title: Myocardial stiffness and the timing difference between tissue Doppler imaging Ea and peak mitral valve opening can distinguish physiological hypertrophy in athletes from hypertrophic cardiomyopathy.
abstract: OBJECTIVE
  To differentiate between physiological and pathological left ventricular hypertrophy in athletes using echocardiography.
  
  
  RESULTS
  Eleven patients with mild hypertrophic cardiomyopathy were compared against 17 international rowers with mild left ventricular hypertrophy, and 30 age matched controls. The time difference between peak Ea (Doppler tissue imaging) and peak mitral valve opening (using M-mode) was measured simultaneously. A novel index (E/Ea)/LVEDD, as a measure of left ventricular stiffness was recorded. In athletes the peak Ea preceded peak mitral opening by: median (interquartile range) 20 ms (10,20), control group 15 ms (0,30), compared with HCM where Ea followed peak mitral opening by 10 ms (0,20), P<0.0001. In athletes the index of left ventricular stiffness was lower than controls 1.2 (0.93,1.4) versus 1.5 (1.3,1.6), and HCM 2.2 (2.0,2.3), P<0.0001.
  
  
  CONCLUSIONS
  Physiological hypertrophy can be differentiated from hypertrophic cardiomyopathy in athletes using the Ea-peak mitral opening difference, and our index of ventricular stiffness.
authors.affiliation: Cardiology Department, St James Hospital, Dublin 8, Ireland. gking@stjames.ie
authors.forename: Gerard
authors.initials: G
authors.lastname: King
authors.forename: Jerome Brendan
authors.initials: JB
authors.lastname: Foley
authors.forename: Colin Forbes
authors.initials: CF
authors.lastname: Royse
authors.forename: Konstantin
authors.initials: K
authors.lastname: Yastrebov
authors.forename: Matthew
authors.initials: M
authors.lastname: Hussey
authors.forename: Gerard
authors.initials: G
authors.lastname: Boyle
authors.forename: Kathleen
authors.initials: K
authors.lastname: Bennet
authors.forename: John
authors.initials: J
authors.lastname: Cosgrave
authors.forename: Peter
authors.initials: P
authors.lastname: Crean
authors.forename: Michael
authors.initials: M
authors.lastname: Walsh
mesh_terms: D000293:Adolescent; D000328:Adult; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003937:Diagnosis, Differential; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000502:physiology; D013177:Sports / Q000502:physiology*; D013223:Statistics as Topic; D013997:Time Factors