scholarly journals A Novel Diagnostic Score Integrating Atrial Dimensions to Differentiate between the Athlete’s Heart and Arrhythmogenic Right Ventricular Cardiomyopathy

2021 ◽  
Vol 10 (18) ◽  
pp. 4094
Author(s):  
Valentina A. Rossi ◽  
David Niederseer ◽  
Justyna M. Sokolska ◽  
Boldizsar Kovacs ◽  
Sarah Costa ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Right Ventricular ◽  
Task Force ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Regional Wall Motion ◽  
Athlete’S Heart ◽  
Diagnostic Score ◽  
Regional Wall Motion Abnormalities ◽  
Wall Motion Abnormalities ◽  
Athlete's Heart

Objective: The 2010 Task Force Criteria (TFC) have not been tested to differentiate ARVC from the athlete’s heart. Moreover, some criteria are not available (myocardial biopsy, genetic testing, morphology of ventricular tachycardia) or subject to interobserver variability (right ventricular regional wall motion abnormalities) in clinical practice. We hypothesized that atrial dimensions are useful and robust to differentiate between both entities and proposed a new diagnostic score based upon readily available parameters including echocardiographic atrial dimensions. Methods: In this observational study, 21 patients with definite ARVC were matched for age, gender and body mass index to 42 athletes. Based on ROC analysis, the following parameters were included in the score: indexed right/left atrial volumes ratio (RAVI/LAVI ratio), NT-proBNP, RVOT measurements (PLAX and PSAX BSA-corrected), tricuspid annular motion (TAM), precordial TWI and depolarization abnormalities according to TFC. Results: ARVC patients had a higher RAVI/LAVI ratio (1.76 ± 1.5 vs. 0.87 ± 0.2, p < 0.001), lower right ventricular function (fac: 29 ± 10.1 vs. 42.2 ± 5%, p < 0.001; TAM: 19.8 ± 5.4 vs. 23.8 ± 3.8 mm, p = 0.001) and higher serum NT-proBNP levels (345 ± 612 vs. 48 ± 57 ng/L, p < 0.001). Our score showed a good performance, which is comparable to the 2010 TFC using those parameters, which are available in routine clinical practice (AUC93%, p < 0.001 (95%CI 0.874–0.995) vs. AUC97%, p < 0.001 (95%CI 0.93–1.00). A score of 6/12 points yielded a specificity of 91% and an improved sensitivity of 67% for ARVC diagnosis as compared to a sensitivity of 41% for the abovementioned readily available 2010 TFC. Conclusions: ARVC patients present with significantly larger RA compared to athletes, resulting in a greater RAVI/LAVI ratio. Our novel diagnostic score includes readily available clinical parameters and has a high diagnostic accuracy to differentiate between ARVC and the athlete’s heart.

A novel diagnostic score to differentiate between athlete"s heart and ARVC

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
VA Rossi ◽  
D Niederseer ◽  
JM Sokolska ◽  
B Kovacs ◽  
S Costa ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Right Ventricular ◽  
Task Force ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Clinical Score ◽  
Athlete’S Heart ◽  
Clinical Parameters ◽  
Diagnostic Score ◽  
Funding Sources ◽  
Athlete's Heart

Abstract Funding Acknowledgements Type of funding sources: None. Background The 2010 Task Force Criteria (TFC), although representing the current gold standard to diagnose arrhythmogenic right ventricular cardiomyopathy (ARVC), have not been tested to differentiate ARVC from the athlete’s heart. Furthermore, not all 6 diagnostic categories are easy to obtain. Purpose We hypothesized that atrial dimensions are useful to differentiate between both entities. Therefore, we developed a new diagnostic score based upon readily available clinical parameters including atrial dimensions on TTE to help distinguishing the athlete’s heart from ARVC in daily clinical practice. Methods In this observational study, 37 patients with definite ARVC (from the Zurich ARVC Program) were compared to 68 athletes. Base on ROC analysis, the following echocardiographic, laboratory and electrocardiographic parameters were included in the final score: indexed right/left atrial volumes (RAVI/LAVI ratio), NT-proBNP, RVOT measurements (PLAX and PSAX adjusted for BSA) on TTE, tricuspid annular motion velocity (TAM) on TTE, precordial electrocardiographic T-wave inversions and depolarization abnormalities according to the TFC. Results ARVC patients had a higher RAVI/LAVI ratio (1.78 ± 1.6vs0.95 ± 0.3,p &lt; 0.001), lower right-ventricular function (fac:28 ± 9.7vs42.1 ± 4.8%,p &lt; 0.001; TAM:17.9 ± 5.6vs23.3 ± 3.7mm,p &lt; 0.001) and higher serum NT-proBNP levels (491 ± 771vs44.8 ± 50.6ng/l,p &lt; 0.001). Our novel score outperformed the performance of the 2010 TFC using those parameters, which are available in routine clinical practice (AUC95%,p &lt; 0.001(95%CI.91-.99)vs.AUC90%,p &lt; 0.001(95%CI.84-.97). A score value of 7/12 points yielded a specificity of 98% and a sensitivity of 61% for a diagnosis of ARVC. Conclusions ARVC patients present with significantly larger RA as compared to athletes, resulting in a greater RAVI/LAVI ratio. Our novel diagnostic score includes readily available clinical parameters and has a high diagnostic accuracy to differentiate between ARVC and the athlete´s heart. Abstract Figure. Novel clinical score

Athletic Training and Arrhythmogenic Right Ventricular Cardiomyopathy

2019 ◽  
Vol 40 (05) ◽  
pp. 295-304 ◽  
Author(s):  
Sara Coelho ◽  
Filipe Silva ◽  
Joana Silva ◽  
Natália António
Keyword(s):  
Right Ventricular ◽  
Athletic Training ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Right Ventricular Dysfunction ◽  
Athlete’S Heart ◽  
Ventricular Cardiomyopathy ◽  
Inherited Cardiomyopathy ◽  
Arrhythmogenic Substrate ◽  
History Of ◽  
Athlete's Heart

AbstractArrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy characterized by ventricular arrhythmias and sudden death in the young and in competitive athletes. The deleterious role of exercise in the natural history of ARVC is clear. Even in the absence of a demonstrated arrhythmogenic substrate, family history or mutations of ARVC, intense physical exercise may in some individuals lead to the development of right ventricular dysfunction and arrhythmogenicity. This led to question the benignity of some adaptive features of the athlete's heart. In fact, there is an overlap between typical aspects of the athlete's heart and pathological changes described in ARVC, being challenging to distinguish the two conditions. The aim of this review is to highlight the aspects that help to distinguish between athlete's heart and ARVC, to review the major findings on exams helping in the differential diagnosis and to determine the implications on eligibility for leisure and competitive sports.

scholarly journals Electrocardiographic Features Differentiating Arrhythmogenic Right Ventricular Cardiomyopathy From an Athlete’s Heart

2018 ◽  
Vol 4 (12) ◽  
pp. 1613-1625 ◽  
Author(s):  
Maria J. Brosnan ◽  
Anneline S.J.M. te Riele ◽  
Laurens P. Bosman ◽  
Edgar T. Hoorntje ◽  
Maarten P. van den Berg ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Athlete’S Heart ◽  
Ventricular Cardiomyopathy ◽  
Athlete's Heart

scholarly journals Cardiac MRI findings to differentiate athlete's heart from hypertrophic (HCM), arrhythmogenic right ventricular (ARVC) and dilated (DCM) cardiomyopathy

2021 ◽  
Author(s):  
J. Kübler ◽  
C. Burgstahler ◽  
J. M. Brendel ◽  
S. Gassenmaier ◽  
F. Hagen ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Volume Index ◽  
Study Cohort ◽  
Mri Findings ◽  
Septal Thickness ◽  
Low Prevalence ◽  
Athlete's Heart

AbstractTo provide clinically relevant criteria for differentiation between the athlete’s heart and similar appearing hypertrophic (HCM), dilated (DCM), and arrhythmogenic right-ventricular cardiomyopathy (ARVC) in MRI. 40 top-level athletes were prospectively examined with cardiac MR (CMR) in two university centres and compared to retrospectively recruited patients diagnosed with HCM (n = 14), ARVC (n = 18), and DCM (n = 48). Analysed MR imaging parameters in the whole study cohort included morphology, functional parameters and late gadolinium enhancement (LGE). Mean left-ventricular enddiastolic volume index (LVEDVI) was high in athletes (105 ml/m2) but significantly lower compared to DCM (132 ml/m2; p = 0.001). Mean LV ejection fraction (EF) was 61% in athletes, below normal in 7 (18%) athletes vs. EF 29% in DCM, below normal in 46 (96%) patients (p < 0.0001). Mean RV-EF was 54% in athletes vs. 60% in HCM, 46% in ARVC, and 41% in DCM (p < 0.0001). Mean interventricular myocardial thickness was 10 mm in athletes vs. 12 mm in HCM (p = 0.0005), 9 mm in ARVC, and 9 mm in DCM. LGE was present in 1 (5%) athlete, 8 (57%) HCM, 10 (56%) ARVC, and 21 (44%) DCM patients (p < 0.0001). Healthy athletes’ hearts are characterized by both hypertrophy and dilation, low EF of both ventricles at rest, and increased interventricular septal thickness with a low prevalence of LGE. Differentiation of athlete’s heart from other non-ischemic cardiomyopathies in MRI can be challenging due to a significant overlap of characteristics also seen in HCM, ARVC, and DCM.

Discrimination of the “Athlete’s Heart” from real disease by electrocardiogram and echocardiogram

2017 ◽  
Vol 27 (S1) ◽  
pp. S80-S88 ◽  
Author(s):  
Christopher C. Erickson
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Right Ventricular ◽  
Athletic Training ◽  
Cardiac Disease ◽  
Physical Training ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Methodological Approach ◽  
Athlete’S Heart ◽  
Ventricular Cardiomyopathy ◽  
Athlete's Heart

AbstractChronic physical training has been shown to produce multiple changes in the heart, resulting in the athlete’s heart phenotype. Some of the changes can make it difficult to discern athlete’s heart from true cardiac disease, most notably hypertrophic cardiomyopathy. Other diseases such as dilated cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy may be difficult to rule in or out. In this article, the physiological cardiac changes of chronic athletic training are reviewed. A methodological approach using electrocardiography and echocardiography to differentiate between athlete’s heart and cardiac disease is proposed.

scholarly journals Magnetic Resonance Detects Structural Heart Disease in Patients with Frequent Ventricular Ectopy and Normal Echocardiographic Findings

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1505
Author(s):  
Raffaele Scorza ◽  
Anders Jansson ◽  
Peder Sörensson ◽  
Mårten Rosenqvist ◽  
Viveka Frykman
Keyword(s):  
Magnetic Resonance ◽  
Right Ventricular ◽  
Wall Motion ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Ventricular Ectopy ◽  
Premature Ventricular Contractions ◽  
Regional Wall ◽  
Regional Wall Motion Abnormalities ◽  
Wall Motion Abnormalities

The prognosis of patients with ventricular ectopy and a normal heart, as evaluated by echocardiography, is virtually unknown. Cardiac magnetic resonance (CMR) can detect focal ventricular anomalies that could act as a possible site of origin for premature ventricular contractions (PVCs). The aim of this study was to investigate the presence of cardiac anomalies in patients with normal findings at echocardiogram. Methods: Fifty-one consecutive patients (23 women, 28 men, mean age 59 years) with very high PVC burden (>10,000 PVC/day) and normal findings at standard echocardiography and exercise test were examined with CMR. The outcome was pathologic findings, defined as impaired ejection fraction, regional wall motion abnormalities, abnormal ventricular volume, myocardial edema and fibrosis. Results: Sixteen out of 51 patients (32%) had structural ventricular abnormalities at CMR. In five patients CMR showed impairment of the left ventricular and/or right ventricular systolic function, and six patients had a dilated left and/or right ventricle. Regional wall motion abnormalities were seen in six patients and fibrosis in four. No patient had CMR signs of edema or met CMR criteria for arrhythmogenic right ventricular cardiomyopathy. Five patients had extra-ventricular findings (enlarged atria in three cases, enlarged thoracic aorta in one case and pericardial effusion in one case). Conclusions: In this study 16 out of 51 patients with a high PVC burden and normal findings at echocardiography showed signs of pathology in the ventricles with CMR. These findings indicate that CMR should be considered in evaluating patients with a high PVC burden and a normal standard investigation.

Imaging testing for differential diagnosis of the athlete’s heart from structural cardiac diseases

ESC CardioMed ◽  
2018 ◽  
pp. 2920-2923
Author(s):  
Antonio Pelliccia
Keyword(s):  
Differential Diagnosis ◽  
Right Ventricular ◽  
Morphological Changes ◽  
Imaging Techniques ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Left Ventricular ◽  
Athlete’S Heart ◽  
Cardiac Diseases ◽  
Criteria For Diagnosis ◽  
Athlete's Heart

Long-term athletic conditioning is responsible for morphological cardiac changes that are collectively described as the ‘athlete’s heart’. Morphological changes are usually mild, but in a not trivial proportion of athletes may be more marked, by mimicking changes usually observed in certain cardiomyopathies, raising the question of differential diagnosis between physiological remodelling and structural cardiac diseases. In this chapter, the morphological features of the physiological left and right ventricular remodelling are described in comparison with the mimicking changes occurring, respectively, in hypertrophic cardiomyopathy, dilated cardiomyopathy, left ventricular non-compaction, and arrhythmogenic right ventricular cardiomyopathy. Differential diagnosis using imaging techniques (i.e. echocardiography and cardiac magnetic resonance) is discussed, and the most efficient and clinically useful criteria for diagnosis in each of the pathological conditions considered are provided.

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