Role of Doppler Diastolic Parameters in Differentiating Physiological Left Ventricular Hypertrophy from Hypertrophic Cardiomyopathy

Gherardo Finocchiaro; Harshil Dhutia; Andrew D'Silva; Aneil Malhotra; Nabeel Sheikh; Rajay Narain; Bode Ensam; Stathis Papatheodorou; Maite Tome; Rajan Sharma; Michael Papadakis; Sanjay Sharma

doi:10.1016/j.echo.2017.11.022

Role of Doppler Diastolic Parameters in Differentiating Physiological Left Ventricular Hypertrophy from Hypertrophic Cardiomyopathy

J Am Soc Echocardiogr. 2018 May;31(5):606-613.e1. doi: 10.1016/j.echo.2017.11.022. Epub 2018 Mar 1.

Affiliations

¹ Cardiology Clinical and Academic Group, St. George's, University of London, London, United Kingdom; St. George's University Hospital NHS Foundation Trust, London, United Kingdom.
² Cardiology Clinical and Academic Group, St. George's, University of London, London, United Kingdom; St. George's University Hospital NHS Foundation Trust, London, United Kingdom. Electronic address: sasharma@sgul.ac.uk.

PMID: 29482976
DOI: 10.1016/j.echo.2017.11.022

Abstract

Background: The association between athletic participation and alteration in diastolic function is not well established. The aims of this study were to determine the spectrum of Doppler parameters of left ventricular (LV) diastolic function in a large cohort of healthy athletes and to quantify the overlap between physiologic LV hypertrophy and hypertrophic cardiomyopathy (HCM).

Methods: A retrospective analysis of indices of LV diastolic function was performed in 1,510 healthy athletes (mean age, 22 ± 5 years; range, 13-33 years; 72% men). The results were compared with those from 58 young patients with HCM.

Results: Septal E' < 7 cm/sec and lateral E' < 10 cm/sec were found in five (0.3%) and eight (0.5%) athletes, respectively. Septal E' was >14.6 cm/sec in 170 (11%) and lateral E' was >19.9 cm/sec in 430 (28%) athletes. Athletes aged >25 years showed lower E' velocities compared with younger athletes (mean septal E', 11.8 ± 6.1 vs 12.9 ± 5.9 cm/sec [P < .001]; mean lateral E', 17.1 ± 3.6 vs 19.3 ± 4.1 cm/sec [P < .001]). Athletes with high indexed LV end-diastolic diameters (>32 mm/m²) exhibited lower septal E' compared with athletes with normal indexed LV end-diastolic diameters (mean septal E', 11.9 ± 6 vs 12.7 ± 6 cm/sec; P = .002). Septal E' < 10 cm/sec and lateral E' < 12 cm/sec showed the best accuracy in differentiating between HCM and athlete's heart.

Conclusions: Reduced septal and lateral E' are rarely observed in young elite athletes. Tissue Doppler velocities tend to decrease with increasing age and LV size, and values representative of supernormal diastolic function are found in less than one-third of young athletes. Cutoff thresholds for Doppler parameters of diastolic function should be corrected for multiple demographic and clinical variables to differentiate cardiac adaptation to exercise from HCM in young individuals.

Keywords: Athlete's heart; Diastolic function; Hypertrophic cardiomyopathy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Athletes
Cardiomyopathy, Hypertrophic / diagnosis
Cardiomyopathy, Hypertrophic / physiopathology*
Diastole
Echocardiography, Doppler / methods*
Exercise Test
Female
Heart Ventricles / diagnostic imaging*
Heart Ventricles / physiopathology
Humans
Hypertrophy, Left Ventricular / diagnosis
Hypertrophy, Left Ventricular / physiopathology*
Male
Middle Aged
Retrospective Studies
Ventricular Function, Left / physiology*
Young Adult