Abstract
ObjectivesDistinguishing hypertrophic cardiomyopathy (HCM) from left ventricular hypertrophy (LVH) due to systematic training (athlete’s heart, AH) from morphologic assessment remains challenging. The purpose of this study was to examine the role of T2 mapping and deformation imaging obtained by cardiovascular magnetic resonance (CMR) to discriminate AH from HCM with (HOCM) or without outflow tract obstruction (HNCM).MethodsThirty-three patients with HOCM, 9 with HNCM, 13 strength-trained athletes as well as individual age- and gender-matched controls received CMR. For T2 mapping, GRASE-derived multi-echo images were obtained and analyzed using dedicated software. Besides T2 mapping analyses, left ventricular (LV) dimensional and functional parameters were obtained including LV mass per body surface area (LVMi), interventricular septum thickness (IVS), and global longitudinal strain (GLS).ResultsWhile LVMi was not significantly different, IVS was thickened in HOCM patients compared to athlete’s. Absolute values of GLS were significantly increased in patients with HOCM/HNCM compared to AH. Median T2 values were elevated compared to controls except in athlete’s heart. ROC analysis revealed T2 values (AUC 0.78) and GLS (AUC 0.91) as good parameters to discriminate AH from overall HNCM/HOCM.ConclusionDiscrimination of pathologic from non-pathologic LVH has implications for risk assessment of competitive sports in athletes. Multiparametric CMR with parametric T2 mapping and deformation imaging may add information to distinguish AH from LVH due to HCM.Key Points• Structural analyses using T2 mapping cardiovascular magnetic resonance imaging (CMR) may help to further distinguish myocardial diseases.• To differentiate pathologic from non-pathologic left ventricular hypertrophy, CMR including T2 mapping was obtained in patients with hypertrophic obstructive/non-obstructive cardiomyopathy (HOCM/HNCM) as well as in strength-trained athletes.• Elevated median T2 values in HOCM/HNCM compared with athlete’s may add information to distinguish athlete’s heart from pathologic left ventricular hypertrophy.
Highlights
Materials and methodsHypertrophic cardiomyopathy (HCM) has implications on risk assessment of competitive athletes due to cardiovascular complications including sudden cardiac death or arrhythmias [1]
To differentiate pathologic from non-pathologic left ventricular hypertrophy, cardiovascular magnetic resonance (CMR) including T2 mapping was obtained in patients with hypertrophic obstructive/non-obstructive cardiomyopathy (HOCM/HNCM) as well as in strength-trained athletes
The steady-state free precession (SSFP) short- and long-axis slices were analyzed according to left (LV) and right ventricular (RV) dimensional and functional parameters (Extended MK Work Space, Philips Medical Systems)
Summary
Materials and methodsHypertrophic cardiomyopathy (HCM) has implications on risk assessment of competitive athletes due to cardiovascular complications including sudden cardiac death or arrhythmias [1]. Left ventricular hypertrophy (LVH) hampers the diagnosis of HCM, as it is a common morphologic feature in high-performance athletes (athlete’s heart, AH). Most sports yield a combination of both mechanisms introducing a mixture of concentric and eccentric hypertrophy respectively. The American and European guidelines recommend the exclusion of athletes with HCM from competitive sports with the exception of low-intensity activity [1, 4, 7, 9]. This supports the need to distinguish different entities of LVH, especially HCM, from AH
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