OBJECTIVE: Distinguishing early dilated cardiomyopathy (DCM) from physiological left ventricular (LV) dilatation with LV ejection fraction 11% from baseline to peak exercise compared with 23% of patients with DCM (p63% in 92% grey-zone athletes compared with 17% patients with DCM (p11% from baseline to peak exercise or achieve a peak LV ejection fraction >63% had sensitivity of 77% and 83%, respectively, and specificity of 96% and 92%, respectively, for predicting DCM. CONCLUSION: Comprehensive assessment using a cascade of routine investigations revealed that exercise stress echocardiography has the greatest discriminatory value in differentiating between grey-zone athletes and asymptomatic patients with DCM. Our findings require validation in larger studies

Behr, E. R.

Bunce, N.

Carr-White, G.

D'Silva, A.

Dhutia, H.

Fanton, Z.

Finnochiaro, G.

Malhotra, A.

Merghani, A.

Millar, L. M.

O'Driscoll, J.

Oxborough, D.

Papadakis, M.

Reed, M.

Sanchez-Fernandez, G.

Sharma, R.

Sharma, S.

Tome Esteban, M. T.

Objective: Distinguishing early dilated cardiomyopathy (DCM) from physiological left ventricular (LV) dilatation with LV ejection fraction 11% from baseline to peak exercise compared with 23% of patients with DCM (p63% in 92% grey-zone athletes compared with 17% patients with DCM (p11% from baseline to peak exercise or achieve a peak LV ejection fraction >63% had sensitivity of 77% and 83%, respectively, and specificity of 96% and 92%, respectively, for predicting DCM. Conclusion: Comprehensive assessment using a cascade of routine investigations revealed that exercise stress echocardiography has the greatest discriminatory value in differentiating between grey-zone athletes and asymptomatic patients with DCM. Our findings require validation in larger studies. © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ

Millar, LM

Fanton, Z

Finocchiaro, G

Sanchez-Fernandez, G

Dhutia, H

Malhotra, A

Merghani, A

Papadakis, M

Behr, ER

Bunce, N

Oxborough, D

Reed, M

O'Driscoll, J

Tome Esteban, MT

D'Silva, A

Carr-White, G

Webb, J

Sharma, R

Sharma, S

LJMU Research Online (Liverpool John Moores University)

English

Differentiation between athlete's heart and dilated cardiomyopathy in athletic individuals

Objective: Distinguishing early dilated cardiomyopathy (DCM) from physiological left ventricular (LV) dilatation with LV ejection fraction &lt;55% in athletes (grey zone) is challenging. We evaluated the role of a cascade of investigations to differentiate these two entities. Methods: Thirty-five asymptomatic active males with DCM, 25 male athletes in the 'grey zone' and 24 male athletes with normal LV ejection fraction underwent N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement, ECG and exercise echocardiography. Grey-zone athletes and patients with DCM underwent cardiovascular magnetic resonance (CMR) and Holter monitoring. Results: Larger LV cavity dimensions and lower LV ejection fraction were the only differences between grey-zone and control athletes. None of the grey-zone athletes had abnormal NT-proBNP, increased ectopic burden/complex arrhythmias or pathological late gadolinium enhancement on CMR. These features were also absent in 71%, 71% and 50% of patients with DCM, respectively. 95% of grey-zone athletes and 60% of patients with DCM had normal ECG. During exercise echocardiography, 96% grey-zone athletes increased LV ejection fraction by &gt;11% from baseline to peak exercise compared with 23% of patients with DCM (p&lt;0.0001). Peak LV ejection fraction was &gt;63% in 92% grey-zone athletes compared with 17% patients with DCM (p&lt;0.0001). Failure to increase LV ejection fraction &gt;11% from baseline to peak exercise or achieve a peak LV ejection fraction &gt;63% had sensitivity of 77% and 83%, respectively, and specificity of 96% and 92%, respectively, for predicting DCM. Conclusion: Comprehensive assessment using a cascade of routine investigations revealed that exercise stress echocardiography has the greatest discriminatory value in differentiating between grey-zone athletes and asymptomatic patients with DCM. Our findings require validation in larger studies.</p

Millar, Lynne Martina

Fanton, Zephryn

Finocchiaro, Gherardo

Sanchez-Fernandez, Gabriel

Dhutia, Harshil

Malhotra, Aneil

Merghani, Ahmed

Papadakis, Michael

Behr, Elijah R.

Bunce, Nick

Oxborough, David

Reed, Matthew

O'Driscoll, Jamie

Tome Esteban, Maria Teresa

D'Silva, Andrew

Carr-White, Gerry

Webb, Jessica

Sharma, Rajan

Sharma, Sanjay

King's Research Portal

OBJECTIVE: Distinguishing early dilated cardiomyopathy (DCM) from physiological left ventricular (LV) dilatation with LV ejection fraction &lt;55% in athletes (grey zone) is challenging. We evaluated the role of a cascade of investigations to differentiate these two entities.METHODS: Thirty-five asymptomatic active males with DCM, 25 male athletes in the 'grey zone' and 24 male athletes with normal LV ejection fraction underwent N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement, ECG and exercise echocardiography. Grey-zone athletes and patients with DCM underwent cardiovascular magnetic resonance (CMR) and Holter monitoring.RESULTS: Larger LV cavity dimensions and lower LV ejection fraction were the only differences between grey-zone and control athletes. None of the grey-zone athletes had abnormal NT-proBNP, increased ectopic burden/complex arrhythmias or pathological late gadolinium enhancement on CMR. These features were also absent in 71%, 71% and 50% of patients with DCM, respectively. 95% of grey-zone athletes and 60% of patients with DCM had normal ECG. During exercise echocardiography, 96% grey-zone athletes increased LV ejection fraction by &gt;11% from baseline to peak exercise compared with 23% of patients with DCM (p&lt;0.0001). Peak LV ejection fraction was &gt;63% in 92% grey-zone athletes compared with 17% patients with DCM (p&lt;0.0001). Failure to increase LV ejection fraction &gt;11% from baseline to peak exercise or achieve a peak LV ejection fraction &gt;63% had sensitivity of 77% and 83%, respectively, and specificity of 96% and 92%, respectively, for predicting DCM.CONCLUSION: Comprehensive assessment using a cascade of routine investigations revealed that exercise stress echocardiography has the greatest discriminatory value in differentiating between grey-zone athletes and asymptomatic patients with DCM. Our findings require validation in larger studies.</p

Behr, Elijah R

The University of Manchester - Institutional Repository

Background: Distinguishing early dilated cardiomyopathy (DCM) from physiological left ventricular (LV) dilatation with mildly reduced LV ejection fraction (‘grey-zone’) is challenging. We evaluated the role of a cascade of investigations to differentiate these two entities.

Methods and Results:  Thirty-five asymptomatic active males with DCM, 25 male athletes in the ‘grey-zone’ and 24 male athlete controls with normal LV ejection fraction were investigated with NT-proBNP, electrocardiography (ECG) and exercise echocardiography. ‘Grey-zone’ athletes and DCM patients underwent cardiovascular magnetic resonance and Holter monitoring. Larger LV cavity dimensions and lower LV ejection fraction were the only differences between control and ‘grey-zone’ athletes. None of the ‘grey-zone’ athletes had an abnormal NT-proBNP, increased ectopic burden/complex arrhythmias or pathological late gadolinium enhancement. These features were absent in 71%, 71% and 50% of DCM patients respectively.  95% of ‘grey-zone’ athletes and 60% DCM patients had a normal ECG.  During exercise echocardiography, 96% of the ‘grey-zone’ athletes increased LV ejection fraction by >11% from baseline to peak exercise compared with 23% DCM patients. Peak LV ejection fraction was >63% in 92% ‘grey-zone’ athletes compared with 17% DCM patients. Failure to increase LV ejection fraction >11% from baseline to peak exercise or achieve a peak LV ejection fraction >63% had a sensitivity of 77% and 83% respectively and specificity of 96% and 92% respectively for predicting DCM. 

Conclusion: Comprehensive assessment using a cascade of routine investigations revealed that exercise stress echocardiography has the greatest discriminatory value in differentiating between ‘grey-zone’ athletes and asymptomatic DCM patients

Canterbury Research and Theses Environment

Differentiation between athlete’s heart and dilated cardiomyopathy in athletic individuals

St George's Online Research Archive

Differentiation between athlete's heart and dilated cardiomyopathy in athletic individuals.

https://repository.canterbury.ac.uk/download/ace40128e068ba020b3297ff1ff5280451bf2b0c13619619212a9faa1e55aff0/366372/Athlete%27s%20Heart%20vs.%20DCM%20Heart%20Manuscript.pdf

Differentiation between athlete's heart and dilated cardiomyopathy in athletic individuals.

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LJMU Research Online (Liverpool John Moores University)

King's Research Portal

The University of Manchester - Institutional Repository

Canterbury Research and Theses Environment

St George's Online Research Archive