Differentiation of Myocardial Properties in Physiological Athletic Cardiac Remodeling and Mild Hypertrophic...

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.