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Zorrzi et al. (1) have recently compared the sensitivity and specificity of the European Society of Cardiology (2010) and the International (2017) ECG criteria for the diagnosis of hypertrophic cardiomyopathy (HCM), concluding that the International criteria have a greater specificity and a slightly lesser sensitivity in making a differential diagnosis from the normal hypertrophy of an endurance athlete's heart.
However, such an analysis presupposes a clear identification of normal from pathological cases, and this appears to be lacking. The sole criterion for the diagnosis of HCM is "the presence of a hypertrophied and non-dilated left ventricle in the absence of other diseases that could produce the same magnitude of hypertrophy," based on an echocardiographic wall thickness equal to or greater than 15 mm in adult index patients and equal or greater to 13 mm in adult relatives.
Given the exclusion of patients with symptoms or evidence with systolic dysfunction, there seems little to exclude the possibility that the individuals identified are not simply exceptionally well-trained endurance athletes, and that what is being examined is simply the ability of the 2 sets of ECG criteria to identify a person who has developed a large heart. It is particularly disturbing that the supposed diagnostic criteria seems to make no allowance for age, body size and sex, all of which undoubtedly influence the range of normal cardiac dimensions.
Zorzi A, Calore C, do Vio, R et al. Accuracy of the ECG for differential diagnosis between hypertrophic cardiomyopathy and athlete's heart: comparison between the European Society of Cardiology (2010) and International (2017) criteria. Br J Sports Med 2018; 52: 667-673.