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Discrimination of the “Athlete’s Heart” from real disease by electrocardiogram and echocardiogram

Published online by Cambridge University Press:  13 January 2017

Christopher C. Erickson
Christopher C. Erickson*
Affiliation:
Departments of Pediatrics and Internal Medicine, Division of Pediatric Cardiology, Children’s Specialty Physicians, Children’s Hospital & Medical Center, University of Nebraska Medical Center, Creighton University Medical Center, Omaha, Nebraska, United States of America
*
Correspondence to: C. C. Erickson, MD, Children’s Hospital & Medical Center, 8200 Dodge Street, Omaha, NE 68114, United States of America. Tel: 402 955 4350; Fax: 402 955 4356; E-mail: [email protected]
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Abstract

Chronic physical training has been shown to produce multiple changes in the heart, resulting in the athlete’s heart phenotype. Some of the changes can make it difficult to discern athlete’s heart from true cardiac disease, most notably hypertrophic cardiomyopathy. Other diseases such as dilated cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy may be difficult to rule in or out. In this article, the physiological cardiac changes of chronic athletic training are reviewed. A methodological approach using electrocardiography and echocardiography to differentiate between athlete’s heart and cardiac disease is proposed.

Keywords

Athlete’s heartathletic traininghypertrophic cardiomyopathyelectrocardiographyechocardiography
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Supplement S1: Sudden Cardiac Arrest in the Young: A Contemporary Perspective , January 2017 , pp. S80 - S88
Copyright
© Cambridge University Press 2017 

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References

1. Galderisi, M, Cardim, N, D’Andrea, A, et al. The multi-modality cardiac imaging approach to the athlete’s heart: an expert consensus of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imag 2015; 16: 2047–2412.Google Scholar
2. Maron, BJ, Casey, SA, Poliac, LC, Gohman, TE, Almquist, AK, Aeppli, DM. Clinical course of hypertrophic cardiomyopathy in a regional United States cohort. JAMA 1999; 281: 650–655.Google Scholar
3. Sharma, S, Maron, BJ, Whyte, G, Firoozi, S, Elliott, PM, McKenna, WJ. Physiologic limits of left ventricular hypertrophy in elite junior athletes: relevance to differential diagnosis of athlete’s heart and hypertrophic cardiomyopathy. J Am Coll Cardiol 2002; 40: 1431–1436.Google Scholar
4. Colan, SD. Hypertrophic cardiomyopathy in childhood. Heart Fail Clin 2010; 6: 433–444.Google Scholar
5. Gersh, BJ, Maron, BJ, Bonow, RO, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: A report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. Circulation 2011; 58: 2703–2738.Google Scholar
6. Wasfy, MM, Weiner, RB. Differentiating the athlete’s heart from hypertrophic cardiomyopathy. Curr Opin Cardiol 2015; 5: 500–505.Google Scholar
7. Pelliccia, A, Maron, BJ, Spataro, A, Proschan, MA, Spirito, P. The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. N Engl J Med 1991; 324: 295–301.Google Scholar
8. Maron, BJ, Pelliccia, A, Spataro, A, Granata, M. Reduction in left ventricular wall thickness after deconditioning in highly trained olympic athletes. Br Heart J 1993; 69: 125–128.Google Scholar
9. Pelliccia, A, Culasso, F, DiPaolo, FM, Maron, BJ. Physiologic left ventricular cavity dilatation in elite athletes. Ann Intern Med 1999; 130: 23–31.Google Scholar
10. Lauschke, J, Maisch, B. Athlete’s heart or hypertrophic cardiomyopathy? Clin Res Cardiol 2009; 98: 80–88.CrossRefGoogle ScholarPubMed
11. Takken, T, Giardini, A, Reybrouck, T, et al. Recommendations for physical activity, recreation sport, and exercise training in paediatric patients with congenital heart disease: a report from the exercise, basic & translational research section of the European Association of Cardiovascular Prevention and Rehabilitation, the European Congenital Heart and Lung Exercise Group, and the association for European paediatric cardiology. Eur J Prev Cardiol 2011; 19: 1034–1065.Google Scholar
12. Stein, R, Medeiros, CM, Rosito, GA, Zimerman, LI, Ribeiro, JP. Intrinsic sinus and atrioventricular node electrophysiologic adaptations in endurance athletes. J Am Coll Cardiol 2002; 39: 1033–1038.Google Scholar
13. Drezner, JA, Ackerman, MJ, Anderson, J, et al. Electrocardiographic interpretation in athletes: the ‘Seattle Criteria’. Br J Sports Med 2013; 47: 122–124.Google Scholar
14. Dores, H, Freitas, A, Malhotra, A, Mendes, M, Sharma, S. The hearts of competitive athletes: an up-to-date overview of exercise-induced cardiac adaptations. Rev Port Cardiol 2014; 34: 51–64.Google Scholar
15. Prakash, K, Sharma, S. The electrocardiogram in highly trained athletes. Clin Sports Med 2015; 34: 419–431.Google Scholar
16. Kovacs, R, Baggish, AL. Cardiovascular adaptation in athletes. Trends Cardiovasc Med 2016; 26: 46–52.Google Scholar
17. Basavarajaiah, S, Boraita, A, Whyte, G, et al. Ethnic differences in left ventricular remodeling in highly-trained athletes relevance to differentiating physiologic left ventricular hypertrophy from hypertrophic cardiomyopathy. J Am Coll Cardiol 2008; 51: 2256–2262.Google Scholar
18. Maron, BJ. Distinguishing hypertrophic cardiomyopathy from athlete’s heart physiologic remodeling: clinical significance, diagnostic strategies and implications for preparticipation screening. Br J Sports Med 2008; 43: 649–656.Google Scholar
19. Corrado, D, Pelliccia, A, Heidbuchel, H, et al. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J 2010; 31: 243–259.Google Scholar
20. Sheikh, N, Papadakis, M, Ghani, S, et al. Comparison of electrocardiographic criteria for the detection of cardiac abnormalities in elite black and white athletes. Circulation 2014; 129: 1637–1649.Google Scholar
21. Caselli, S, Maron, MS, Urbano-Moral, JA, Pandian, NG, Maron, BJ, Pelliccia, A. Differentiating left ventricular hypertrophy in athletes from that in patients with hypertrophic cardiomyopathy. Am J Cardiol 2014; 114: 1383–1389.Google Scholar
22. Okada, K, Yamada, S, Iwano, H, et al. Myocardial shortening in 3 orthogonal directions and its transmural variation in patients with nonobstructive hypertrophic cardiomyopathy. Circ J 2015; 79: 2471–2479.Google Scholar
23. Rickers, C, Wilke, NM, Jerosch-Herold, M, et al. Utility of cardiac MRI in the diagnosis of hypertrophic cardiomyopathy. Circulation 2005; 112: 855–861.CrossRefGoogle ScholarPubMed
24. Maron, M. Clinical utility of cardiovascular magnetic resonance in hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 2012; 14: 13–34.Google Scholar
25. Chun, S, Woo, A. Echocardiography in hypertrophic cardiomyopathy: in with strain, out with straining? J Am Soc Echocardiol 2015; 28: 204–209.Google Scholar
26. Wittlieb-Weber, CA, Cohen, MS, McBride, MG, et al. Elevated left ventricular outflow tract velocities on exercise stress echocardiography may be a normal physiologic response in healthy youth. J Am Soc Echocardiol 2013; 26: 1372–1378.Google Scholar
27. Rowin, EJ, Maron, BJ, Appelbaum, E. Significance of false negative electrocardiograms in preparticipation screening of athletes for hypertrophic cardiomyopathy. Am J Cardiol 2012; 110: 1027–1032.Google Scholar
28. Marcus, FI, McKenna, WJ, Sherrill, D, et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the task force criteria. European Heart J 2010; 31: 806–814.Google Scholar
29. Pelliccia, A, Maron, BJ, De Luca, R, Di Paolo, FM, Spataro, A, Culasso, F. Remodeling of left ventricular hypertrophy in elite athletes after long-term deconditioning. Circulation 2002; 105: 944–949.Google Scholar
30. Lipshultz, SE, Orav, E, Wilkinson, JD, et al. Risk stratification at diagnosis for children with hypertrophic cardiomyopathy: an analysis of data from the pediatric cardiomyopathy registry. Lancet 2013; 382: 1889–1897.Google Scholar