Pelliccia A, Maron B J, Spataro A, Proschan M A, Spirito P
Department of Medicine, Comitato Olimpico Nazionale Italiano, Rome.
N Engl J Med. 1991 Jan 31;324(5):295-301. doi: 10.1056/NEJM199101313240504.
In some highly trained athletes, the thickness of the left ventricular wall may increase as a consequence of exercise training and resemble that found in cardiac diseases associated with left ventricular hypertrophy, such as hypertrophic cardiomyopathy. In these athletes, the differential diagnosis between physiologic and pathologic hypertrophy may be difficult.
To address this issue, we measured left ventricular dimensions with echocardiography in 947 elite, highly trained athletes who participated in a wide variety of sports.
The thickest left ventricular wall among the athletes measured 16 mm. Wall thicknesses within a range compatible with the diagnosis of hypertrophic cardiomyopathy (greater than or equal to 13 mm) were identified in only 16 of the 947 athletes (1.7 percent); 15 were rowers or canoeists, and 1 was a cyclist. Therefore, the wall was greater than or equal to 13 mm thick in 7 percent of 219 rowers, canoeists, and cyclists but in none of 728 participants in 22 other sports. All athletes with walls greater than or equal to 13 mm thick also had enlarged left ventricular end-diastolic cavities (dimensions, 55 to 63 mm).
On the basis of these data, a left-ventricular-wall thickness of greater than or equal to 13 mm is very uncommon in highly trained athletes, virtually confined to athletes training in rowing sports, and associated with an enlarged left ventricular cavity. In addition, the upper limit to which the thickness of the left ventricular wall may be increased by athletic training appears to be 16 mm. Therefore, athletes with a wall thickness of more than 16 mm and a nondilated left ventricular cavity are likely to have primary forms of pathologic hypertrophy, such as hypertrophic cardiomyopathy.
在一些训练有素的运动员中，左心室壁厚度可能会因运动训练而增加，类似于与左心室肥厚相关的心脏病（如肥厚型心肌病）中发现的情况。在这些运动员中，生理性和病理性肥厚的鉴别诊断可能很困难。
为解决这一问题，我们对947名参加各种运动的精英、训练有素的运动员进行了超声心动图测量左心室尺寸。
运动员中最厚的左心室壁为16毫米。在947名运动员中，只有16名（1.7%）的壁厚度在与肥厚型心肌病诊断相符的范围内（大于或等于13毫米）；15名是赛艇运动员或皮划艇运动员，1名是自行车运动员。因此，在219名赛艇运动员、皮划艇运动员和自行车运动员中，7%的人的壁厚度大于或等于13毫米，但在其他22项运动的728名参与者中没有。所有壁厚度大于或等于13毫米的运动员左心室舒张末期腔也都增大（尺寸为55至63毫米）。
根据这些数据，左心室壁厚度大于或等于13毫米在训练有素的运动员中非常罕见，几乎仅限于从事赛艇运动训练的运动员，并且与左心室腔增大有关。此外，运动训练可能使左心室壁厚度增加的上限似乎是16毫米。因此，壁厚度超过16毫米且左心室腔未扩张的运动员可能患有原发性病理性肥厚，如肥厚型心肌病。
