DETERMINANTS OF DIASTOLIC FUNCTION IN ATHLETES AND ROLE OF LEFT VENTRICULAR RELAXATION IN DIFFERENTIATING PHYSIOLOGICAL ADAPTATION FROM HYPERTROPHIC CARDIOMYOPATHY
The association between athletic participation and changes in diastolic function and specifically the determinants of these alterations are not well established. The aim of the study was to analyse the diastolic function in a large cohort of athletes and to investigate the role of tissue Doppler imaging (TDI) in the differential diagnosis with hypertrophic cardiomyopathy (HCM).
From 2007 to 2014 a total of 1510 athletes (age 22±5, range 13-33, males 72%) with complete trans-mitral Doppler and TDI data, considered to be free from any cardiac disease after a normal echocardiogram were considered. Diastolic function of 435 HCM patients were compared; a subgroup of 58 age and sex matched HCM patients were further used for comparison.
Decreased septal E’ velocities (<10 m/s) and lateral E’ velocities (<13 m/s) were observed in 143 (9%) and 66 (4%) athletes respectively. A septal and lateral E/E’ ratio > 8 were present in 373 (25%) and 24 (1.5%) cases respectively. When considering 58 young HCM patients, septal E’ <10 had a sensitivity of 78% and a specificity of 91% in distinguishing HCM from “athlete's heart” and showed an area under the curve of 0.84 (95% CI=0.82-0.86, p<0.001). In contrast lateral E’ < 13 had a sensitivity of 67% and a specificity of 96% with an area under the curve of 0.81; 95% CI=0.79-0.83, p<0.001. Multivariate analysis identified age > 25 years (HR: 2.96, CI 95% 2.06 to 4.25, p<0.001) and left ventricular end-diastolic diameter (LVEDD) > 57 mm (HR: 1.91, CI 95% 2.14 to 2.92, p=0.003) as independent predictors of reduced septal E’ (<10 m/s). Age > 25 years (HR: 1.94, CI 95% 1.15 to 3.28, p=0.01), body weight (HR: 1.03, CI 95% 1.01 to 1.05, p<0.001) and LVEDD > 57 mm (HR: 1.84, CI 95% 1.01 to 1.38, p=0.04) were independently associated with reduced lateral E’ (<13 m/s).
Reduced septal and lateral E’ velocities are commonly observed in young elite athletes and are associated with increasing age, weight and left ventricular cavity size. The yield of these parameters in differentiating athlete's heart from HCM is limited.
Autor / Fonte:Gherardo Finocchiaro; Harshil Dhutia; Michael Papadakis; Alexandros Steriotis; Keerthi Prakash; Elijah Behr; Nabeel Sheikh; Sanjay Sharma. J Am Coll Cardiol. 2016;67(13_S):1526-1526. doi:10.1016/S0735-1097(16)31527-3