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Cirovic S, Malmgren A, Kurdie R, Bilal D, Dencker M, Gudmundsson P. Vortex formation time in female athletes. Int J Cardiovasc Imaging 2024; 40:373-384. [PMID: 38008878 PMCID: PMC10884071 DOI: 10.1007/s10554-023-02995-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/25/2023] [Indexed: 11/28/2023]
Abstract
Regular, vigorous physical activity can have a significant impact on cardiac function, leading to cardiac morphological alterations that may be challenging to distinguish from pathological changes. Therefore, new screening methods are needed to accurately differentiate between adaptive changes and pathological alterations in athletes. Vortex formation time (VFT) is an emerging method that shows potential in this regard, as it involves the formation of a rotating vortex ring in the left ventricle during the early filling phase of diastole. In this study, we investigated the difference in VFT between two groups of women: professional handball players and healthy middle-aged female athletes, along with their corresponding control groups. By using echocardiography-Doppler analysis of the heart, VFT was calculated based on the left ventricular ejection fraction, the ratio between the end-diastolic volume and the diameter of the mitral annulus, and the ratio of the atrial contraction volume to the total inflow via the mitral valve. The study reveals a significant increase in VFT in both professional handball players and middle-aged female athletes compared to their respective control groups. Moreover, statistically significant differences between handball players and middle-aged female athletes were observed, indicating that the level of physical activity may affect the VFT. These results suggest that VFT could be a promising screening tool for identifying cardiac adaptations due to long-term vigorous training, potentially enabling more accurate diagnoses of cardiac morphological alterations in athletes.
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Affiliation(s)
- Stefan Cirovic
- Biomedical Sciences, Faculty of Health and Society, Malmö University, Malmö, 205 06, Sweden.
| | - Andreas Malmgren
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Malmö, 205 06, Sweden
| | - Rayane Kurdie
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Malmö, 205 06, Sweden
| | - Dejan Bilal
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Malmö, 205 06, Sweden
| | - Magnus Dencker
- Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Malmö, 205 06, Sweden
| | - Petri Gudmundsson
- Biomedical Sciences, Faculty of Health and Society, Malmö University, Malmö, 205 06, Sweden
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Sangha V, Dhingra LS, Oikonomou E, Aminorroaya A, Sikand NV, Sen S, Krumholz HM, Khera R. Identification of Hypertrophic Cardiomyopathy on Electrocardiographic Images with Deep Learning. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.23.23300490. [PMID: 38234746 PMCID: PMC10793540 DOI: 10.1101/2023.12.23.23300490] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Background Hypertrophic cardiomyopathy (HCM) affects 1 in every 200 individuals and is the leading cause of sudden cardiac death in young adults. HCM can be identified using an electrocardiogram (ECG) raw voltage data and deep learning approaches, but their point-of-care application is limited by the inaccessibility of these signal data. We developed a deep learning-based approach that overcomes this limitation and detects HCM from images of 12-lead ECGs across layouts. Methods We identified ECGs from patients with HCM features present on cardiac magnetic resonance imaging (CMR) or those within 30 days of an echocardiogram documenting thickened interventricular septum (end-diastolic interventricular septum thickness > 15mm). Patients with CMR-confirmed HCM were considered as cases during the final model evaluation. The model was validated within clinical settings at YNHH and externally on ECG images from the prospective, population-based UK Biobank cohort. We localized class-discriminating signals in ECG images using gradient-weighted class activation mapping. Results Overall, 124,553 ECGs from 66,987 individuals (HCM cases and controls) were used for model development. The model demonstrated high discrimination for HCM across various ECG image formats and calibrations in internal validation (area under receiving operation characteristics [AUROC] 0.96) and external sets of ECG images from UK Biobank (AUROC 0.94). A positive screen for HCM was associated with a 100-fold higher odds of CMR-confirmed HCM (OR 102.4, 95% Confidence Interval, 57.4 - 182.6) in the held-out set. Class-discriminative patterns localized to the anterior and lateral leads (V4-V5). Conclusions We developed and externally validated a deep learning model that identifies HCM from ECG images with excellent discrimination. This approach represents an automated, efficient, and accessible screening strategy for HCM.
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Affiliation(s)
- Veer Sangha
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Engineering Science, Oxford University, Oxford, UK
| | - Lovedeep Singh Dhingra
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Evangelos Oikonomou
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Arya Aminorroaya
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Nikhil V Sikand
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Sounok Sen
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, CT, USA
| | - Rohan Khera
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, CT, USA
- Section of Health Informatics, Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
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3
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Korotkikh AV, Vakhnenko JV, Kashtanov MG. Some Topical Aspects of the "Sports Heart" Problem (Literature Review). Part I. Curr Probl Cardiol 2023; 48:101878. [PMID: 37343777 DOI: 10.1016/j.cpcardiol.2023.101878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 06/23/2023]
Abstract
The cardiovascular system experiences the greatest overload, morphological and functional changes inelite sport, which in a number of athletes undergoes nonadaptive (pathological) remodeling both functional and morphological. The latter is characterized by certain objective features, including echocardiography indicators, which occupies a special place in sports cardiology. Structural and functional changes beyond the generally accepted norm (pronounced cardiac hypertrophy or dilatation, high arterial hypertension) can be associated with systolic or diastolic myocardial dysfunction and impaired electrical properties, some of which are predictors of severe complications up to sudden cardiac death and pose a serious problem regarding the admission of athletes to training and competition. This review is devoted to summarizing the views of authoritative specialists in the field of sports medicine on the criteria of pathological remodeling of the heart muscle, the role of echocardiography in its diagnosis, the discussion of the limits of the norm of response to blood pressure load, the analysis of the main causes of sudden cardiac death of athletes, the realities and prospects of genetic selection in sports.
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Affiliation(s)
| | - Julia V Vakhnenko
- Cardiac Surgery Clinic, Amur State Medical Academy, Blagoveshchensk, Russia
| | - Maksim G Kashtanov
- Experimental laboratory, Ural Federal University, Ekaterinburg, Russia; Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Catheterization laboratory, Russian Academy of Science, Tomsk, Russia; Sverdlovsk Regional Hospital No.1, Catheterization laboratory, Ekaterinburg, Russia
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Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, Kaski JP. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44:3503-3626. [PMID: 37622657 DOI: 10.1093/eurheartj/ehad194] [Citation(s) in RCA: 339] [Impact Index Per Article: 339.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Rafailakis L, Deli CK, Fatouros IG, Tsiokanos A, Draganidis D, Poulios A, Soulas D, Jamurtas AZ. Functional and Morphological Adaptations in the Heart of Children Aged 12-14 Years following Two Different Endurance Training Protocols. Sports (Basel) 2023; 11:157. [PMID: 37624137 PMCID: PMC10459334 DOI: 10.3390/sports11080157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/13/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
This study investigated the cardiac functional and the morphological adaptations because of two endurance training protocols. Untrained children (N = 30, age: 12-14 years) were divided into three groups (N = 10/group). The first group did not perform any session (CONTROL), the second performed ventilatory threshold endurance training (VTT) for 12 weeks (2 sessions/week) at an intensity corresponding to the ventilatory threshold (VT) and the third (IT) performed two sessions per week at 120% of maximal oxygen uptake (VO2max). Two other sessions (30 min running at 55-65% of VO2max) per week were performed in VVT and IT. Echocardiograms (Left Ventricular end Diastolic Diameter, LVEDd; Left Ventricular end Diastolic Volume, LVEDV; Stroke Volume, SV; Ejection Fraction, EF; Posterior Wall Thickness of the Left Ventricle, PWTLV) and cardiopulmonary ergospirometry (VO2max, VT, velocity at VO2max (vVO2max), time in vVO2max until exhaustion (Tlim) was conducted before and after protocols. Significant increases were observed in both training groups in LVEDd (VTT = 5%; IT = 3.64%), in LVEDV (VTT = 23.7%; ITT = 13.6%), in SV (VTT = 25%; IT = 16.9%) but not in PWTLV and EF, after protocols. No differences were noted in the CONTROL group. VO2max and VT increased significantly in both training groups by approximately 9% after training. Our results indicate that intensity endurance training does not induce meaningful functional and morphological perturbations in the hearts of children.
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Affiliation(s)
| | | | | | | | | | | | | | - Athanasios Z. Jamurtas
- Department of Physical Education and Sport Science, University of Thessaly, 42100 Trikala, Greece; (L.R.); (C.K.D.); (I.G.F.); (A.T.); (D.D.); (D.S.)
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6
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Rashdan L, Hodovan J, Masri A. Imaging cardiac hypertrophy in hypertrophic cardiomyopathy and its differential diagnosis. Curr Opin Cardiol 2023:00001573-990000000-00084. [PMID: 37421401 DOI: 10.1097/hco.0000000000001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
PURPOSE OF REVIEW The aim of this study was to review imaging of myocardial hypertrophy in hypertrophic cardiomyopathy (HCM) and its phenocopies. The introduction of cardiac myosin inhibitors in HCM has emphasized the need for careful evaluation of the underlying cause of myocardial hypertrophy. RECENT FINDINGS Advances in imaging of myocardial hypertrophy have focused on improving precision, diagnosis, and predicting prognosis. From improved assessment of myocardial mass and function, to assessing myocardial fibrosis without the use of gadolinium, imaging continues to be the primary tool in understanding myocardial hypertrophy and its downstream effects. Advances in differentiating athlete's heart from HCM are noted, and the increasing rate of diagnosis in cardiac amyloidosis using noninvasive approaches is especially highlighted due to the implications on treatment approach. Finally, recent data on Fabry disease are shared as well as differentiating other phenocopies from HCM. SUMMARY Imaging hypertrophy in HCM and ruling out other phenocopies is central to the care of patients with HCM. This space will continue to rapidly evolve, as disease-modifying therapies are under investigation and being advanced to the clinic.
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Affiliation(s)
- Lana Rashdan
- Hypertrophic Cardiomyopathy Center, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
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Boraita A, Díaz-Gonzalez L, Valenzuela PL, Heras ME, Morales-Acuna F, Castillo-García A, Lucia MJ, Suja P, Santos-Lozano A, Lucia A. Normative Values for Sport-Specific Left Ventricular Dimensions and Exercise-Induced Cardiac Remodeling in Elite Spanish Male and Female Athletes. SPORTS MEDICINE - OPEN 2022; 8:116. [PMID: 36107355 PMCID: PMC9478009 DOI: 10.1186/s40798-022-00510-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 08/18/2022] [Indexed: 11/25/2022]
Abstract
Background There is debate about the magnitude of geometrical remodeling [i.e., left ventricle (LV) cavity enlargement vs. wall thickening] in the heart of elite athletes, and no limits of normality have been yet established for different sports. We aimed to determine sex- and sport-specific normative values of LV dimensions in elite white adult athletes. Methods This was a single-center, retrospective study of Spanish elite athletes. Athletes were grouped by sport and its relative dynamic/static component (Mitchell’s classification). LV dimensions were measured with two-dimensional-guided M-mode echocardiography imaging to compute normative values. We also developed an online and app-based calculator (https://sites.google.com/lapolart.es/athlete-lv/welcome?authuser=0) to provide clinicians with sports- and Mitchell’s category-specific Z-scores for different LV dimensions. Results We studied 3282 athletes (46 different sports, 37.8% women, mean age 23 ± 6 years). The majority (85.4%) showed normal cardiac geometry, particularly women (90.9%). Eccentric hypertrophy was relatively prevalent (13.4%), and concentric remodeling or hypertrophy was a rare finding (each < 0.8% of total). The proportion of normal cardiac geometry and eccentric hypertrophy decreased and increased, respectively, with the dynamic (in both sexes) or static component (in male athletes) of the sport irrespective of the other (static or dynamic) component. The 95th percentile values of LV dimensions did not exceed the following limits in any of the Mitchell categories: septal wall thickness, 12 mm (males) and 10 mm (females); LV posterior wall, 11 mm and 10 mm; and LV end-diastolic diameter, 64 mm and 57 mm. Conclusions The majority of elite athletes had normal LV geometry, and although some presented with LV eccentric hypertrophy, concentric remodeling or hypertrophy was very uncommon. The present study provides sport-specific normative values that can serve to identify those athletes for whom a detailed examination might be recommendable (i.e., those exceeding the 95th percentile for their sex and sport). Supplementary Information The online version contains supplementary material available at 10.1186/s40798-022-00510-2.
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Danielian A, Shah AB. Differentiating Physiology from Pathology: The Gray Zones of the Athlete's Heart. Clin Sports Med 2022; 41:425-440. [PMID: 35710270 DOI: 10.1016/j.csm.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Routine vigorous exercise can lead to electrical, structural, and functional adaptations that can enhance exercise performance. There are several factors that determine the type and magnitude of exercise-induced cardiac remodeling (EICR) in trained athletes. In some athletes with pronounced cardiac remodeling, there can be an overlap in morphologic features with mild forms of cardiomyopathy creating gray zone scenarios whereby distinguishing health from disease can be difficult. An integrated clinical approach that factors athlete-specific characteristics (sex, size, sport, ethnicity, and training history) and findings from multimodality imaging are essential to help make this distinction.
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Affiliation(s)
- Alfred Danielian
- Las Vegas Heart Associates- Affiliated with Mountain View Hospital, 2880 North Tenaya Way Suite 100, Las Vegas, NV 89128, USA
| | - Ankit B Shah
- Sports & Performance Cardiology Program, MedStar Health, 3333 North Calvert Street Suite 500 JPB, Baltimore, MD 21218, USA.
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Cha MJ, Kim C, Park CH, Hong YJ, Shin JM, Kim TH, Cha YJ, Park CH. Differential Diagnosis of Thick Myocardium according to Histologic Features Revealed by Multiparametric Cardiac Magnetic Resonance Imaging. Korean J Radiol 2022; 23:581-597. [PMID: 35555885 PMCID: PMC9174501 DOI: 10.3348/kjr.2021.0815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/21/2022] [Accepted: 02/27/2022] [Indexed: 11/16/2022] Open
Abstract
Left ventricular (LV) wall thickening, or LV hypertrophy (LVH), is common and occurs in diverse conditions including hypertrophic cardiomyopathy (HCM), hypertensive heart disease, aortic valve stenosis, lysosomal storage disorders, cardiac amyloidosis, mitochondrial cardiomyopathy, sarcoidosis and athlete’s heart. Cardiac magnetic resonance (CMR) imaging provides various tissue contrasts and characteristics that reflect histological changes in the myocardium, such as cellular hypertrophy, cardiomyocyte disarray, interstitial fibrosis, extracellular accumulation of insoluble proteins, intracellular accumulation of fat, and intracellular vacuolar changes. Therefore, CMR imaging may be beneficial in establishing a differential diagnosis of LVH. Although various diseases share LV wall thickening as a common feature, the histologic changes that underscore each disease are distinct. This review focuses on CMR multiparametric myocardial analysis, which may provide clues for the differentiation of thickened myocardium based on the histologic features of HCM and its phenocopies.
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Affiliation(s)
- Min Jae Cha
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Cherry Kim
- Department of Radiology, Korea University Ansan Hospital, Ansan, Korea
| | - Chan Ho Park
- Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Yoo Jin Hong
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Min Shin
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Hoon Kim
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Jin Cha
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Chul Hwan Park
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Servatius H, Raab S, Asatryan B, Haeberlin A, Branca M, de Marchi S, Brugger N, Nozica N, Goulouti E, Elchinova E, Lam A, Seiler J, Noti F, Madaffari A, Tanner H, Baldinger SH, Reichlin T, Wilhelm M, Roten L. Differences in Atrial Remodeling in Hypertrophic Cardiomyopathy Compared to Hypertensive Heart Disease and Athletes' Hearts. J Clin Med 2022; 11:jcm11051316. [PMID: 35268407 PMCID: PMC8910879 DOI: 10.3390/jcm11051316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Hypertrophic cardiomyopathy (HCM), hypertensive heart disease (HHD) and athletes’ heart share an increased prevalence of atrial fibrillation. Atrial cardiomyopathy in these patients may have different characteristics and help to distinguish these conditions. Methods: In this single-center study, we prospectively collected and analyzed electrocardiographic (12-lead ECG, signal-averaged ECG (SAECG), 24 h Holter ECG) and echocardiographic data in patients with HCM and HHD and in endurance athletes. Patients with atrial fibrillation were excluded. Results: We compared data of 27 patients with HCM (70% males, mean age 50 ± 14 years), 324 patients with HHD (52% males, mean age 75 ± 5.5 years), and 215 endurance athletes (72% males, mean age 42 ± 7.5 years). HCM patients had significantly longer filtered P-wave duration (153 ± 26 ms) and PR interval (191 ± 48 ms) compared to HHD patients (144 ± 16 ms, p = 0.012 and 178 ± 31, p = 0.034, respectively) and athletes (134 ± 14 ms, p = 0.001 and 165 ± 26 ms, both p < 0.001, respectively). HCM patients had a mean of 4.9 ± 16 premature atrial complexes per hour. Premature atrial complexes per hour were significantly more frequent in HHD patients (27 ± 86, p < 0.001), but not in athletes (2.7 ± 23, p = 0.639). Left atrial volume index (LAVI) was 43 ± 14 mL/m2 in HCM patients and significantly larger than age- and sex-corrected LAVI in HHD patients 30 ± 10 mL/m2; p < 0.001) and athletes (31 ± 9.5 mL/m2; p < 0.001). A borderline interventricular septum thickness ≥13 mm and ≤15 mm was found in 114 (35%) HHD patients, 12 (6%) athletes and 3 (11%) HCM patients. Conclusions: Structural and electrical atrial remodeling is more advanced in HCM patients compared to HHD patients and athletes.
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Affiliation(s)
- Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
- Correspondence: ; Tel.: +41-31-664-17-01
| | - Simon Raab
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Mattia Branca
- CTU Bern, University of Bern, 3010 Bern, Switzerland;
| | - Stefano de Marchi
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Nicolas Brugger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Nikolas Nozica
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Eleni Goulouti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Elena Elchinova
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Anna Lam
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Samuel H. Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; (S.R.); (B.A.); (A.H.); (S.d.M.); (N.B.); (N.N.); (E.G.); (E.E.); (A.L.); (J.S.); (F.N.); (A.M.); (H.T.); (S.H.B.); (T.R.); (M.W.); (L.R.)
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11
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Mascia G, Olivotto I, Brugada J, Arbelo E, Di Donna P, Della Bona R, Canepa M, Porto I. Sport practice in hypertrophic cardiomyopathy: running to stand still? Int J Cardiol 2021; 345:77-82. [PMID: 34662670 DOI: 10.1016/j.ijcard.2021.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Abstract
During the last decades, the practice of sport and hypertrophic cardiomyopathy (HCM) were considered as incompatible, since evidence was not sufficient to gauge the risk associated to repeat and/or vigorous exercise across the spectrum of HCM. Additionally, it was acknowledged thatrisk stratification tools developed for HCM were not derived from athlete cohorts. Recent epidemiological studies focused on HCM both in the general population and in athletes, however, have de-emphasized the contribution of this condition to the risk of sport-associated sudden death, supporting the possibility of allowing the practice of some sports, even at professional level, for certain low-risk HCM categories. We hereby analyze the complex interaction of vigorous and continuative exercise with HCM, revising the available evidence for sports eligibility in HCM, the challenges and limitations of shared decision-making, as well as the potential harms and benefits of a highly personalised exercise schedule in subjects diagnosed with this complex disease.
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Affiliation(s)
- Giuseppe Mascia
- IRCCS Ospedale Policlinico San Martino, Italian IRCCS Cardiovascular Network, Genoa, Italy
| | - Iacopo Olivotto
- Careggi University Hospital, University of Florence, Florence, Italy
| | - Josep Brugada
- Arrhythmia Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain; Arrhythmia Section, Cardiology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigació August Pi iSunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid (Spain)
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigació August Pi iSunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid (Spain)
| | - Paolo Di Donna
- IRCCS Ospedale Policlinico San Martino, Italian IRCCS Cardiovascular Network, Genoa, Italy
| | - Roberta Della Bona
- IRCCS Ospedale Policlinico San Martino, Italian IRCCS Cardiovascular Network, Genoa, Italy
| | - Marco Canepa
- IRCCS Ospedale Policlinico San Martino, Italian IRCCS Cardiovascular Network, Genoa, Italy; Department of Internal Medicine (DIMI), Chair of Cardiovascular Diseases, University of Genoa, Genoa, Italy
| | - Italo Porto
- IRCCS Ospedale Policlinico San Martino, Italian IRCCS Cardiovascular Network, Genoa, Italy; Department of Internal Medicine (DIMI), Chair of Cardiovascular Diseases, University of Genoa, Genoa, Italy.
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12
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Differences in American Athletes Undergoing Preparticipation Examination by Sex, Participation Level, and Age. Clin J Sport Med 2021; 31:e432-e441. [PMID: 32073474 DOI: 10.1097/jsm.0000000000000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 08/17/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the preparticipation examination findings among American athletes by sex, participation level, and age. DESIGN Hypothesis-generating retrospective cohort study. SETTING Saint-Luke's Athletic Heart Center, Kansas City, Missouri. PARTICIPANTS A total of 2954 student athletes. INTERVENTIONS Athletes underwent preparticipation examination, which included history and physical, electrocardiogram, and 2-D transthoracic echocardiogram. MAIN OUTCOME MEASURES Differences noted on screening preparticipation examination by sex, participation level, and age. RESULTS Female athletes reported more symptoms than male athletes (odds ratio [OR] = 1.61; 95% confidence interval [CI], 1.32-1.97; P < 0.0001) but had lower prevalence of abnormal electrocardiogram (OR 0.52; CI, 0.39-0.68; P < 0.0001). College athletes reported fewer symptoms than novice athletes (OR 0.35; CI, 0.29-0.43; P < 0.0001) with no difference in the prevalence of abnormal electrocardiography (ECG) (OR 0.96; CI, 0.73-1.26; P = 0.78). Older athletes reported fewer symptoms than younger athletes (OR 0.61; CI, 0.52-0.71; P < 0.0001) with no difference in the prevalence of abnormal ECG (OR 1.00; CI, 0.81-1.23; P = 0.89). There were 43 athletes with clinically important findings with no difference in prevalence of these findings across sex, participation level, and age. CONCLUSIONS Among this American cohort of athletes, male athletes reported fewer symptoms and had higher prevalence of abnormal ECG findings compared with female athletes. College and older athletes reported fewer symptoms and had no difference in prevalence of abnormal ECG findings compared with novice and younger athletes, respectively. Despite these differences between groups, the prevalence of clinically important findings was comparable among groups.
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13
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Pambo P, Adu-Adadey M, Agbodzakey H, Scharhag J. Electrocardiographic and Echocardiographic Findings in Elite Ghanaian Male Soccer Players. Clin J Sport Med 2021; 31:e373-e379. [PMID: 31876793 DOI: 10.1097/jsm.0000000000000801] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/22/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To analyze the athlete's heart of adult and adolescent elite male soccer players by electrocardiography (ECG) and echocardiography (ECHO) and to describe typical ECG and ECHO findings in this cohort (West African elite soccer players). DESIGN A cross-sectional study of ECGs and ECHOs conducted as part of precompetition medical assessment for national male soccer teams preparing for various Fédération Internationale de Football Association (FIFA) tournaments in 2016 and 2017. SETTING Ghana National Football Association. PARTICIPANTS One hundred fifty-nine players playing for the National male soccer teams preparing for tournaments in 2016 and 2017. INTERVENTIONS Precompetition medical assessment using ECGs and ECHOs. MAIN OUTCOME MEASURES Number of athletes with abnormal ECGs and ECHO findings. RESULTS Twenty-three percent of the players had abnormal ECGs. Nine percent of the participants had T-wave inversions in lateral leads (V5-V6). Sokolow-Lyon criteria for left ventricular hypertrophy were present in 64% of participants. Thirty-six (23%) players had left ventricular wall thickness (LVWT) ≥13 mm, with no player exceeding 16 mm. Four percent of players had left ventricular cavity dimension greater than 60 mm. Relative wall thickness >0.42 was present in 44% of the players. CONCLUSIONS Uncommon ECG changes seem to be more common in elite Ghanaian soccer players compared with previously reported results for Caucasians and even mixed populations of black athletes. Although ST elevation, T-wave inversions, and LVWT up to 15 mm are common, ST depression, deep T-waves in lateral leads, and LVWT ≥16 mm always warrant further clinical and scientific investigations.
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Affiliation(s)
- Prince Pambo
- University of Health and Allied Sciences, Ho, Ghana
- Civil Service/Stadium Clinic, School of Allied Sciences, Ghana Health Service
- Sports Medicine Department, Institute for Sports and Preventive Medicine, Saarland University, Saarbrucken, Germany
| | - Martin Adu-Adadey
- National Cardiothoracic Centre, Korle-Bu Teaching Hospital, Accra, Ghana ; and
| | - Hope Agbodzakey
- Civil Service/Stadium Clinic, School of Allied Sciences, Ghana Health Service
| | - Jürgen Scharhag
- Sports Medicine Department, Institute for Sports and Preventive Medicine, Saarland University, Saarbrucken, Germany
- Department of Sports Medicine, Exercise Physiology and Prevention, University of Vienna, Vienna, Austria
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14
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Maurizi N, Baldi M, Castelletti S, Lisi C, Galli M, Bianchi S, Panzera F, Fumagalli C, Mochi N, Parati G, Olivotto I, Cecchi F. Age-dependent diagnostic yield of echocardiography as a second-line diagnostic investigation in athletes with abnormalities at preparticipation screening. J Cardiovasc Med (Hagerstown) 2021; 22:759-766. [PMID: 34230438 DOI: 10.2459/jcm.0000000000001215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Systematic pre-participation screening of subjects practicing sports activity has the potential to identify athletes at risk of sudden cardiac death. However, limited evidence are present concerning the yield of echocardiography as a second-line exam in athletes with abnormal pre-participation screening. METHODS Consecutive athletes were screened (2011-2017) in a community-based sports medicine center in Tuscany, with familial history, physical examination and ECG. Patients with abnormal/>1 borderline ECG findings, symptoms/signs of cardiovascular diseases, cardiovascular risk factors or family history of juvenile/genetic cardiac disease underwent echocardiography. RESULTS A total of 30109 athletes (age 21 [15;31]) were evaluated. Of these, 6234 (21%) were aged 8-11 years, 18309 (61%) 12-18 years, 4442 (15%) 19-35 years, 1124 (4%) >35 years. A total of 2569 (9%) athletes were addressed to echocardiography. Referral rates increased significantly with age (5% in preadolescents to 38% in master athletes, P< 0.01). Subclinical heart diseases were found in 290/30109 (0.8%) and were common >35 years (135/1124, 11%), but rare at 19-35 years (91/4442, 2%), very rare <18 years (64/24 543, 0.2%; P< 0.01). Seventy-four (0.3%) athletes were disqualified because of the structural alterations identified, 29 (0.1%) with cardiac structural diseases at risk for sudden death. CONCLUSIONS Italian community-based pre-participation screening showed an age-dependent yield, with a three-fold increase in referral in athletes >35 years. Subclinical structural abnormalities potentially predisposing to sudden death were rare (0.01%), mostly in post-pubertal and senior athletes. Age-specific pre-participation screening protocols may help optimize resources and improve specificity.
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Affiliation(s)
- Niccolò Maurizi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
- Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Massimo Baldi
- Complex Operative Unit, USL Tuscany Center, Pistoia, Italy
| | - Silvia Castelletti
- Department of Cardiovascular, Neural and Metabolic Sciences, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
| | - Corrado Lisi
- Complex Operative Unit, USL Tuscany Center, Pistoia, Italy
| | - Michele Galli
- Complex Operative Unit, USL Tuscany Center, Pistoia, Italy
| | | | | | - Carlo Fumagalli
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Nicola Mochi
- Complex Operative Unit, USL Tuscany Center, Pistoia, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Franco Cecchi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
- Department of Cardiovascular, Neural and Metabolic Sciences, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
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15
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Denis M, Bachoro M, Gebreslassie W, Oladunni T. Automatic Electrocardiogram Detection of Suspected Hypertrophic Cardiomyopathy: Application to Wearable Heart Monitors. IEEE SENSORS LETTERS 2021; 5:6001804. [PMID: 36313055 PMCID: PMC9610197 DOI: 10.1109/lsens.2021.3096382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In this letter, an automatic detection algorithm for hypertrophic cardiomyopathy (HCM) is presented. Of particular interest is the algorithm's ability to differentiate HCM subjects and healthy volunteers from a single lead ECG dataset. Suspected HCM subjects are identified by the primary clinical abnormality associated with HCM: left ventricular hypertrophy (LVH). In total, n = 43 human subjects ECG datasets are investigated: n = 21 healthy volunteers and n = 22 LVH patients. Significant differences of p-value 0.01 and 0.04 were found for the respective ECG parameters, i.e., S-wave amplitude and ST-segment, when differentiating between the LVH patients and healthy human volunteers.
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Affiliation(s)
- Max Denis
- Department of Mechanical Engineering, University of the District of Columbia, Washington, DC 20008 USA
- Biomedical Engineering Program, University of the District of Columbia, Washington, DC 20008 USA
| | - Mulatu Bachoro
- Department of Mechanical Engineering, University of the District of Columbia, Washington, DC 20008 USA
- Biomedical Engineering Program, University of the District of Columbia, Washington, DC 20008 USA
| | - Winta Gebreslassie
- Department of Mechanical Engineering, University of the District of Columbia, Washington, DC 20008 USA
- Biomedical Engineering Program, University of the District of Columbia, Washington, DC 20008 USA
| | - Timothy Oladunni
- Department of Computer Science & Information Technology, University of the District of Columbia, Washington, DC 20008 USA
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16
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Lander BS, Phelan DM, Martinez MW, Dineen EH. Hypertrophic Cardiomyopathy: Updates Through the Lens of Sports Cardiology. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021; 23:53. [PMID: 34054288 PMCID: PMC8144867 DOI: 10.1007/s11936-021-00934-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
Purpose of review This review will summarize the distinction between hypertrophic cardiomyopathy (HCM) and exercise-induced cardiac remodeling (EICR), describe treatments of particular relevance to athletes with HCM, and highlight the evolution of recommendations for exercise and competitive sport participation relevant to individuals with HCM. Recent findings Whereas prior guidelines have excluded individuals with HCM from more than mild-intensity exercise, recent data show that moderate-intensity exercise improves functional capacity and indices of cardiac function and continuation of competitive sports may not be associated with worse outcomes. Moreover, recent studies of athletes with implantable cardioverter defibrillators (ICDs) demonstrated a safer profile than previously understood. In this context, the updated American Heart Association/American College of Cardiology (AHA/ACC) and European Society of Cardiology (ESC) HCM guidelines have increased focus on shared decision-making and liberalized restrictions on exercise and sport participation among individuals with HCM. Summary New data demonstrating the safety of exercise in individuals with HCM and in athletes with ICDs, in addition to a focus on shared decision-making, have led to the most updated guidelines easing restrictions on exercise and competitive athletics in this population. Further athlete-specific studies of HCM, especially in the context of emerging therapies such as mavacamten, are important to inform accurate risk stratification and eligibility recommendations.
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Affiliation(s)
- Bradley S Lander
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY 10032 USA
| | - Dermot M Phelan
- Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC 28203 USA
| | - Matthew W Martinez
- Department of Cardiovascular Medicine, Atlantic Health, Morristown Medical Center, Morristown, NJ 07960 USA.,Sports Cardiology and Hypertrophic Cardiomyopathy, 111 S Madison Ave, Suite 300, Morristown, NJ 07960 USA
| | - Elizabeth H Dineen
- Division of Cardiology, University of California Irvine, 333 City Blvd W, Suite 400, Orange, CA 92868 USA
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17
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Drezner JA, Malhotra A, Prutkin JM, Papadakis M, Harmon KG, Asif IM, Owens DS, Marek JC, Sharma S. Return to play with hypertrophic cardiomyopathy: are we moving too fast? A critical review. Br J Sports Med 2021; 55:1041-1047. [PMID: 33472848 PMCID: PMC8408577 DOI: 10.1136/bjsports-2020-102921] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2020] [Indexed: 12/31/2022]
Abstract
The diagnosis of a potentially lethal cardiovascular disease in a young athlete presents a complex dilemma regarding athlete safety, patient autonomy, team or institutional risk tolerance and medical decision-making. Consensus cardiology recommendations previously supported the ‘blanket’ disqualification of athletes with hypertrophic cardiomyopathy (HCM) from competitive sport. More recently, epidemiological studies examining the relative contribution of HCM as a cause of sudden cardiac death (SCD) in young athletes and reports from small cohorts of older athletes with HCM that continue to exercise have fueled debate whether it is safe to play with HCM. Shared decision-making is endorsed within the sports cardiology community in which athletes can make an informed decision about treatment options and potentially elect to continue competitive sports participation. This review critically examines the available evidence relevant to sports eligibility decisions in young athletes diagnosed with HCM. Histopathologically, HCM presents an unstable myocardial substrate that is vulnerable to ventricular tachyarrhythmias during exercise. Studies support that young age and intense competitive sports are risk factors for SCD in patients with HCM. We provide an estimate of annual mortality based on our understanding of disease prevalence and the incidence of HCM-related SCD in different athlete populations. Adolescent and young adult male athletes and athletes participating in a higher risk sport such as basketball, soccer and American football exhibit a greater risk. This review explores the potential harms and benefits of sports disqualification in athletes with HCM and details the challenges and limitations of shared decision-making when all parties may not agree.
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Affiliation(s)
- Jonathan A Drezner
- Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
| | - Aneil Malhotra
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Jordan M Prutkin
- Department of Internal Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Michael Papadakis
- Cardiology, Clinical Academic Group, St George's, University of London, London, UK
| | - Kimberly G Harmon
- Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
| | - Irfan M Asif
- Center for Health Promotion, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David S Owens
- Department of Internal Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Joseph C Marek
- Cardiology, Advocate Heart Institute, Downers Grove, Illinois, USA
| | - Sanjay Sharma
- Cardiology, Clinical Academic Group, St George's, University of London, London, UK
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18
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Austin AV, Owens DS, Prutkin JM, Salerno JC, Ko B, Pelto HF, Rao AL, Siebert DM, Carrol JS, Harmon KG, Drezner JA. Do 'pathologic' cardiac murmurs in adolescents identify structural heart disease? An evaluation of 15 141 active adolescents for conditions that put them at risk of sudden cardiac death. Br J Sports Med 2021; 56:88-94. [PMID: 33451997 DOI: 10.1136/bjsports-2019-101718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed whether the presence and character of a cardiac murmur in adolescents were associated with structural heart disease that confers risk of sudden cardiac death (SCD). METHODS We performed a retrospective analysis of 15 141 adolescents age 12-19 who underwent a heart screen with history, physical examination and ECG. Participants with any screening abnormality underwent an echocardiogram for the assessment of structural heart disease. Murmurs were classified as physiological or pathological according to standard clinical criteria, and participants with murmurs were compared with a comparison group without murmurs. The primary outcome was echocardiogram-detected structural heart disease associated with SCD. RESULTS 905 participants with a cardiac murmur (mean age 15.8; 58% male) and 4333 participants without a murmur (comparison group; mean age 15.8; 55% male) had an echocardiogram to detect structural heart disease. 743 (82%) murmurs were described as physiological and 162 (18%) as pathological. Twenty-five (2.8%) participants with murmurs and 61 (1.4%) participants without murmurs had structural heart disease. Three (0.3%) participants in the murmur group were diagnosed with hypertrophic cardiomyopathy (HCM) which was the only identified condition associated with SCD. Two participants with HCM had physiological murmurs, one had a pathological murmur, and all three had an abnormal ECG. The most common minor structural heart disease was bicuspid aortic valve in both the murmur (7; 0.8%) and comparison (20; 0.5%) groups. The positive predictive value of physiological versus pathological murmurs for identifying any structural heart disease was 2.4% versus 4.3% (p=0.21), respectively. The positive predictive value of having any murmur versus no murmur for identifying structural heart disease was 2.8% versus 1.4% (p=0.003), respectively. CONCLUSIONS In adolescents, the traditional classification of cardiac murmurs as 'physiologic' or 'pathologic' does not differentiate for structural heart disease that puts individuals at risk for SCD. We recommend ECG evaluation in all patients with a cardiac murmur found during preparticipation screening to increase detection of HCM.
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Affiliation(s)
- Ashley V Austin
- Department of Family Medicine, Sports Medicine Section, University of Washington, Seattle, Washington, USA
| | - David S Owens
- Department of Internal Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Jordan M Prutkin
- Department of Internal Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Jack C Salerno
- Division of Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Brian Ko
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Hank F Pelto
- Department of Family Medicine, Sports Medicine Section, University of Washington, Seattle, Washington, USA
| | - Ashwin L Rao
- Department of Family Medicine, Sports Medicine Section, University of Washington, Seattle, Washington, USA
| | - David M Siebert
- Department of Family Medicine, Sports Medicine Section, University of Washington, Seattle, Washington, USA
| | - Jennifer S Carrol
- Department of Family Medicine, Sports Medicine Section, University of Washington, Seattle, Washington, USA
| | - Kimberly G Harmon
- Department of Family Medicine, Sports Medicine Section, University of Washington, Seattle, Washington, USA
| | - Jonathan A Drezner
- Department of Family Medicine, Sports Medicine Section, University of Washington, Seattle, Washington, USA
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19
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Ozo U, Sharma S. The Impact of Ethnicity on Cardiac Adaptation. Eur Cardiol 2020; 15:e61. [PMID: 32944090 DOI: 10.15420/ecr.2020.01] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/22/2020] [Indexed: 01/15/2023] Open
Abstract
Regular intensive exercise is associated with a plethora of electrical, structural and functional adaptations within the heart to promote a prolonged and sustained increase in cardiac output. Bradycardia, increased cardiac dimensions, enhanced ventricular filling, augmentation of stroke volume and high peak oxygen consumption are recognised features of the athlete's heart. The type and magnitude of these adaptations to physical exercise are governed by age, sex, ethnicity, sporting discipline and intensity of sport. Some athletes, particularly those of African or Afro-Caribbean (black) origin reveal changes that overlap with diseases implicated in sudden cardiac death. In such instances, erroneous interpretation has potentially serious consequences ranging from unfair disqualification to false reassurance. This article focuses on ethnic variation in the physiological cardiac adaption to exercise.
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20
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Leischik R, Dworrak B, Strauss M, Horlitz M, Pareja-Galeano H, de la Guía-Galipienso F, Lippi G, Lavie CJ, Perez MV, Sanchis-Gomar F. Special Article - Exercise-induced right ventricular injury or arrhythmogenic cardiomyopathy (ACM): The bright side and the dark side of the moon. Prog Cardiovasc Dis 2020; 63:671-681. [PMID: 32224113 DOI: 10.1016/j.pcad.2020.03.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/22/2020] [Indexed: 02/06/2023]
Abstract
There is still debate on the range of normal physiologic changes of the right ventricle or ventricular (RV) function in athletes. Genetic links to arrhythmogenic cardiomyopathy (ACM) are well-established. There is no current consensus on the importance of extensive exercise and exercise-induced injury to the RV. During the intensive exercise of endurance sports, the cardiac structures adapt to athletic load over time. Some athletes develop RV cardiomyopathy possibly caused by genetic predisposition, whilst others develop arrhythmias from the RV. Endurance sports lead to increased volume and pressure load in both ventricles and increased myocardial mass. The extent of volume increase and changes in myocardial structure contribute to impairment of RV function and pose a challenge in cardiovascular sports medicine. Genetic predisposition to ACM may play an important role in the risk of sudden cardiac death of athletes. In this review, we discuss and evaluate existing results and opinions. Intensive training in competitive dynamic/power and endurance sports leads to specific RV adaptation, but physiological adaptation without genetic predisposition does not necessarily lead to severe complications in endurance sports. Discriminating between physiological adaptation and pathological form of ACM or RV impairment provoked by reinforced exercise presents a challenge to clinical sports cardiologists.
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Affiliation(s)
- Roman Leischik
- Department of Cardiology, Section Prevention and Sports Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, 58095 Witten, Germany.
| | - Birgit Dworrak
- Department of Cardiology, Section Prevention and Sports Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, 58095 Witten, Germany
| | - Marcus Strauss
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure Medicine, University Hospital Muenster, Cardiol, 48149 Muenster, Germany
| | - Mark Horlitz
- Department of Cardiology, Section Prevention and Sports Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, 58095 Witten, Germany
| | - Helios Pareja-Galeano
- Facultad de Ciencias del Deporte y Fisioterapia, Universidad Europea, 28670 Madrid, Spain
| | - Fernando de la Guía-Galipienso
- Cardiology Service of Marina Baixa Hospital, Alicante, Spain; REMA Sports Cardiology Clinic, 03700 Denia, Alicante, Spain
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, 37134 Verona, Italy
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 70121 New Orleans, LA, USA
| | - Marco V Perez
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 94305-5110 Stanford, CA, USA
| | - Fabian Sanchis-Gomar
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 94305-5110 Stanford, CA, USA; Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, 46010 Valencia, Spain.
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21
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Emery MS, Kovacs RJ. Sudden Cardiac Death in Athletes. JACC-HEART FAILURE 2019; 6:30-40. [PMID: 29284578 DOI: 10.1016/j.jchf.2017.07.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 12/24/2022]
Abstract
Sudden cardiac death is a tragedy at any age and under any circumstances but is perhaps most tragic when it claims the life of the athlete, the individual who epitomizes health and a healthy lifestyle. Sports cardiologists from around the world have worked to quantitate the incidence of sudden cardiac death (SCD) in the athlete, to identify risk factors, to develop pre-participation screening tools, and to formulate plans to deal with on-field SCD. Progress has been made, but much remains to be done in order to make both competitive and recreational sports safer for both patients with known cardiac disease and athletes without known or suspected cardiac abnormalities.
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Affiliation(s)
- Michael S Emery
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana; Center for Cardiovascular Care in Athletics, Indiana University Health, Indianapolis, Indiana
| | - Richard J Kovacs
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana; Center for Cardiovascular Care in Athletics, Indiana University Health, Indianapolis, Indiana.
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22
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Abstract
PURPOSE OF REVIEW The optimal approach to screening young people to decrease the risk of sudden death remains unknown. It deserves the passionate attention that researchers, clinicians and families have given it. The new data from January 2018 to July 2019 are reviewed here. RECENT FINDINGS Cardiac findings associated with a risk of sudden death were reported in 0.4% of screened athletes. Well run programs continue report varying sensitivity for screening ECGs (between 86 and 100%). One major article reported a higher incidence of sudden death in young people than has been previously published (6.8/100 000 athletes). SUMMARY The rate of important findings in sophisticated screening programs is approximately 0.4%, suggesting that this is near the population rate of detectable disease in most athletic groups. ECGs are unquestionably capable of detecting disease that can be missed by history and physical, but the performance characteristics of ECGs continue to vary from study to study. In addition, the underlying cost and infrastructure of ECG and echocardiographic screening remains unaddressed by the recent literature. A few small studies have started to look at alternative technology approaches to ECG screening. VIDEO ABSTRACT.
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23
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Cho JY, Kim KH, Rink L, Hornsby K, Park H, Park JH, Yoon HJ, Ahn Y, Jeong MH, Cho JG, Park JC. University athletes and changes in cardiac geometry: insight from the 2015 Gwangju Summer Universiade. Eur Heart J Cardiovasc Imaging 2019; 20:407-416. [PMID: 30541113 DOI: 10.1093/ehjci/jey196] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 09/12/2018] [Accepted: 11/16/2018] [Indexed: 11/13/2022] Open
Abstract
AIMS There is a paucity of data regarding the changes of cardiac geometry in highly trained international and multiracial university athletes. We aimed to investigate the incidence of structural cardiac abnormalities and changes of cardiac geometry in highly trained university athletes. METHODS AND RESULTS Comprehensive echocardiographic studies were performed in 1185 university athletes through the Check-up Your Heart Program during the 2015 Gwangju Summer Universiade. Participants were divided into two groups: normal vs. abnormal left ventricular (LV) geometry (concentric remodelling, concentric hypertrophy, or eccentric hypertrophy). Structural heart diseases associated with sudden cardiac death were not identified, but minor structural cardiac abnormalities were common in university athletes. One hundred and fifty-six athletes (13.2%) had abnormal LV geometry; concentric remodelling (n = 73, 6.2%), concentric hypertrophy (n = 25, 2.1%), and eccentric hypertrophy (n = 58, 4.9%). Abnormal LV geometry was significantly more common in athletes of African descent and in endurance, mixed, or power disciplines. In multivariate logistic regression analysis, athletes of African descent [odds ratio (OR) 2.16, 95% confidence interval (CI) 1.34-3.46; P = 0.001], endurance disciplines (OR 1.79, 95% CI 1.26-2.54; P = 0.001), and training time (OR 1.01, 95% CI 1.00-1.02; P = 0.045) were independent predictors of abnormal LV geometry. CONCLUSION A large scale cardiovascular screening programme of the 2015 Summer Universiade demonstrated that abnormal LV geometry is not uncommon (13.2%) and concentric remodelling is the most common pattern of LV geometric change in young trained university athletes. Race, type of sport, and training time are significant predictors of abnormal LV geometry. Structural cardiac abnormalities are common in university athletes even though they are minor abnormalities.
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Affiliation(s)
- Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, Korea
| | - Lawrence Rink
- International University Sports Federation (FISU), Quartier UNIL-Centre, Bâtiment Synathlon, Lausanne, Switzerland.,Indiana University School of Medicine, Indiana University Sports Medicine, 550 Landmark Avenue, Bloomington, IN, USA
| | - Kyle Hornsby
- International University Sports Federation (FISU), Quartier UNIL-Centre, Bâtiment Synathlon, Lausanne, Switzerland.,Indiana University School of Medicine, Indiana University Sports Medicine, 550 Landmark Avenue, Bloomington, IN, USA
| | - Hyukjin Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, Korea
| | - Jae-Hyeong Park
- Department of Cardiology, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, Korea
| | - Hyun Ju Yoon
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, Korea
| | - Jeong Gwan Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, Korea
| | - Jong Chun Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju, Korea
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24
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Cantinotti M, Koestenberger M, Santoro G, Assanta N, Franchi E, Paterni M, Iervasi G, D'Andrea A, D'Ascenzi F, Giordano R, Galderisi M. Normal basic 2D echocardiographic values to screen and follow up the athlete's heart from juniors to adults: What is known and what is missing. A critical review. Eur J Prev Cardiol 2019; 27:1294-1306. [PMID: 31266355 DOI: 10.1177/2047487319862060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In the last few years, multiple echocardiographic nomograms have been published. However, normal values calculated in the general population are not applicable to athletes, whose hearts may be enlarged and hypercontractile. Accordingly, athletes require specific nomograms. Our aim is to provide a critical review of echocardiographic nomograms on two-dimensional (2D) measures for athletes. We performed a systematic search in the National Library of Medicine for Medical Subject Headings and free text terms including echocardiography, athletes, normal values and nomograms. The search was refined by adding the keywords heart, sport, elite, master, children and young. Twenty-eight studies were selected for the final analysis. Our research revealed that currently available ranges of normality for athletes reported by different authors are quite consistent, with limited exceptions (e.g. atria, aorta). Numerical and methodological limitations, however, emerged. Numerical limitations included a limited sample size (e.g. < 450 subjects) of the population assessed and the paucity of data in women, non-Caucasian athletes, and junior and master athletes. Some data on M-mode measurements are available, while those for some specific structures (e.g. left atrial (LA) area and volumes, right ventricular diameters and aorta) are limited or rare (e.g. LA area). There was heterogeneity in data normalization (by gender, sport type and ethnicity) and their expression was limited to mean values (Z-scores have rarely been employed), while variability analysis was often lacking or incomplete. We conclude that comprehensive nomograms using an appropriate sample size, evaluating a complete dataset of 2D (and three-dimensional) measures and built using a rigorous statistical approach are warranted.
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Affiliation(s)
- Massimiliano Cantinotti
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy.,Institute of Clinical Physiology, Pisa, Italy
| | - Martin Koestenberger
- Division of Paediatric Cardiology, Department of Paediatrics, Medical University Graz, Austria.,European Pediatric Pulmonary Vascular Disease Network, Berlin, Germany
| | - Giuseppe Santoro
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Nadia Assanta
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | - Eliana Franchi
- Fondazione G. Monasterio CNR-Regione Toscana, Massa and Pisa, Italy
| | | | | | - Antonello D'Andrea
- Division of Cardiology, Umberto I' Hospital Nocera Inferiore (Salerno), Luigi Vanvitelli University, Caserta, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Raffaele Giordano
- Adult and Pediatric Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Maurizio Galderisi
- Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
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25
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Pelliccia A, Solberg EE, Papadakis M, Adami PE, Biffi A, Caselli S, La Gerche A, Niebauer J, Pressler A, Schmied CM, Serratosa L, Halle M, Van Buuren F, Borjesson M, Carrè F, Panhuyzen-Goedkoop NM, Heidbuchel H, Olivotto I, Corrado D, Sinagra G, Sharma S. Recommendations for participation in competitive and leisure time sport in athletes with cardiomyopathies, myocarditis, and pericarditis: position statement of the Sport Cardiology Section of the European Association of Preventive Cardiology (EAPC). Eur Heart J 2018; 40:19-33. [DOI: 10.1093/eurheartj/ehy730] [Citation(s) in RCA: 219] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 10/20/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Antonio Pelliccia
- Department of Medicine, Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, Rome, Italy
| | | | - Michael Papadakis
- Cardiology Clinical Academic Group, St George’s, University of London, London, UK
| | - Paolo Emilio Adami
- Department of Medicine, Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, Rome, Italy
- International Association of Athletics Federations, IAAF, Monaco
| | - Alessandro Biffi
- Department of Medicine, Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, Rome, Italy
| | - Stefano Caselli
- Cardiovascular Center Zürich, Klinik im Park, Zürich Switzerland
| | - Andrè La Gerche
- National Centre for Sports Cardiology, Baker Heart and Diabetes Institute & St Vincent’s Hospital, Melbourne, Australia
| | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation, and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Axel Pressler
- Prevention and Sports Medicine, Technical University of Munich, Germany
- Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance. Munich, Germany
| | | | - Luis Serratosa
- Hospital Universitario Quironsalud Madrid, Spain
- Ripoll y De Prado Sport Clinic, FIFA Medical Centre of Excellence, Spain
| | - Martin Halle
- Prevention and Sports Medicine, Technical University of Munich, Germany
- Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance. Munich, Germany
| | - Frank Van Buuren
- Catholic Hospital Southwestfalia, St. Martinus-Hospital Olpe, Germany
| | - Mats Borjesson
- Department of Neuroscience and Physiology and Center for Health and Performance, Gothenburg University, Gothenburg, Sweden
- Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | | | - Nicole M Panhuyzen-Goedkoop
- Heart Centre & Sports Cardiology Department, Amsterdam Medical Centres, Amsterdam, Netherlands
- Sports Medical Centre Papendal, Arnhem, Netherlands
| | - Hein Heidbuchel
- Cardiology, University Hospital and University of Antwerp, Antwerp, Belgium
- Hasselt University, Hasselt, Belgium
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova Medical School, Padova. Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St George’s, University of London, London, UK
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26
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Augustine DX, Howard L. Left Ventricular Hypertrophy in Athletes: Differentiating Physiology From Pathology. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:96. [PMID: 30367318 DOI: 10.1007/s11936-018-0691-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW The changes that occur in athlete's heart are influenced by a number of factors including age, gender, ethnicity and the type of cardiovascular training. It is therefore important that the clinician is able to integrate all of these factors when assessing athletes to be able to guide investigations appropriately and to distinguish pathology from physiology. This review discusses the potential diagnostic conundrums when trying to differentiate physiological left ventricular hypertrophy from pathological hypertrophic cardiomyopathy in athletes. The mechanism of physiological and pathological hypertrophy is discussed together with history, clinical and investigational findings that can help to identify pathology. RECENT FINDINGS Athletes with hypertrophic cardiomyopathy are more likely to have non-concentric left ventricular hypertrophy (LVH), an elevated relative wall thickness, lateral ECG changes and a smaller LV cavity than athletes with physiological LVH. Certain diastolic echocardiographic parameters when used as part of an algorithm (e'; E/E'; E/A) can help to distinguish physiology from pathology, and there is evidence that assessment of global longitudinal strain during exercise echocardiography may be of use in the future. Cardiac MRI is an important imaging modality that can have an additive effect over echocardiography in the diagnosis of cardiomyopathy. Late gadolinium enhancement is a recognised advantage for cardiac magnetic resonance to allow detection of fibrosis in hypertrophic cardiomyopathy. T1 mapping and extracellular volume quantification may be a tool for the future to help distinguish athlete's heart from HCM. Cardiac adaptation to exercise and training in athletes, the athlete's heart causes electrophysiological and geometric changes that may mimic mild phenotypes of a pathological cardiomyopathy. This review article summarises a systematic approach to the assessment of left ventricular hypertrophy in athletes and describes pertinent clinical and investigation findings that can help to differentiate physiology from pathology.
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Affiliation(s)
- Daniel X Augustine
- Royal United Hospital Bath NHS Foundation Trust, Bath, UK.
- Cardiology Clinical Academic Group, St George's, University of London, London, UK.
| | - Liz Howard
- Cardiology Clinical Academic Group, St George's, University of London, London, UK
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27
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Malhotra A, Dhutia H, Finocchiaro G, Gati S, Beasley I, Clift P, Cowie C, Kenny A, Mayet J, Oxborough D, Patel K, Pieles G, Rakhit D, Ramsdale D, Shapiro L, Somauroo J, Stuart G, Varnava A, Walsh J, Yousef Z, Tome M, Papadakis M, Sharma S. Outcomes of Cardiac Screening in Adolescent Soccer Players. N Engl J Med 2018; 379:524-534. [PMID: 30089062 DOI: 10.1056/nejmoa1714719] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Reports on the incidence and causes of sudden cardiac death among young athletes have relied largely on estimated rates of participation and varied methods of reporting. We sought to investigate the incidence and causes of sudden cardiac death among adolescent soccer players in the United Kingdom. METHODS From 1996 through 2016, we screened 11,168 adolescent athletes with a mean (±SD) age of 16.4±1.2 years (95% of whom were male) in the English Football Association (FA) cardiac screening program, which consisted of a health questionnaire, physical examination, electrocardiography, and echocardiography. The FA registry was interrogated to identify sudden cardiac deaths, which were confirmed with autopsy reports. RESULTS During screening, 42 athletes (0.38%) were found to have cardiac disorders that are associated with sudden cardiac death. A further 225 athletes (2%) with congenital or valvular abnormalities were identified. After screening, there were 23 deaths from any cause, of which 8 (35%) were sudden deaths attributed to cardiac disease. Cardiomyopathy accounted for 7 of 8 sudden cardiac deaths (88%). Six athletes (75%) with sudden cardiac death had had normal cardiac screening results. The mean time between screening and sudden cardiac death was 6.8 years. On the basis of a total of 118,351 person-years, the incidence of sudden cardiac death among previously screened adolescent soccer players was 1 per 14,794 person-years (6.8 per 100,000 athletes). CONCLUSIONS Diseases that are associated with sudden cardiac death were identified in 0.38% of adolescent soccer players in a cohort that underwent cardiovascular screening. The incidence of sudden cardiac death was 1 per 14,794 person-years, or 6.8 per 100,000 athletes; most of these deaths were due to cardiomyopathies that had not been detected on screening. (Funded by the English Football Association and others.).
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Affiliation(s)
- Aneil Malhotra
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Harshil Dhutia
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Gherardo Finocchiaro
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Sabiha Gati
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Ian Beasley
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Paul Clift
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Charlotte Cowie
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Antoinette Kenny
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Jamil Mayet
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - David Oxborough
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Kiran Patel
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Guido Pieles
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Dhrubo Rakhit
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - David Ramsdale
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Leonard Shapiro
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - John Somauroo
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Graham Stuart
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Amanda Varnava
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - John Walsh
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Zaheer Yousef
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Maite Tome
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Michael Papadakis
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Sanjay Sharma
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
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Oder D, Liu D, Hu K, Üçeyler N, Salinger T, Müntze J, Lorenz K, Kandolf R, Gröne HJ, Sommer C, Ertl G, Wanner C, Nordbeck P. α-Galactosidase A Genotype N215S Induces a Specific Cardiac Variant of Fabry Disease. ACTA ACUST UNITED AC 2018; 10:CIRCGENETICS.116.001691. [PMID: 29018006 DOI: 10.1161/circgenetics.116.001691] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 07/28/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy is the most common type of cardiomyopathy, but many patients lack sarcomeric/myofilament mutations. We studied whether cardio-specific α-galactosidase A gene variants are misinterpreted as hypertrophic cardiomyopathy because of the lack of extracardiac organ involvement. METHODS AND RESULTS All subjects who tested positive for the N215S genotype (n=26, 13 females, mean age 49±17 [range, 14-74] years) were characterized in this prospective monocentric longitudinal cohort study to determine genotype-specific clinical characteristics of the N215S (c.644A>G [p.Asn215Ser]) α-galactosidase A gene variant. All subjects were initially referred with suspicion of genetically determined hypertrophic cardiomyopathy. Cardiac hypertrophy (interventricular septum, 12±4 [7-23] mm; left ventricular posterior wall, 11±4 [7-21] mm; left ventricular mass, 86±41 [46-195] g/m2) was progressive, systolic function mainly preserved (cardiac index 2.8±0.6 [1.9-3.9] L/min per m2), and diastolic function mildly abnormal. Cardiac magnetic resonance imaging revealed replacement fibrosis in loco typico (18/26, 69%), particularly in subjects >50 years. Elderly subjects had advanced heart failure, and 6 (23%) were suggested for implantable cardioverter-defibrillator therapy. Leukocyte α-galactosidase A enzyme activity was mildly reduced in 19 subjects and lyso-globotriaosylceramide slightly elevated (median, 4.9; interquartile range, 1.3-9.1 ng/mL). Neurological and renal impairments (serum creatinine, 0.87±0.20; median, 0.80; interquartile range, 0.70-1.01 mg/dL; glomerular filtration rate, 102±23; median, 106; interquartile range, 84-113 mL/min) were discreet. Only 2 subjects developed clinically relevant proteinuria. CONCLUSIONS α-Galactosidase A genotype N215S does not lead to the development of a classical Fabry phenotype but induces a specific cardiac variant of Fabry disease mimicking nonobstructive hypertrophic cardiomyopathy. The lack of prominent noncardiac impairment leads to a significant delay in diagnosis and Fabry-specific therapy.
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Affiliation(s)
- Daniel Oder
- From the Department of Internal Medicine I and Comprehensive Heart Failure Center (CHFC) (D.O., D.L., K.H., T.S., J.M., K.L., G.E., C.W., P.N.), Fabry Center for Interdisciplinary Therapy (FAZIT) (D.O., D.L., K.H., N.Ü., T.S., J.M., C.S., G.E., C.W., P.N.), and Department of Neurology (N.Ü., C.S.), University Hospital Würzburg, Germany; West German Heart and Vascular Center Essen, University Hospital Essen, Germany (K.L.); Leibniz-Institut für Analytische Wissenschaften-ISAS-e.V., Dortmund, Germany (K.L.); Department of Molecular Pathology, University Hospital of Tübingen, Germany (R.K.); and Department of Cellular and Molecular Pathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (H.-J.G.)
| | - Dan Liu
- From the Department of Internal Medicine I and Comprehensive Heart Failure Center (CHFC) (D.O., D.L., K.H., T.S., J.M., K.L., G.E., C.W., P.N.), Fabry Center for Interdisciplinary Therapy (FAZIT) (D.O., D.L., K.H., N.Ü., T.S., J.M., C.S., G.E., C.W., P.N.), and Department of Neurology (N.Ü., C.S.), University Hospital Würzburg, Germany; West German Heart and Vascular Center Essen, University Hospital Essen, Germany (K.L.); Leibniz-Institut für Analytische Wissenschaften-ISAS-e.V., Dortmund, Germany (K.L.); Department of Molecular Pathology, University Hospital of Tübingen, Germany (R.K.); and Department of Cellular and Molecular Pathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (H.-J.G.)
| | - Kai Hu
- From the Department of Internal Medicine I and Comprehensive Heart Failure Center (CHFC) (D.O., D.L., K.H., T.S., J.M., K.L., G.E., C.W., P.N.), Fabry Center for Interdisciplinary Therapy (FAZIT) (D.O., D.L., K.H., N.Ü., T.S., J.M., C.S., G.E., C.W., P.N.), and Department of Neurology (N.Ü., C.S.), University Hospital Würzburg, Germany; West German Heart and Vascular Center Essen, University Hospital Essen, Germany (K.L.); Leibniz-Institut für Analytische Wissenschaften-ISAS-e.V., Dortmund, Germany (K.L.); Department of Molecular Pathology, University Hospital of Tübingen, Germany (R.K.); and Department of Cellular and Molecular Pathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (H.-J.G.)
| | - Nurcan Üçeyler
- From the Department of Internal Medicine I and Comprehensive Heart Failure Center (CHFC) (D.O., D.L., K.H., T.S., J.M., K.L., G.E., C.W., P.N.), Fabry Center for Interdisciplinary Therapy (FAZIT) (D.O., D.L., K.H., N.Ü., T.S., J.M., C.S., G.E., C.W., P.N.), and Department of Neurology (N.Ü., C.S.), University Hospital Würzburg, Germany; West German Heart and Vascular Center Essen, University Hospital Essen, Germany (K.L.); Leibniz-Institut für Analytische Wissenschaften-ISAS-e.V., Dortmund, Germany (K.L.); Department of Molecular Pathology, University Hospital of Tübingen, Germany (R.K.); and Department of Cellular and Molecular Pathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (H.-J.G.)
| | - Tim Salinger
- From the Department of Internal Medicine I and Comprehensive Heart Failure Center (CHFC) (D.O., D.L., K.H., T.S., J.M., K.L., G.E., C.W., P.N.), Fabry Center for Interdisciplinary Therapy (FAZIT) (D.O., D.L., K.H., N.Ü., T.S., J.M., C.S., G.E., C.W., P.N.), and Department of Neurology (N.Ü., C.S.), University Hospital Würzburg, Germany; West German Heart and Vascular Center Essen, University Hospital Essen, Germany (K.L.); Leibniz-Institut für Analytische Wissenschaften-ISAS-e.V., Dortmund, Germany (K.L.); Department of Molecular Pathology, University Hospital of Tübingen, Germany (R.K.); and Department of Cellular and Molecular Pathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (H.-J.G.)
| | - Jonas Müntze
- From the Department of Internal Medicine I and Comprehensive Heart Failure Center (CHFC) (D.O., D.L., K.H., T.S., J.M., K.L., G.E., C.W., P.N.), Fabry Center for Interdisciplinary Therapy (FAZIT) (D.O., D.L., K.H., N.Ü., T.S., J.M., C.S., G.E., C.W., P.N.), and Department of Neurology (N.Ü., C.S.), University Hospital Würzburg, Germany; West German Heart and Vascular Center Essen, University Hospital Essen, Germany (K.L.); Leibniz-Institut für Analytische Wissenschaften-ISAS-e.V., Dortmund, Germany (K.L.); Department of Molecular Pathology, University Hospital of Tübingen, Germany (R.K.); and Department of Cellular and Molecular Pathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (H.-J.G.)
| | - Kristina Lorenz
- From the Department of Internal Medicine I and Comprehensive Heart Failure Center (CHFC) (D.O., D.L., K.H., T.S., J.M., K.L., G.E., C.W., P.N.), Fabry Center for Interdisciplinary Therapy (FAZIT) (D.O., D.L., K.H., N.Ü., T.S., J.M., C.S., G.E., C.W., P.N.), and Department of Neurology (N.Ü., C.S.), University Hospital Würzburg, Germany; West German Heart and Vascular Center Essen, University Hospital Essen, Germany (K.L.); Leibniz-Institut für Analytische Wissenschaften-ISAS-e.V., Dortmund, Germany (K.L.); Department of Molecular Pathology, University Hospital of Tübingen, Germany (R.K.); and Department of Cellular and Molecular Pathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (H.-J.G.)
| | - Reinhard Kandolf
- From the Department of Internal Medicine I and Comprehensive Heart Failure Center (CHFC) (D.O., D.L., K.H., T.S., J.M., K.L., G.E., C.W., P.N.), Fabry Center for Interdisciplinary Therapy (FAZIT) (D.O., D.L., K.H., N.Ü., T.S., J.M., C.S., G.E., C.W., P.N.), and Department of Neurology (N.Ü., C.S.), University Hospital Würzburg, Germany; West German Heart and Vascular Center Essen, University Hospital Essen, Germany (K.L.); Leibniz-Institut für Analytische Wissenschaften-ISAS-e.V., Dortmund, Germany (K.L.); Department of Molecular Pathology, University Hospital of Tübingen, Germany (R.K.); and Department of Cellular and Molecular Pathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (H.-J.G.)
| | - Hermann-Josef Gröne
- From the Department of Internal Medicine I and Comprehensive Heart Failure Center (CHFC) (D.O., D.L., K.H., T.S., J.M., K.L., G.E., C.W., P.N.), Fabry Center for Interdisciplinary Therapy (FAZIT) (D.O., D.L., K.H., N.Ü., T.S., J.M., C.S., G.E., C.W., P.N.), and Department of Neurology (N.Ü., C.S.), University Hospital Würzburg, Germany; West German Heart and Vascular Center Essen, University Hospital Essen, Germany (K.L.); Leibniz-Institut für Analytische Wissenschaften-ISAS-e.V., Dortmund, Germany (K.L.); Department of Molecular Pathology, University Hospital of Tübingen, Germany (R.K.); and Department of Cellular and Molecular Pathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (H.-J.G.)
| | - Claudia Sommer
- From the Department of Internal Medicine I and Comprehensive Heart Failure Center (CHFC) (D.O., D.L., K.H., T.S., J.M., K.L., G.E., C.W., P.N.), Fabry Center for Interdisciplinary Therapy (FAZIT) (D.O., D.L., K.H., N.Ü., T.S., J.M., C.S., G.E., C.W., P.N.), and Department of Neurology (N.Ü., C.S.), University Hospital Würzburg, Germany; West German Heart and Vascular Center Essen, University Hospital Essen, Germany (K.L.); Leibniz-Institut für Analytische Wissenschaften-ISAS-e.V., Dortmund, Germany (K.L.); Department of Molecular Pathology, University Hospital of Tübingen, Germany (R.K.); and Department of Cellular and Molecular Pathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (H.-J.G.)
| | - Georg Ertl
- From the Department of Internal Medicine I and Comprehensive Heart Failure Center (CHFC) (D.O., D.L., K.H., T.S., J.M., K.L., G.E., C.W., P.N.), Fabry Center for Interdisciplinary Therapy (FAZIT) (D.O., D.L., K.H., N.Ü., T.S., J.M., C.S., G.E., C.W., P.N.), and Department of Neurology (N.Ü., C.S.), University Hospital Würzburg, Germany; West German Heart and Vascular Center Essen, University Hospital Essen, Germany (K.L.); Leibniz-Institut für Analytische Wissenschaften-ISAS-e.V., Dortmund, Germany (K.L.); Department of Molecular Pathology, University Hospital of Tübingen, Germany (R.K.); and Department of Cellular and Molecular Pathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (H.-J.G.)
| | - Christoph Wanner
- From the Department of Internal Medicine I and Comprehensive Heart Failure Center (CHFC) (D.O., D.L., K.H., T.S., J.M., K.L., G.E., C.W., P.N.), Fabry Center for Interdisciplinary Therapy (FAZIT) (D.O., D.L., K.H., N.Ü., T.S., J.M., C.S., G.E., C.W., P.N.), and Department of Neurology (N.Ü., C.S.), University Hospital Würzburg, Germany; West German Heart and Vascular Center Essen, University Hospital Essen, Germany (K.L.); Leibniz-Institut für Analytische Wissenschaften-ISAS-e.V., Dortmund, Germany (K.L.); Department of Molecular Pathology, University Hospital of Tübingen, Germany (R.K.); and Department of Cellular and Molecular Pathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (H.-J.G.)
| | - Peter Nordbeck
- From the Department of Internal Medicine I and Comprehensive Heart Failure Center (CHFC) (D.O., D.L., K.H., T.S., J.M., K.L., G.E., C.W., P.N.), Fabry Center for Interdisciplinary Therapy (FAZIT) (D.O., D.L., K.H., N.Ü., T.S., J.M., C.S., G.E., C.W., P.N.), and Department of Neurology (N.Ü., C.S.), University Hospital Würzburg, Germany; West German Heart and Vascular Center Essen, University Hospital Essen, Germany (K.L.); Leibniz-Institut für Analytische Wissenschaften-ISAS-e.V., Dortmund, Germany (K.L.); Department of Molecular Pathology, University Hospital of Tübingen, Germany (R.K.); and Department of Cellular and Molecular Pathology, German Cancer Research Center (DKFZ), Heidelberg, Germany (H.-J.G.). .,
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AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current Evidence, Knowledge Gaps, Recommendations, and Future Directions: Erratum. Clin J Sport Med 2018; 28:324. [PMID: 29762263 DOI: 10.1097/jsm.0000000000000382] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Abstract
Competitive sports activity is associated with an increased risk of sudden cardiovascular death in adolescents and young adults with inherited cardiomyopathies. Many young subjects aspire to continue competitive sport after a diagnosis of cardiomyopathy and the clinician is frequently confronted with the problem of eligibility and the request of designing specific exercise programs. Since inherited cardiomyopathies are the leading cause of sudden cardiovascular death during sports performance, a conservative approach implying disqualification of affected athletes from most competitive athletic disciplines is recommended by all the available international guidelines. On the other hand, we know that the health benefits of practicing recreational sports activity can overcome the potential arrhythmic risk in these patients, provided that the type and level of exercise are tailored on the basis of the specific risk profile of the underlying cardiomyopathy. This article will review the available evidence on the sports-related risk of sudden cardiac death and the recommendations regarding eligibility of individuals affected by inherited cardiomyopathies for sports activities.
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Affiliation(s)
- A Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
| | - A Pelliccia
- Institute of Sports Medicine and Science, Rome, Italy
| | - D Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
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31
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Zorzi A, Calore C, Vio R, Pelliccia A, Corrado D. Accuracy of the ECG for differential diagnosis between hypertrophic cardiomyopathy and athlete’s heart: comparison between the European Society of Cardiology (2010) and International (2017) criteria. Br J Sports Med 2017; 52:667-673. [DOI: 10.1136/bjsports-2016-097438] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/21/2017] [Accepted: 05/29/2017] [Indexed: 01/01/2023]
Abstract
BackgroundInterpretation of the athlete’s ECG is based on differentiation between benign ECG changes and potentially pathological abnormalities. The aim of the study was to compare the 2010 European Society of Cardiology (ESC) and the 2017 International criteria for differential diagnosis between hypertrophic cardiomyopathy (HCM) and athlete’s heart.MethodsThe study populations included 200 patients with HCM and 563 athletes grouped as follows: ‘group 1’, including normal ECG and isolated increase of QRS voltages, which are considered non-pathologic according to ESC and International criteria; ‘group 2’, including left atrial enlargement or left axis deviation in isolation and Q-waves with an amplitude ≥4 mm but <25% of the ensuing R-wave and a duration <0.04 s which are considered pathologic according to the ESC but not according to the International criteria; and ‘group 3’, including abnormalities which are considered pathologic according to ESC and International criteria.ResultsOverall, the 2010 ESC criteria showed a sensitivity of 95.5% and a specificity of 86.9%. Considering group 2 ECG changes as normal according to the International criteria led to a statistically significant (p<0.001) increase of specificity to 95.9%, associated with a non-significant (p=0.47) reduction of sensitivity to 93%. Among patients with HCM, there was a significant increase of maximal left ventricular wall thickness from group 1 to 3 (p=0.02).ConclusionsThe use of 2017 International criteria is associated with a substantial increase in specificity and a marginal decrease in sensitivity for differential diagnosis between HCM and athlete’s heart.
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McClean G, Riding NR, Ardern CL, Farooq A, Pieles GE, Watt V, Adamuz C, George KP, Oxborough D, Wilson MG. Electrical and structural adaptations of the paediatric athlete’s heart: a systematic review with meta-analysis. Br J Sports Med 2017; 52:230. [DOI: 10.1136/bjsports-2016-097052] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2017] [Indexed: 01/27/2023]
Abstract
AimTo describe the electrocardiographic (ECG) and echocardiographic manifestations of the paediatric athlete’s heart, and examine the impact of age, race and sex on cardiac remodelling responses to competitive sport.DesignSystematic review with meta-analysis.Data sourcesSix electronic databases were searched to May 2016: MEDLINE, PubMed, EMBASE, Web of Science, CINAHL and SPORTDiscus.Inclusion criteria(1) Male and/or female competitive athletes, (2) participants aged 6–18 years, (3) original research article published in English language.ResultsData from 14 278 athletes and 1668 non-athletes were included for qualitative (43 articles) and quantitative synthesis (40 articles). Paediatric athletes demonstrated a greater prevalence of training-related and training-unrelated ECG changes than non-athletes. Athletes ≥14 years were 15.8 times more likely to have inferolateral T-wave inversion than athletes <14 years. Paediatric black athletes had significantly more training-related and training-unrelated ECG changes than Caucasian athletes. Age was a positive predictor of left ventricular (LV) internal diameter during diastole, interventricular septum thickness during diastole, relative wall thickness and LV mass. When age was accounted for, these parameters remained significantly larger in athletes than non-athletes. Paediatric black athletes presented larger posterior wall thickness during diastole (PWTd) than Caucasian athletes. Paediatric male athletes also presented larger PWTd than females.ConclusionsThe paediatric athlete’s heart undergoes significant remodelling both before and during ‘maturational years’. Paediatric athletes have a greater prevalence of training related and training-unrelated ECG changes than non-athletes, with age, race and sex mediating factors on cardiac electrical and LV structural remodelling.
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Zdravkovic M, Milovanovic B, Hinic S, Soldatovic I, Durmic T, Koracevic G, Prijic S, Markovic O, Filipovic B, Lovic D. Correlation between ECG changes and early left ventricular remodeling in preadolescent footballers. Physiol Int 2017; 104:42-51. [PMID: 28361571 DOI: 10.1556/2060.104.2017.1.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The aim of this study was to assess the early electrocardiogram (ECG) changes induced by physical training in preadolescent elite footballers. This study included 94 preadolescent highly trained male footballers (FG) competing in Serbian Football League (minimum of 7 training hours/week) and 47 age-matched healthy male controls (less than 2 training hours/week) (CG). They were screened by ECG and echocardiography at a tertiary referral cardio center. Sokolow-Lyon index was used as a voltage electrocardiographic criterion for left ventricular hypertrophy diagnosis. Characteristic ECG intervals and voltage were compared and reference range was given for preadolescent footballers. Highly significant differences between FG and CG were registered in all ECG parameters: P-wave voltage (p < 0.001), S-wave (V1 or V2 lead) voltage (p < 0.001), R-wave (V5 and V6 lead) voltage (p < 0.001), ECG sum of S V1-2 + R V5-6 (p < 0.001), T-wave voltage (p < 0.001), QRS complex duration (p < 0.001), T-wave duration (p < 0.001), QTc interval duration (p < 0.001), and R/T ratio (p < 0.001). No differences were found in PQ interval duration between these two groups (p > 0.05). During 6-year follow-up period, there was no adverse cardiac event in these footballers. None of them expressed pathological ECG changes. Benign ECG changes are presented in the early stage of athlete's heart remodeling, but they are not related to pathological ECG changes and they should be regarded as ECG pattern of LV remodeling.
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Affiliation(s)
- M Zdravkovic
- 1 Faculty of Medicine, University Hospital Medical Center Bezanijska Kosa, University of Belgrade , Belgrade, Serbia
| | - B Milovanovic
- 1 Faculty of Medicine, University Hospital Medical Center Bezanijska Kosa, University of Belgrade , Belgrade, Serbia
| | - S Hinic
- 1 Faculty of Medicine, University Hospital Medical Center Bezanijska Kosa, University of Belgrade , Belgrade, Serbia
| | - I Soldatovic
- 2 Faculty of Medicine, Institute for Medical Statistics, University of Belgrade , Belgrade, Serbia
| | - T Durmic
- 3 Faculty of Medicine, Institute of Forensic Medicine, University of Belgrade , Belgrade, Serbia
| | - G Koracevic
- 4 Faculty of Medicine, Clinic for Cardiology, University of Nis , Nis, Serbia
| | - S Prijic
- 5 Department of Cardiology, Faculty of Medicine, Institute for Child and Mother Care "Vukan Cupic", University of Belgrade , Belgrade, Serbia
| | - O Markovic
- 1 Faculty of Medicine, University Hospital Medical Center Bezanijska Kosa, University of Belgrade , Belgrade, Serbia
| | - B Filipovic
- 1 Faculty of Medicine, University Hospital Medical Center Bezanijska Kosa, University of Belgrade , Belgrade, Serbia
| | - D Lovic
- 6 Clinic for Internal Diseases "InterMedica" , Nis, Serbia
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34
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Drezner JA, O'Connor FG, Harmon KG, Fields KB, Asplund CA, Asif IM, Price DE, Dimeff RJ, Bernhardt DT, Roberts WO. AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current Evidence, Knowledge Gaps, Recommendations and Future Directions. Curr Sports Med Rep 2017; 15:359-75. [PMID: 27618246 DOI: 10.1249/jsr.0000000000000296] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cardiovascular screening in young athletes is widely recommended and routinely performed prior to participation in competitive sports. While there is general agreement that early detection of cardiac conditions at risk for sudden cardiac arrest and death (SCA/D) is an important objective, the optimal strategy for cardiovascular screening in athletes remains an issue of considerable debate. At the center of the controversy is the addition of a resting electrocardiogram (ECG) to the standard preparticipation evaluation using history and physical examination. The American Medical Society for Sports Medicine (AMSSM) formed a task force to address the current evidence and knowledge gaps regarding preparticipation cardiovascular screening in athletes from the perspective of a primary care sports medicine physician. The absence of definitive outcomes-based evidence at this time precludes AMSSM from endorsing any single or universal cardiovascular screening strategy for all athletes, including legislative mandates. This statement presents a new paradigm to assist the individual physician in assessing the most appropriate cardiovascular screening strategy unique to their athlete population, community needs, and resources. The decision to implement a cardiovascular screening program, with or without the addition of ECG, necessitates careful consideration of the risk of SCA/D in the targeted population and the availability of cardiology resources and infrastructure. Importantly, it is the individual physician's assessment in the context of an emerging evidence-base that the chosen model for early detection of cardiac disorders in the specific population provides greater benefit than harm. AMSSM is committed to advancing evidenced-based research and educational initiatives that will validate and promote the most efficacious strategies to foster safe sport participation and reduce SCA/D in athletes.
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Affiliation(s)
- Jonathan A Drezner
- 1Department of Family Medicine, University of Washington, Seattle, WA; 2Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; 3Department of Family Medicine, University of North Carolina, Greensboro, NC; 4Department of Health and Kinesiology, Georgia Southern University, Statesboro, GA; 5Department of Family Medicine, University of South Carolina Greenville School of Medicine, Greenville, SC; 6Department of Family Medicine, Carolinas Healthcare System, Charlotte, NC; 7Departments of Orthopedic Surgery, Family & Community Medicine, and Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; 8Departments of Pediatrics, Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI; 9Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
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Abstract
Sudden cardiac death (SCD) in a young person is a rare but tragic occurrence. The impact is widespread, particularly in the modern era of media coverage and visibility of social media. Hypertrophic cardiomyopathy (HCM) is reported historically as the most common cause of SCD in athletes younger than 35 years of age. A diagnosis of HCM may be challenging in athletes as pathological hypertrophy of the left ventricle may also mimic physiological left ventricular hypertrophy (LVH) in response to exercise. Differentiation of physiological LVH from HCM requires an array of clinical tools that rely on detecting subtle features of disease in a supposedly healthy person who represents the segment of society with the highest functional capacity. Most studies are based on comparisons of clinical tests between healthy unaffected athletes and sedentary individuals with HCM. However, data are emerging that report the clinical features of athletes with HCM. This article focuses on studies that help shed further light to aid the clinical differentiation of physiological LVH from HCM. This distinction is particularly important in a young person: a diagnosis of HCM has significant ramifications on participation in competitive sport, yet an erroneous diagnosis of physiological adaptation in a young athlete with HCM may subject them to an increased risk of SCD.
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Affiliation(s)
- Aneil Malhotra
- Cardiology Clinical and Academic Group, St. George's University of London London, UK
| | - Sanjay Sharma
- Cardiology Clinical and Academic Group, St. George's University of London London, UK
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36
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Drezner JA, O'Connor FG, Harmon KG, Fields KB, Asplund CA, Asif IM, Price DE, Dimeff RJ, Bernhardt DT, Roberts WO. AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current evidence, knowledge gaps, recommendations and future directions. Br J Sports Med 2016; 51:153-167. [PMID: 27660369 DOI: 10.1136/bjsports-2016-096781] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 11/04/2022]
Abstract
Cardiovascular screening in young athletes is widely recommended and routinely performed prior to participation in competitive sports. While there is general agreement that early detection of cardiac conditions at risk for sudden cardiac arrest and death (SCA/D) is an important objective, the optimal strategy for cardiovascular screening in athletes remains an issue of considerable debate. At the centre of the controversy is the addition of a resting ECG to the standard preparticipation evaluation using history and physical examination. The American Medical Society for Sports Medicine (AMSSM) formed a task force to address the current evidence and knowledge gaps regarding preparticipation cardiovascular screening in athletes from the perspective of a primary care sports medicine physician. The absence of definitive outcome-based evidence at this time precludes AMSSM from endorsing any single or universal cardiovascular screening strategy for all athletes, including legislative mandates. This statement presents a new paradigm to assist the individual physician in assessing the most appropriate cardiovascular screening strategy unique to their athlete population, community needs and resources. The decision to implement a cardiovascular screening programme, with or without the addition of ECG, necessitates careful consideration of the risk of SCA/D in the targeted population and the availability of cardiology resources and infrastructure. Importantly, it is the individual physician's assessment in the context of an emerging evidence base that the chosen model for early detection of cardiac disorders in the specific population provides greater benefit than harm. AMSSM is committed to advancing evidenced-based research and educational initiatives that will validate and promote the most efficacious strategies to foster safe sport participation and reduce SCA/D in athletes.
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Affiliation(s)
- Jonathan A Drezner
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Francis G O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Kimberly G Harmon
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Karl B Fields
- Department of Family Medicine, University of North Carolina, Greensboro, North Carolina, USA
| | - Chad A Asplund
- Department of Health and Kinesiology, Georgia Southern University, Statesboro, Georgia, USA
| | - Irfan M Asif
- Department of Family Medicine, University of South Carolina Greenville School of Medicine, Greenville, South Carolina, USA
| | - David E Price
- Department of Family Medicine, Carolinas Healthcare System, Charlotte, North Carolina, USA
| | - Robert J Dimeff
- Departments of Orthopedic Surgery, Family and Community Medicine, and Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David T Bernhardt
- Departments of Pediatrics, Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - William O Roberts
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
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37
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Abstract
PURPOSE OF REVIEW Exercise-induced cardiac remodeling (EICR), or athlete's heart, refers to the cardiac structural and functional adaptations to exercise training. Although the degree of physiological left ventricular hypertrophy (LVH) is typically mild in trained athletes, in some LVH is substantial enough to prompt concern for hypertrophic cardiomyopathy (HCM). This review summarizes the available imaging tools to help make this important clinical distinction. RECENT FINDINGS Advanced echocardiographic techniques (tissue and Doppler and speckle tracking) and cardiac magnetic resonance imaging are being investigated to aid in the differentiation of EICR and HCM in 'gray-zone' hypertrophy cases. Higher early diastolic (E') velocity by tissue Doppler imaging has been documented in athletes. HCM patients have been found to have lower global longitudinal strain (GLS) when compared with athletes with LVH. Analysis of twisting and untwisting of the LV with speckle tracking may also help distinguish athlete's heart from HCM. Studies of the expected degree and time course of LVH regression after exercise cessation (in the setting of prescribed detraining) are needed as this may be a useful adjunct to determine the cause of LVH in particularly challenging cases. SUMMARY Ongoing research with novel imaging techniques continues to improve the ability to distinguish athlete's heart from HCM in situations of 'gray-zone' hypertrophy.
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Affiliation(s)
- Meagan M Wasfy
- Cardiovascular Performance Program, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA
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38
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Affiliation(s)
- Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Newtown, NSW, 2042, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Joanna Sweeting
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Newtown, NSW, 2042, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Michael J Ackerman
- Departments of Medicine, Pediatrics, and Molecular Pharmacologyand Experimental Therapeutics, Divisions of Cardiovascular Diseases and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
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39
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Machado Leite S, Freitas J, Campelo M, Maciel MJ. Electrocardiographic evaluation in athletes: ‘Normal’ changes in the athlete's heart and benefits and disadvantages of screening. Rev Port Cardiol 2016; 35:169-77. [DOI: 10.1016/j.repc.2015.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 09/13/2015] [Indexed: 10/22/2022] Open
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40
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Machado Leite S, Freitas J, Campelo M, Maciel MJ. Electrocardiographic evaluation in athletes: ‘Normal’ changes in the athlete's heart and benefits and disadvantages of screening. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2015.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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41
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Aagaard P, Phelan D. Athlete Screening for Cardiomyopathies: Recent Insights and Latest Guidelines. CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0494-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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42
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Galderisi M, Cardim N, D'Andrea A, Bruder O, Cosyns B, Davin L, Donal E, Edvardsen T, Freitas A, Habib G, Kitsiou A, Plein S, Petersen SE, Popescu BA, Schroeder S, Burgstahler C, Lancellotti P. The multi-modality cardiac imaging approach to the Athlete's heart: an expert consensus of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2016; 16:353. [PMID: 25681828 DOI: 10.1093/ehjci/jeu323] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The term 'athlete's heart' refers to a clinical picture characterized by a slow heart rate and enlargement of the heart. A multi-modality imaging approach to the athlete's heart aims to differentiate physiological changes due to intensive training in the athlete's heart from serious cardiac diseases with similar morphological features. Imaging assessment of the athlete's heart should begin with a thorough echocardiographic examination.Left ventricular (LV) wall thickness by echocardiography can contribute to the distinction between athlete's LV hypertrophy and hypertrophic cardiomyopathy (HCM). LV end-diastolic diameter becomes larger (>55 mm) than the normal limits only in end-stage HCM patients when the LV ejection fraction is <50%. Patients with HCM also show early impairment of LV diastolic function, whereas athletes have normal diastolic function.When echocardiography cannot provide a clear differential diagnosis, cardiac magnetic resonance (CMR) imaging should be performed.With CMR, accurate morphological and functional assessment can be made. Tissue characterization by late gadolinium enhancement may show a distinctive, non-ischaemic pattern in HCM and a variety of other myocardial conditions such as idiopathic dilated cardiomyopathy or myocarditis. The work-up of athletes with suspected coronary artery disease should start with an exercise ECG. In athletes with inconclusive exercise ECG results, exercise stress echocardiography should be considered. Nuclear cardiology techniques, coronary cardiac tomography (CCT) and/or CMR may be performed in selected cases. Owing to radiation exposure and the young age of most athletes, the use of CCT and nuclear cardiology techniques should be restricted to athletes with unclear stress echocardiography or CMR.
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MESH Headings
- Adult
- Arrhythmogenic Right Ventricular Dysplasia/diagnosis
- Cardiac Imaging Techniques/methods
- Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography
- Cardiomegaly/diagnosis
- Cardiomegaly, Exercise-Induced
- Cardiomyopathy, Dilated/diagnosis
- Cardiomyopathy, Hypertrophic/diagnosis
- Consensus
- Contrast Media
- Death, Sudden, Cardiac/prevention & control
- Echocardiography, Stress/methods
- Electrocardiography
- European Union
- Gadolinium
- Humans
- Hypertrophy, Left Ventricular/diagnosis
- Magnetic Resonance Imaging, Cine
- Predictive Value of Tests
- Sensitivity and Specificity
- Societies, Medical
- Technetium Tc 99m Sestamibi
- Tomography, Emission-Computed, Single-Photon
- Tomography, X-Ray Computed/methods
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43
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Wilson MG, Ellison GM, Cable NT. Basic science behind the cardiovascular benefits of exercise. Br J Sports Med 2016; 50:93-9. [DOI: 10.1136/bjsports-2014-306596rep] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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44
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The Impending Dilemma of Electrocardiogram Screening in Athletic Children. Pediatr Cardiol 2016; 37:1-13. [PMID: 26289947 DOI: 10.1007/s00246-015-1239-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/31/2015] [Indexed: 10/23/2022]
Abstract
Sudden cardiac death (SCD) affects 2/100,000 young, active athletes per year of which 40% are less than 18 years old. In 2004, the International Olympic Committee accepted the Lausanne Recommendations, including a 12-lead electrocardiogram (ECG), as a pre-participation screening tool for adult Olympic athletes. The debate on extending those recommendations to the pediatric population has recently begun. The aims of our study were to highlight the characteristics of the young athlete ECG, phenotypical manifestations of SCD-related disease in children, and challenges of implanting ECG screening in athletic children. A systematic review of the literature is performed. We searched available electronic medical databases for articles relevant to SCD, ECG, silent cardiac diseases, and athletic children. We focused on ECG screening and description in a pediatric population. We identified 2240 studies. Sixty-two relevant articles and one book were selected. In children, prepubertal ECG and the ECG phenotype of most SCD-related diseases differ notably from adults. The characteristics of the prepubertal ECG and of the phenotypical manifestation of SCD-related disease in children will result in less specific and less sensitive ECG-based screening programs. Those limitations advise against extending the adult recommendation to children, without further studies. Until then, history and physical exam should remain the cornerstone of screening for SCD-related pathologies in children.
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45
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Machado M, Vaz Silva M. Benign and pathological electrocardiographic changes in athletes. Rev Port Cardiol 2015; 34:753-70. [PMID: 26643438 DOI: 10.1016/j.repc.2015.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/01/2015] [Accepted: 07/25/2015] [Indexed: 01/02/2023] Open
Abstract
Sudden cardiac death is the leading cause of death in athletes during sport. It is a tragic event that generates significant media attention and discussion throughout society as to whether everything possible had been done to prevent it. Regular physical exercise causes cardiac remodeling at both the mechanical and electrical level, known as athlete's heart, resulting in an electrocardiogram (ECG) considered abnormal compared with the ECGs of the general population. Some of these electrocardiographic changes are considered normal or physiological in athletes, while others suggest underlying cardiac disease with the potential to cause sudden cardiac death. There is thus an urgent need to define the electrocardiographic patterns that allow or prohibit participation in sports, and to differentiate them in terms of gender, ethnicity and age. The purpose of this review is to present the latest data on the electrocardiographic changes considered benign or pathological that are typically found in athletes and to critically analyze the most recent criteria for classifying ECGs in this population (the Seattle criteria), comparing them with previous guidelines and with the latest studies on the subject. This article also examines the question of including ECGs in pre-participation screening programs, the US and European approaches to the subject, and the most up-to-date data on the sensitivity, specificity and cost-effectiveness of the ECG in athletes.
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Affiliation(s)
- Marino Machado
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - Manuel Vaz Silva
- Serviço de Cardiologia/Departamento de Medicina, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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46
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Machado M, Vaz Silva M. Benign and pathological electrocardiographic changes in athletesBenign and pathological electrocardiographic changes in athletes. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2015.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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47
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Wilson MG, Ellison GM, Cable NT. Republished: Basic science behind the cardiovascular benefits of exercise. Postgrad Med J 2015; 91:704-11. [DOI: 10.1136/postgradmedj-2014-306596rep] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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48
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Calore C, Zorzi A, Sheikh N, Nese A, Facci M, Malhotra A, Zaidi A, Schiavon M, Pelliccia A, Sharma S, Corrado D. Electrocardiographic anterior T-wave inversion in athletes of different ethnicities: differential diagnosis between athlete's heart and cardiomyopathy. Eur Heart J 2015; 37:2515-27. [DOI: 10.1093/eurheartj/ehv591] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 10/12/2015] [Indexed: 01/27/2023] Open
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49
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Chatard JC, Mujika I, Goiriena JJ, Carré F. Screening young athletes for prevention of sudden cardiac death: Practical recommendations for sports physicians. Scand J Med Sci Sports 2015; 26:362-74. [PMID: 26432052 DOI: 10.1111/sms.12502] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 12/13/2022]
Abstract
Regular intensive exercise in athletes increases the relative risk of sudden cardiac death (SCD) compared with the relatively sedentary population. Most cases of SCD are due to silent cardiovascular diseases, and pre-participation screening of athletes at risk of SCD is thus of major importance. However, medical guidelines and recommendations differ widely between countries. In Italy, the National Health System recommends pre-participation screening for all competitive athletes including personal and family history, a physical examination, and a resting 12-lead electrocardiogram (ECG). In the United States, the American College of Cardiology and the American Heart Association recommend a pre-participation screening program limited to the use of specific questionnaires and a clinical examination. The value of a 12-lead ECG is debated based on issues surrounding cost-efficiency and feasibility. The aim of this review was to focus on (i) the incidence rate of cardiac diseases in relation to SCD; (ii) the value of conducting a questionnaire and a physical examination; (iii) the value of a 12-lead resting ECG; (iv) the importance of other cardiac evaluations in the prevention of SCD; and (v) the best practice for pre-participation screening.
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Affiliation(s)
- J-C Chatard
- Laboratory of Exercise Physiology, Faculty of Medicine Jacques Lisfranc, University of Lyon-Saint-Etienne, Saint-Etienne, France
| | - I Mujika
- Department of Physiology, Faculty of Medicine and Odontology, University of the Basque Country, Leioa, Basque Country, Spain.,School of Kinesiology and Health Research Center, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - J J Goiriena
- Department of Physiology, Faculty of Medicine and Odontology, University of the Basque Country, Leioa, Basque Country, Spain
| | - F Carré
- Laboratory of Exercise Physiology, Faculty of Medicine, University of Rennes, Rennes, France
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50
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Sheikh N, Papadakis M, Schnell F, Panoulas V, Malhotra A, Wilson M, Carré F, Sharma S. Clinical Profile of Athletes With Hypertrophic Cardiomyopathy. Circ Cardiovasc Imaging 2015. [PMID: 26198026 DOI: 10.1161/circimaging.114.003454] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The phenotype of individuals with hypertrophic cardiomyopathy (HCM) who exercise regularly is unknown. This study characterized the clinical profile of young athletes with HCM. METHODS AND RESULTS The electrical, structural, and functional cardiac parameters from 106 young (14-35 years) athletes with HCM were compared with 101 sedentary HCM patients. A subset of athletes with HCM exhibiting morphologically mild (13-16 mm), concentric disease was compared with 55 healthy athletes with mild physiological left ventricular hypertrophy (LVH). Most athletes with HCM (96%) exhibited T-wave inversion and had milder LVH (15.8±3.4 mm versus 19.7±6.5 mm, P<0.001), larger left ventricular cavity dimensions (47.8±6.0 mm versus 44.3±7.7 mm, P<0.001), and superior indices of diastolic function (average E/E' 7.9±2.4 versus 10.7±3.9, P<0.001) compared with sedentary HCM patients. In athletes with HCM, LVH was frequently (36%) confined to the apex and only 15 individuals (14%) exhibited mild concentric LVH mimicking physiological LVH. In these 15 athletes, conventional structural and functional cardiac parameters showed modest sensitivity and specificity for differentiating HCM from physiological LVH: 13% had a left ventricular cavity >54 mm, 87% had a left atrium ≤40, and 100% had an E/E' <12. CONCLUSIONS Athletes with HCM exhibit less LVH, larger left ventricular cavities, and normal indices of diastolic function compared with sedentary patients. Only a minority of athletes with HCM constitute the conventional gray zone of mild, concentric LVH. In this minority, conventional echocardiographic parameters alone are insufficient to differentiate HCM from physiological LVH and should be complemented by additional structural and functional assessments to minimize the risk of false reassurance.
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Affiliation(s)
- Nabeel Sheikh
- From the St. George's University of London, UK (N.S., M.P., A.M., S.S.); University Hospital Lewisham, London, UK (N.S., M.P., A.M., S.S.); French Institute of Health and Medical Research (INSERM), Rennes, France (F.S., F.C.); National Heart and Lung Institute, Imperial College London, UK (V.P.); and Aspetar, Department of Sports Medicine, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (M.W.)
| | - Michael Papadakis
- From the St. George's University of London, UK (N.S., M.P., A.M., S.S.); University Hospital Lewisham, London, UK (N.S., M.P., A.M., S.S.); French Institute of Health and Medical Research (INSERM), Rennes, France (F.S., F.C.); National Heart and Lung Institute, Imperial College London, UK (V.P.); and Aspetar, Department of Sports Medicine, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (M.W.)
| | - Frédéric Schnell
- From the St. George's University of London, UK (N.S., M.P., A.M., S.S.); University Hospital Lewisham, London, UK (N.S., M.P., A.M., S.S.); French Institute of Health and Medical Research (INSERM), Rennes, France (F.S., F.C.); National Heart and Lung Institute, Imperial College London, UK (V.P.); and Aspetar, Department of Sports Medicine, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (M.W.)
| | - Vasileios Panoulas
- From the St. George's University of London, UK (N.S., M.P., A.M., S.S.); University Hospital Lewisham, London, UK (N.S., M.P., A.M., S.S.); French Institute of Health and Medical Research (INSERM), Rennes, France (F.S., F.C.); National Heart and Lung Institute, Imperial College London, UK (V.P.); and Aspetar, Department of Sports Medicine, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (M.W.)
| | - Aneil Malhotra
- From the St. George's University of London, UK (N.S., M.P., A.M., S.S.); University Hospital Lewisham, London, UK (N.S., M.P., A.M., S.S.); French Institute of Health and Medical Research (INSERM), Rennes, France (F.S., F.C.); National Heart and Lung Institute, Imperial College London, UK (V.P.); and Aspetar, Department of Sports Medicine, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (M.W.)
| | - Mathew Wilson
- From the St. George's University of London, UK (N.S., M.P., A.M., S.S.); University Hospital Lewisham, London, UK (N.S., M.P., A.M., S.S.); French Institute of Health and Medical Research (INSERM), Rennes, France (F.S., F.C.); National Heart and Lung Institute, Imperial College London, UK (V.P.); and Aspetar, Department of Sports Medicine, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (M.W.)
| | - François Carré
- From the St. George's University of London, UK (N.S., M.P., A.M., S.S.); University Hospital Lewisham, London, UK (N.S., M.P., A.M., S.S.); French Institute of Health and Medical Research (INSERM), Rennes, France (F.S., F.C.); National Heart and Lung Institute, Imperial College London, UK (V.P.); and Aspetar, Department of Sports Medicine, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (M.W.)
| | - Sanjay Sharma
- From the St. George's University of London, UK (N.S., M.P., A.M., S.S.); University Hospital Lewisham, London, UK (N.S., M.P., A.M., S.S.); French Institute of Health and Medical Research (INSERM), Rennes, France (F.S., F.C.); National Heart and Lung Institute, Imperial College London, UK (V.P.); and Aspetar, Department of Sports Medicine, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (M.W.).
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