title: Differentiating hypertrophic cardiomyopathy from athlete's heart: An electrocardiographic and echocardiographic approach.
abstract: Differential diagnosis of hypertrophic cardiomyopathy (HCM) vs athlete's heart is challenging in individuals with mild-moderate left-ventricular hypertrophy. This study aimed to assess ECG and echocardiographic parameters proposed for the differential diagnosis of HCM. The study included 75 men in three groups: control (n=30), "gray zone" athletes with interventricular septum (IVS) measuring 13-15mm (n=25) and HCM patients with IVS of 13-18mm (n=20). The most significant differences were found in relative septal thickness (RST), calculated as the ratio of 2 x IVS to left ventricle end-diastolic diameter (LV-EDD) (0.37, 0.51, 0.71, respectively; p<0.01) and in spatial QRS-T angle as visually estimated (9.8, 33.6, 66.2, respectively; p<0.01). The capacity for differential HCM diagnosis of each of the 5 criteria was assessed using the area under the curve (AUC), as follows: LV-EDD<54 (0.60), family history (0.61), T-wave inversion (TWI) (0.67), spatial QRS-T angle>45 (0.75) and RST>0.54 (0.92). Pearson correlation between spatial QRS-T angle>45 and TWI was 0.76 (p 0.01). The combination of spatial QRS-T angle>45 and RST>0.54 for diagnosis of HCM had an AUC of 0.79. The best diagnostic criteria for HCM was RST>0.54. The spatial QRS-T angle>45 did not add sensitivity if TWI was present. No additional improvement in differential diagnosis was obtained by combining parameters.
authors.affiliation: Institut del Tórax, Hospital Clinic, Universidad de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Catalonia, Spain. Electronic address: grazioli@clinic.ub.es.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Grazioli
authors.affiliation: Sportmed, Cardiology, Córdoba, Argentina.
authors.forename: Domingo
authors.initials: D
authors.lastname: Usín
authors.affiliation: Institut del Tórax, Hospital Clinic, Universidad de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Catalonia, Spain.
authors.forename: Emilce
authors.initials: E
authors.lastname: Trucco
authors.affiliation: Institut del Tórax, Hospital Clinic, Universidad de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Catalonia, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Sanz
authors.affiliation: Institut del Tórax, Hospital Clinic, Universidad de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Catalonia, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Montserrat
authors.affiliation: Institut del Tórax, Hospital Clinic, Universidad de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Catalonia, Spain.
authors.forename: Bàrbara
authors.initials: B
authors.lastname: Vidal
authors.affiliation: Consell Català de l'Esport, Catalonia, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Gutierrez
authors.affiliation: Futbol Club Barcelona, Catalonia, Spain.
authors.forename: Ramon
authors.initials: R
authors.lastname: Canal
authors.affiliation: Institut del Tórax, Hospital Clinic, Universidad de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Catalonia, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
authors.affiliation: Institut del Tórax, Hospital Clinic, Universidad de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Catalonia, Spain.
authors.forename: Lluis
authors.initials: L
authors.lastname: Mont
authors.affiliation: Institut del Tórax, Hospital Clinic, Universidad de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Catalonia, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Sitges
mesh_terms: D000328:Adult; D000465:Algorithms; D006332:Cardiomegaly / Q000175:diagnosis*; D059267:Cardiomegaly, Exercise-Induced; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013177:Sports / Q000706:statistics & numerical data
keywords: Athlete's heart; Echocardiography; Hypertrophic cardiomyopathy; Spatial QRS-T angle