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Borderline Arrhythmogenic Cardiomyopathy in an Athlete: Exercise Testing May Support Clinical Decision-Making
Simon Wernhart1, Martin Halle1, Mark J Haykowsky2
1Department for Preventive Sports Medicine and Sports Cardiology, TUM School of Medicine and Health, TUM University Hospital, Technical University of Munich (TUM), Munich, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
Background:
Arrhythmogenic cardiomyopathy (ACM) bears a considerable risk of malignant arrhythmias and heart failure, but diagnosis in athletes can be challenging.
Case Summary:
We present a male 52-year-old long-distance runner with palpitations, a dilated right ventricle with apical akinesia, nonsustained ventricular tachycardia, and negative genetic testing. We performed combined stress echocardiography and cardiopulmonary exercise testing showing blunted exercise response and a decrease in right ventricular strain during exercise. Although the modified task force criteria were not met, a diagnosis of ACM based on impaired exercise response was made, and termination of high-intensity endurance and restriction to 150 minutes/wk of moderate-intensity training was recommended.
Discussion:
The modified task force criteria are recommended for clinical decision-making, but clinical uncertainties remain in gene-elusive cases. Stress testing may complement current guidelines to unmask underlying cardiomyopathy.
Take-Home Message:
Stress testing should be considered in athletes showing borderline features of ACM.
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