The demanding grey zone: Sport indices by cardiac magnetic resonance imaging differentiate hypertrophic cardiomyopathy from athlete’s heart

• Published in: PloS one Vol. 14; no. 2; p. e0211624
• Main Authors: Czimbalmos, Csilla, Csecs, Ibolya, Toth, Attila, Kiss, Orsolya, Suhai, Ferenc Imre, Sydo, Nora, Dohy, Zsofia, Apor, Astrid, Merkely, Bela, Vago, Hajnalka
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 14.02.2019; Public Library of Science (PLoS)
• Subjects: Athletes; Biology and Life Sciences; Blood pressure; Cardiomegaly - physiopathology; Cardiomegaly, Exercise-Induced - physiology; Cardiomyopathy; Cardiomyopathy, Hypertrophic - physiopathology; Care and treatment; Diagnosis; Diagnostic systems; Electrocardiography; Female; Female athletes; Gender; Health aspects; Heart; Heart hypertrophy; Heart Ventricles - physiopathology; Humans; Hypertrophic cardiomyopathy; Hypertrophy; Hypertrophy, Left Ventricular - physiopathology; Magnetic resonance; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Measurement; Medical diagnosis; Medicine and Health Sciences; Methods; Middle Aged; Myocardial diseases; NMR; Nuclear magnetic resonance; Patients; Physiology; Prospective Studies; Research and Analysis Methods; Resonance; Social Sciences; Sports - physiology; Sports injuries; Subgroups; Task forces; Ventricle; Wall thickness; Women athletes; Hungary
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0211624

We aimed to characterize gender specific left ventricular hypertrophy using a novel, accurate and less time demanding cardiac magnetic resonance (CMR) quantification method to differentiate physiological hypertrophy and hypertrophic cardiomyopathy based on a large population of highly trained athletes and hypertrophic cardiomyopathy patients. Elite athletes (n = 150,>18 training hours/week), HCM patients (n = 194) and athletes with hypertrophic cardiomyopathy (n = 10) were examined by CMR. CMR based sport indices such as maximal end-diastolic wall thickness to left ventricular end-diastolic volume index ratio (EDWT/LVEDVi) and left ventricular mass to left ventricular end-diastolic volume ratio (LVM/LVEDV) were calculated, established using both conventional and threshold-based quantification method. Whereas 47.5% of male athletes, only 4.1% of female athletes were in the grey zone of hypertrophy (EDWT 13-16mm). EDWT/LVEDVi discriminated between physiological and pathological left ventricular hypertrophy with excellent diagnostic accuracy (AUCCQ:0.998, AUCTQ:0.999). Cut-off value for LVM/LVEDVCQ<0.82 mm×m2/ml and for EDWT/LVEDViTQ<1.27 discriminated between physiological and pathological left ventricular hypertrophy with a sensitivity of 77.8% and 89.2%, a specificity of 86.7% and 91.3%, respectively. LVM/LVEDV evaluated using threshold-based quantification performed significantly better than conventional quantification even in the male subgroup with EDWT between 13-16mm (p<0.001). Almost 50% of male highly trained athletes can reach EDWT of 13 mm. CMR based sport indices provide an important tool to distinguish hypertrophic cardiomyopathy from athlete's heart, especially in highly trained athletes in the grey zone of hypertrophy.