Augustine Daniel X, Howard Liz
Royal United Hospital Bath NHS Foundation Trust, Bath, UK.
Cardiology Clinical Academic Group, St George's, University of London, London, UK.
Curr Treat Options Cardiovasc Med. 2018 Oct 26;20(12):96. doi: 10.1007/s11936-018-0691-2.
The changes that occur in athlete's heart are influenced by a number of factors including age, gender, ethnicity and the type of cardiovascular training. It is therefore important that the clinician is able to integrate all of these factors when assessing athletes to be able to guide investigations appropriately and to distinguish pathology from physiology. This review discusses the potential diagnostic conundrums when trying to differentiate physiological left ventricular hypertrophy from pathological hypertrophic cardiomyopathy in athletes. The mechanism of physiological and pathological hypertrophy is discussed together with history, clinical and investigational findings that can help to identify pathology.
Athletes with hypertrophic cardiomyopathy are more likely to have non-concentric left ventricular hypertrophy (LVH), an elevated relative wall thickness, lateral ECG changes and a smaller LV cavity than athletes with physiological LVH. Certain diastolic echocardiographic parameters when used as part of an algorithm (e'; E/E'; E/A) can help to distinguish physiology from pathology, and there is evidence that assessment of global longitudinal strain during exercise echocardiography may be of use in the future. Cardiac MRI is an important imaging modality that can have an additive effect over echocardiography in the diagnosis of cardiomyopathy. Late gadolinium enhancement is a recognised advantage for cardiac magnetic resonance to allow detection of fibrosis in hypertrophic cardiomyopathy. T1 mapping and extracellular volume quantification may be a tool for the future to help distinguish athlete's heart from HCM. Cardiac adaptation to exercise and training in athletes, the athlete's heart causes electrophysiological and geometric changes that may mimic mild phenotypes of a pathological cardiomyopathy. This review article summarises a systematic approach to the assessment of left ventricular hypertrophy in athletes and describes pertinent clinical and investigation findings that can help to differentiate physiology from pathology.
运动员心脏发生的变化受多种因素影响，包括年龄、性别、种族和心血管训练类型。因此，临床医生在评估运动员时能够整合所有这些因素非常重要，以便能够适当地指导检查，并区分病理状态与生理状态。本综述讨论了在试图区分运动员生理性左心室肥厚与病理性肥厚型心肌病时可能出现的诊断难题。文中讨论了生理性和病理性肥厚的机制，以及有助于识别病理状态的病史、临床和检查结果。
与生理性左心室肥厚的运动员相比，肥厚型心肌病运动员更可能出现非同心性左心室肥厚（LVH）、相对室壁厚度升高、心电图外侧改变以及左心室腔较小。某些舒张期超声心动图参数作为算法（e'; E/E'; E/A）的一部分使用时，有助于区分生理状态与病理状态，并且有证据表明运动超声心动图期间整体纵向应变的评估未来可能会有用。心脏磁共振成像（MRI）是一种重要的成像方式，在心肌病诊断中对超声心动图可能具有辅助作用。钆延迟强化是心脏磁共振成像公认的优势，可用于检测肥厚型心肌病中的纤维化。T1映射和细胞外容积定量可能是未来帮助区分运动员心脏与肥厚型心肌病的一种工具。运动员心脏对运动和训练的适应性改变会导致电生理和几何变化，这些变化可能类似于病理性心肌病的轻度表型。本文综述总结了评估运动员左心室肥厚的系统方法，并描述了有助于区分生理状态与病理状态的相关临床和检查结果。
