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Left Ventricular Hypertrophy in Athletes: Differentiating Physiology From Pathology

  • Sports Cardiology (M Papadakis, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Purpose of review

The changes that occur in athlete’s heart are influenced by a number of factors including age, gender, ethnicity and the type of cardiovascular training. It is therefore important that the clinician is able to integrate all of these factors when assessing athletes to be able to guide investigations appropriately and to distinguish pathology from physiology. This review discusses the potential diagnostic conundrums when trying to differentiate physiological left ventricular hypertrophy from pathological hypertrophic cardiomyopathy in athletes. The mechanism of physiological and pathological hypertrophy is discussed together with history, clinical and investigational findings that can help to identify pathology.

Recent findings

Athletes with hypertrophic cardiomyopathy are more likely to have non-concentric left ventricular hypertrophy (LVH), an elevated relative wall thickness, lateral ECG changes and a smaller LV cavity than athletes with physiological LVH. Certain diastolic echocardiographic parameters when used as part of an algorithm (e′; E/E′; E/A) can help to distinguish physiology from pathology, and there is evidence that assessment of global longitudinal strain during exercise echocardiography may be of use in the future. Cardiac MRI is an important imaging modality that can have an additive effect over echocardiography in the diagnosis of cardiomyopathy. Late gadolinium enhancement is a recognised advantage for cardiac magnetic resonance to allow detection of fibrosis in hypertrophic cardiomyopathy. T1 mapping and extracellular volume quantification may be a tool for the future to help distinguish athlete’s heart from HCM.

Summary

Cardiac adaptation to exercise and training in athletes, the athlete’s heart causes electrophysiological and geometric changes that may mimic mild phenotypes of a pathological cardiomyopathy. This review article summarises a systematic approach to the assessment of left ventricular hypertrophy in athletes and describes pertinent clinical and investigation findings that can help to differentiate physiology from pathology.

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Abbreviations

AH:

Athlete’s heart

BSA:

Body surface area

ECG:

Electrocardiogram

ECV:

Extracellular volume

EF:

Ejection fraction

GLS:

Global longitudinal strain

HCM:

Hypertrophic cardiomyopathy

LGE:

Late gadolinium enhancement

LV:

Left ventricle

LVEDd:

Left ventricular end diastolic diameter

LVH:

Left ventricular hypertrophy

LVMI:

Left ventricular mass index

LVOT:

Left ventricular outflow tract

RWT:

Relative wall thickness

SCD:

Sudden cardiac death

TWI:

T wave inversion

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Authors and Affiliations

  1. Royal United Hospital Bath NHS Foundation Trust, Bath, UK

    Daniel X. Augustine MD

  2. Cardiology Clinical Academic Group, St George’s, University of London, London, UK

    Daniel X. Augustine MD & Liz Howard

Authors
  1. Daniel X. Augustine MD
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  2. Liz Howard
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Correspondence to Daniel X. Augustine MD.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Sports Cardiology

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Augustine, D.X., Howard, L. Left Ventricular Hypertrophy in Athletes: Differentiating Physiology From Pathology. Curr Treat Options Cardio Med 20, 96 (2018). https://doi.org/10.1007/s11936-018-0691-2

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  • DOI: https://doi.org/10.1007/s11936-018-0691-2

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