower native T1-time (1204 ms) and ECV (22.7%) than HCM carriers (1265 ms and 25.6%, respectively).
- MD > 44 ms (AUC 0.78) and native T1-time > 1230 ms (AUC 0.83, 100% sensitivity for HCM) demonstrated significant discriminatory ability.
Conclusions:
- STE-derived mechanical dispersion and CMR-derived native T1-time are valuable tools for differentiating athlete's heart from mild hypertrophic cardiomyopathy.
- These imaging modalities offer improved diagnostic accuracy, aiding clinicians in distinguishing between physiological and pathological cardiac changes.
Abstract:
Clinical differentiation between athletes' hearts and those with hypertrophic cardiomyopathy (HCM) can be challenging. We aimed to explore the role of speckle tracking echocardiography (STE) and cardiac magnetic resonance imaging (CMR) in the differentiation between athletes' hearts and those with mild HCM. We compared 30 competitive endurance elite athletes (7% female, age 41 ± 9 years) and 20 mild phenotypic mutation-positive HCM carriers (15% female, age 51 ± 12 years) with left ventricular wall thickness 13 ± 1 mm. Mechanical dispersion (MD) was assessed by means of STE. Native T1-time and extracellular volume (ECV) were assessed by means of CMR. MD was higher in HCM mutation carriers than in athletes (54 ± 16 ms vs. 40 ± 11 ms, p = 0.001). Athletes had a lower native T1-time (1204 (IQR 1191, 1234) ms vs. 1265 (IQR 1255, 1312) ms, p < 0.001) and lower ECV (22.7 ± 3.2% vs. 25.6 ± 4.1%, p = 0.01). MD > 44 ms optimally discriminated between athletes and HCM mutation carriers (AUC 0.78, 95% CI 0.65-0.91). Among the CMR parameters, the native T1-time had the best discriminatory ability, identifying all HCM mutation carriers (100% sensitivity) with a specificity of 75% (AUC 0.83, 95% CI 0.71-0.96) using a native T1-time > 1230 ms as the cutoff. STE and CMR tissue characterization may be tools that can differentiate athletes' hearts from those with mild HCM.
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