Department of Cardiology, University of Padua, Italy.
Br J Sports Med. 2010 Feb;44(2):148-54. doi: 10.1136/bjsm.2007.042853. Epub 2008 Jul 4.
Regular intensive physical activity is associated with non-pathological changes in cardiac morphology. Differential diagnosis with arrhythmogenic right ventricular cardiomyopathy (ARVC) constitutes a frequent problem, especially in athletes showing ventricular arrhythmias with left bundle branch block morphology.
To assess the different clinical and non-invasive instrumental features of the subjects affected by ARVC and by athletes.
Three groups of subjects (40 ARVC patients, 40 athletes and 40 controls, mean age 27 (9) years) were examined with family and personal history, physical examination, 12-lead ECG, 24-h ECG, signal-averaged ECG and 2-D and Doppler echocardiography.
12-Lead ECG was abnormal in 62% of ARVC patients versus 7.5% of athletes and 2.5% of controls (p<0.0001). Ventricular arrhythmias and late potentials were present in 70% and 55% of ARVC subjects, respectively (vs 5% of athletes and 7.5% of controls, p<0.0001). Left ventricular parietal wall thickness and left ventricular end-diastolic diameters were significantly higher in athletes. Both athletes and ARVC patients presented a right ventricular (RV) enlargement compared with controls. Moreover, RV outflow tract, measured on parasternal long axis and at the level of aortic root, was significantly larger in ARVC patients (33.6 (4.7) mm vs 29.1 (3.4) mm and 35.6 (6.8) mm vs 30.1 (2.9) mm; p<0.0001), and RV fractional shortening and ejection fraction were significantly lower in ARVC patients compared with athletes (40 (7.9)% vs 44 (10)%; p=0.05 and 52.9 (8)% vs 59.9 (4.5)%; p<0.0001). A thickened moderator band was found to be present in similar percentage in ARVC patients and athletes.
An accurate clinical and instrumental non-invasive evaluation including echocardiography as imaging technique allows to distinguish RV alterations typical of ARVC from those detected in athletes as a consequence of intensive physical activity.
经常进行剧烈的体育活动与心脏形态的非病理性变化有关。与心律失常性右室心肌病（ARVC）的鉴别诊断是一个常见的问题，尤其是在表现出左束支传导阻滞形态的室性心律失常的运动员中。
评估受 ARVC 和运动员影响的个体的不同临床和非侵入性仪器特征。
对三组受试者（40 名 ARVC 患者、40 名运动员和 40 名对照者，平均年龄 27（9）岁）进行了家族和个人史、体格检查、12 导联心电图、24 小时心电图、信号平均心电图和 2 维及多普勒超声心动图检查。
12 导联心电图异常在 ARVC 患者中占 62%，在运动员中占 7.5%，在对照组中占 2.5%（p<0.0001）。70%的 ARVC 患者存在室性心律失常，55%的患者存在晚电位（vs 5%的运动员和 7.5%的对照组，p<0.0001）。运动员的左心室壁厚度和左心室舒张末期直径明显高于对照组。运动员和 ARVC 患者的右心室（RV）均较对照组增大。此外，胸骨旁长轴和主动脉根部水平测量的 RV 流出道在 ARVC 患者中明显较大（33.6（4.7）mm vs 29.1（3.4）mm 和 35.6（6.8）mm vs 30.1（2.9）mm；p<0.0001），而 ARVC 患者的 RV 短轴缩短分数和射血分数明显低于运动员（40（7.9）% vs 44（10）%；p=0.05 和 52.9（8）% vs 59.9（4.5）%；p<0.0001）。在 ARVC 患者和运动员中，发现增厚的 moderator 带的存在比例相似。
包括超声心动图在内的准确的临床和仪器无创评估可以区分 ARVC 特有的 RV 改变与因剧烈体育活动引起的运动员的 RV 改变。
