Abstract 15662: Exercise Echocardiography Has a High Sensitivity and Specificity in Differentiating Athlete’s Heart From Dilated Cardiomyopathy
Introduction: Around 12% of athletes have a phenotype that overlaps with mild dilated cardiomyopathy (DCM); however uncertainty remains as to how to distinguish athletic adaptation from pathology. We hypothesised that exercise echocardiography can differentiate athlete’s heart (AH) from DCM.
Methods: 24 asymptomatic patients (NYHA I) with non-ischaemic DCM were recruited from the cardiology clinic (including 6 endurance athletes with DCM). 43 athletes were also recruited from cardiac screening and local sports clubs. 24 were amateur competitive athletes exercising for ≥10 hours per week and 19 elite cyclists who compete in the UCI world tour. All subjects underwent exercise echocardiogram using a tilting cycle ergometer.
Results: Stroke volume (SV) at baseline was higher in the athletes (93.7±13.1 vs 78±26.5, p=0.019). 42/43 (97.7%) of the athletes increased SV at peak exercise compared to 15/24 (62.5%) patients with DCM (SV 2.13 (range -24 to 34) vs 18.6 (-7 to39), p<0.0001 in the DCM patients and athletes respectively). Change in EF from baseline to peak was significantly different in the two groups (1.3% vs 17.3% p<0.0001 in DCM patients and athletes). In the DCM patients, 10 dropped their EF, 12 had a modest increase of EF between 1-10% and in 2 the EF improved by >10%. All athletes demonstrated an increase in EF of>10%. Using in increase LVEF of ≥10% to define contractile reserve the sensitivity and specificity of exercise echocardiography to distinguish AH from DCM was 91.7% and 100%. E’ and S’ at baseline, peak and recovery were higher in the athletes. Global longitudinal strain (GLS) was higher in the athletes; however 37/43 athletes had a GLS below the normal range. To conclude, SV augmentation and demonstration of contractile reserve with exercise has a high diagnostic accuracy in differentiating AH from DCM. Incorporating parameters of diastolic and longitudinal function during exercise and GLS further increases the utility of exercise echocardiography.
Author Disclosures: L. Millar: None. G. Fernandez: None. H. Dhutia: None. J. Myott: None. A. Malhotra: None. G. Finocchiaro: None. M. Tome: None. R. Narain: None. M. Papadakis: None. T. Keteepe-Arachi: None. E. Behr: None. K. Prakash: None. S. Sharma: None. R. Sharma: None.
- © 2016 by American Heart Association, Inc.