Bakogiannis Constantinos, Mouselimis Dimitrios, Tsarouchas Anastasios, Papatheodorou Efstathios, Vassilikos Vassilios P, Androulakis Emmanuel
Cardiovascular Prevention and Digital Cardiology Lab, Third Department of Cardiology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
Eur J Sport Sci. 2023 Jan;23(1):143-154. doi: 10.1080/17461391.2021.2001576. Epub 2021 Dec 2.
Hypertrophic cardiomyopathy (HCM) is a common cause of sudden cardiac death in athletes. Cardiac Magnetic Resonance (CMR) imaging is considered an excellent tool to differentiate between HCM and athlete's heart. The aim of this systematic review was to highlight the novel CMR-derived parameters with significant discriminative capacity between the two conditions. A systematic search in the MEDLINE, EMBASE and Cochrane Reviews databases was performed. Eligible studies were considered the ones comparing novel CMR-derived parameters on athletes and HCM patients. Therefore, studies that only examined Cine-derived volumetric parameters were excluded. Particular attention was given to binary classification results from multi-variate regression models and ROC curve analyses. Bias assessment was performed with the Quality Assessment on Diagnostic Accuracy Studies. Five (5) studies were included in the systematic review, with a total of 284 athletes and 373 HCM patients. Several novel indices displayed discriminatory potential, such as native T1 mapping and T2 values, LV global longitudinal strain, late gadolinium enhancement and whole-LV fractal dimension. Diffusion tensor imaging enabled quantification of the secondary eigenvalue angle and fractional anisotropy in one study, which also proved capable of reliably detecting HCM in a mixed athlete/patient sample. Several novel CMR-derived parameters, most of which are currently under development, show promising results in discerning between athlete's heart and HCM. Prospective studies examining the discriminatory capacity of all promising modalities side-by-side will yield definitive answers on their relative importance; diagnostic models can incorporate the best performing variables for optimal results.
肥厚型心肌病（HCM）是运动员心源性猝死的常见原因。心脏磁共振（CMR）成像被认为是区分HCM和运动员心脏的优秀工具。本系统评价的目的是突出具有显著鉴别能力的新型CMR衍生参数，以区分这两种情况。我们在MEDLINE、EMBASE和Cochrane综述数据库中进行了系统检索。符合条件的研究是那些比较运动员和HCM患者新型CMR衍生参数的研究。因此，仅检查电影衍生容积参数的研究被排除在外。我们特别关注多变量回归模型和ROC曲线分析的二元分类结果。我们使用诊断准确性研究质量评估进行偏倚评估。五项研究被纳入系统评价，共有284名运动员和373名HCM患者。几个新型指标显示出鉴别潜力，如固有T1映射和T2值、左心室整体纵向应变、钆延迟增强和左心室整体分形维数。在一项研究中，扩散张量成像能够量化二次特征值角度和分数各向异性，该研究还证明能够在运动员/患者混合样本中可靠地检测HCM。几个新型CMR衍生参数，其中大多数目前仍在开发中，在区分运动员心脏和HCM方面显示出有前景的结果。对所有有前景的模式的鉴别能力进行并行检验的前瞻性研究将对它们的相对重要性给出明确答案；诊断模型可以纳入表现最佳的变量以获得最佳结果。
