Differentiating Athletes From ARVC | Journal Scan

Jun 22, 2015
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Authors:
Zaidi A, Sheikh N, Jongman JK, et al.
Citation:
Clinical Differentiation Between Physiological Remodeling and Arrhythmogenic Right Ventricular Cardiomyopathy in Athletes With Marked Electrocardiographic Repolarization Anomalies. J Am Coll Cardiol 2015;65:2702-2711.
Summary By:
Martin LaPage, MD

Study Questions:

What is the accuracy of the current arrhythmogenic right ventricular cardiomyopathy (ARVC) diagnostic criteria when applied to athletes exhibiting phenotypic overlap with the disease?

Methods:

Study investigators compared three groups: 1) athletes with electrocardiogram (ECG) T-wave inversion (TWI) (n = 45), 2) athletes without ECG TWI (n = 35), and 3) patients with new diagnosis of definite ARVC by 2010 Task Force Criteria (n = 35). Assessed parameters included data from ECG, echocardiogram, magnetic resonance imaging (MRI), signal-averaged ECG (SAECG), Holter, and exercise test. A predictive model for differentiating ARVC from benign athletic changes was calculated.

Results:

There was significant phenotypic overlap between athletes and patients with ARVC for several criteria. Poor discriminators included presence of TWI, fewer than three abnormal SAECG parameters, and right ventricular (RV) fractional area contraction of 31-40% among others. Athletes were more likely to demonstrate ventricular hypertrophy on ECG in addition to other specific parameters. Multiple phenotypic findings were more strongly associated with ARVC including symptoms, ventricular arrhythmias, three abnormal SAECG parameters, wall motion abnormalities, RV fractional area contraction <30% by echo or RV ejection fraction <45% by MRI, and maximal precordial RS amplitude on ECG (V-Ampmax) among others. The final model included five parameters: SAECG abnormalities, ventricular ectopy burden, V-Ampmax, RV/left ventricular dimension ratio, and exercise duration. The model is included as an interactive calculator in the online data supplement and provides a positive predictive value of 100% and negative predictive value of 98.6% to differentiate athletic remodeling from ARVC.

Conclusions:

TWI and symmetric ventricular dilation may be found in athletes and not be markers of ARVC. Differentiation of athletic changes from ARVC should consider additional parameters beyond the 2010 Task Force Criteria for ARVC.

Perspective:

Athletes may present phenotypic findings associated with ARVC due to ventricular remodeling. Differentiating these benign changes from those of ARVC is an important diagnostic ability. By analyzing a large number of parameters, the authors created a predictive model to differentiate benign athletic changes from pathologic findings.

Keywords: Arrhythmias, Cardiac, Arrhythmogenic Right Ventricular Dysplasia, Athletes, Echocardiography, Electrocardiography, Exercise Test, Heart Conduction System, Heart Failure, Hypertrophy, Magnetic Resonance Imaging, Ventricular Premature Complexes, Ventricular Remodeling


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