title: Efficacy of various "classic" echocardiographic and laboratory indices in distinguishing the "gray zone" between athlete's heart and hypertrophic cardiomyopathy: a pilot study.
abstract: Left ventricular hypertrophy (LVH) with intraventricular septum thickness (IVST) between 1.2 and 1.5 cm in athletes represents a "gray zone" between physiologic adaptation and mild hypertrophic cardiomyopathy (HCM). Various echo and laboratory parameters have been reported till now in the literature to discriminate the "gray zone" entities. Aim of this study was to assess the efficacy of these "classic" parameters in differentiating physiologic LVH in athletes from mild HCM in a highly selected population. Nine highly trained athletes with IVST (1.28 ± 0.07 cm), 9 patients with mild HCM (1.38 ± 0.11 cm), and 26 athletes without LVH (1.06 ± 0.09 cm; P < 0.0005) underwent echocardiographic study, cardiopulmonary treadmill exercise stress test, and brain natriuretic peptide (BNP) measurement before and after exercise. Among all parameters tested, 7 were found to significantly differ between "gray zone" groups. After bootstrapping analysis, it was found that athletes with left ventricular end-diastolic diameter <4.74 cm, mitral deceleration time >200 ms, isovolumic relaxation time >94 ms, tricuspid E/A < 1.63, septum Em < 9.5 cm/sec, relative wall thickness >0.445, and a BNP value at rest >9.84 pg/mL had a greater possibility for having underlying cardiomyopathy. A 10-point score based on these parameters showed accuracy (area under the curve = 0.958 [95%CI: 0.738-1.0; P = 0.00005, standard error = 0.0342]) for revealing HCM in a gray zone athletic population. Differentiation of adaptive LVH versus HCM in a gray zone population could be facilitated by recognition of certain features referring to LV dimensions, diastolic function, and BNP.
authors.affiliation: Third Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece. statpag@yahoo.gr
authors.forename: Efstathios D
authors.initials: ED
authors.lastname: Pagourelias
authors.forename: Georgios K
authors.initials: GK
authors.lastname: Efthimiadis
authors.forename: Evangelia
authors.initials: E
authors.lastname: Kouidi
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Zorou
authors.forename: Georgios
authors.initials: G
authors.lastname: Giannoglou
authors.forename: Asterios
authors.initials: A
authors.lastname: Deligiannis
authors.forename: Vasilis G
authors.initials: VG
authors.lastname: Athyros
authors.forename: Asterios
authors.initials: A
authors.lastname: Karagiannis
authors.forename: Paraschos
authors.initials: P
authors.lastname: Geleris
mesh_terms: D000293:Adolescent; D000328:Adult; D056352:Athletes; D059267:Cardiomegaly, Exercise-Induced / Q000502:physiology*; D002312:Cardiomyopathy, Hypertrophic / Q000097:blood / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010865:Pilot Projects; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D020097:Natriuretic Peptide, Brain