Background Athlete's heart should be differentiated from the hypertrophic cardiomyopathy (HCM)-leading cause of exercise related sudden cardiac death in young athletes. Some genetic variations of HCM are characterized by a benign clinical course and a delayed onset of the disease. Therefore, substantial increase of left ventricular wall thickness (LVWT) in adolescent athletes needs relevant strategies in pre-participation screening (PPS).
Objective To identify adolescent athletes with left ventricular hypertrophy (LVH) and differentiate physiological LVH from HCM.
Design Observational follow-up study.
Setting: Sports Medicine Clinical Centre.
Participants 978 asymptomatic and normotensive highly trained (≥12 h/week) adolescent athletes (92.9% males) aged 12–18 years, representatives of national teams of 14 sporting disciplines.
Interventions Cardiovascular evaluation with medical history, physical examination, 12-lead resting and stress electrocardiography, and echocardiography. LV structure and function were measured in 2002–2006.
Main outcome measurements The participants were followed prospectively until 2008 with respect to LVH, and until 2012 with respect to HCM.
Results 12 (1.2%) athletes, all males had LVWT ≥12 mm (12–15) and normal ECG pattern: 10 of them had normal diastolic indices and LV end diastolic diameter (LVEDD) 52.6±4.8mm (46–61); other 2 athletes had LVEDD<45mm. One of them had normal diastolic function and peak oxygen uptake (VO2max) of 58.8 mL/kg/min. An other athlete (15 yrs) with LVWT 15 mm, LVEDD 43 mm, and decreased VO2max of 41.5 mL/kg/min,Tissue Doppler Imaging (TDI) revealed mildly reduced É-9cm/s and heightened E/É-8.8. Three months of detraining slightly decreased LVWT but did not improve LVEDD and TDI indices. The athlete was advised against competitive sports and referred for further cardiovascular evaluation. Follow-up over a longer period revealed advanced changes in LVWT and diastolic indices, and confirmed HCM.
Conclusions Substantial LVH in Georgian elite adolescent athletes is rare. PPS with systematical approach can be a valuable tool in differentiation between physiological LVH and mild expression of HCM.
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