Abstract
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.
Highlights
The athlete’s heart is a physiological condition of morphological and functional alterations induced by repetitive and intense exercise
To the best of our knowledge, this is the first study assessing the diagnostic value of atrial dimensions and serum NT-proBNP to differentiate between arrhythmogenic right ventricular cardiomyopathy (ARVC) and the athlete’s heart, integrating these findings into a novel diagnostic score to better discriminate between both phenocopies
We report the following main findings: 1. ARVC patients presented with significantly larger right atrium (RA), but smaller left atrium (LA) dimensions as compared to athletes, resulting in a greater right atrial volume indexed for BSA (RAVI)/left atrial volume indexed for BSA (LAVI) ratio
Summary
The athlete’s heart is a physiological condition of morphological and functional alterations induced by repetitive and intense exercise. The correct identification and recognition of exercise-induced alterations allows the differentiation of healthy subjects from patients who suffer from an underlying structural heart disease potentially mimicking the athlete’s heart. There is a significant overlap between myocardial morphologic alterations described in arrhythmogenic right ventricular cardiomyopathy (ARVC) and the athlete’s heart, so that it is often challenging to distinguish the two conditions [2]. The 2010 Task Force Criteria (TFC) provide specific, challenging, criteria to help distinguishing between both phenocopies [3]. Data from other diagnostic categories of the 2010 TFC, such as endomyocardial biopsy and genetic testing, are expensive, while the morphology of ventricular tachycardia is sometimes difficult to obtain
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