title: Mechanical Dispersion by Strain Echocardiography: A Novel Tool to Diagnose Hypertrophic Cardiomyopathy in Athletes.
abstract: BACKGROUND
  Previous studies have demonstrated that global longitudinal strain (GLS) is altered in patients with hypertrophic cardiomyopathy (HCM) in comparison with athletes. Nevertheless, these results rely on studies comparing sedentary patients with HCM with healthy athletes. The aims of this study were to confirm these findings in an appropriate group of athletes with HCM and to study the additive value of novel parameters (i.e., mechanical dispersion and exercise GLS).
  
  
  METHODS
  Thirty-six athletes with HCM were prospectively included and were compared with 36 sedentary patients with HCM, 36 healthy athletes, and 36 sedentary control subjects of similar age. Athlete groups had similar training duration and HCM groups similar maximal wall thickness. All underwent echocardiography at rest and during submaximal exercise. GLS was assessed; the SD of time to maximal myocardial shortening of longitudinal strain was calculated as a parameter of mechanical dispersion.
  
  
  RESULTS
  The HCM sedentary group showed the lowest resting and exercise GLS. Resting GLS was not different between athletes with HCM and the two control groups, but exercise GLS enabled the differentiation of athletes with HCM from healthy athletes. Mechanical dispersion was higher in both HCM groups compared with both control groups at rest and during exercise. Receiver operating characteristic analysis in the athlete groups demonstrated that resting mechanical dispersion (area under the curve = 0.949 ± 0.023) had better ability to identify HCM compared with GLS at rest (area under the curve = 0.644 ± 0.069) (P < .001) or during exercise (area under the curve = 0.706 ± 0.066) (P < .005).
  
  
  CONCLUSIONS
  In athletes, normal resting GLS does not rule out the diagnosis of HCM. Mechanical dispersion of longitudinal strain seems to be a promising tool for the diagnosis of HCM in athletes.
authors.affiliation: Department of Sport Medicine, Pontchaillou Hospital, Department of Physiology, Rennes1 University, Rennes, France; INSERM UMR 1099, Rennes, France. Electronic address: frederic.schnell@chu-rennes.fr.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Schnell
authors.affiliation: INSERM UMR 1099, Rennes, France.
authors.forename: David
authors.initials: D
authors.lastname: Matelot
authors.affiliation: Department of Cardiology, Pontchaillou Hospital, Rennes, France.
authors.forename: Magalie
authors.initials: M
authors.lastname: Daudin
authors.affiliation: INSERM UMR 1099, Rennes, France.
authors.forename: Gaelle
authors.initials: G
authors.lastname: Kervio
authors.affiliation: INSERM UMR 1099, Rennes, France; Department of Cardiology, Pontchaillou Hospital, Rennes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Mabo
authors.affiliation: Department of Sport Medicine, Pontchaillou Hospital, Department of Physiology, Rennes1 University, Rennes, France; INSERM UMR 1099, Rennes, France.
authors.forename: François
authors.initials: F
authors.lastname: Carré
authors.affiliation: INSERM UMR 1099, Rennes, France; Department of Cardiology, Pontchaillou Hospital, Rennes, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Donal
mesh_terms: D000328:Adult; D059267:Cardiomegaly, Exercise-Induced; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D025401:Echocardiography, Stress / Q000379:methods*; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013314:Stress, Mechanical
keywords: Athletes; Exercise echocardiography; Hypertrophic cardiomyopathy; Mechanical dispersion; Strain