Role of the electrocardiogram in differentiating genetically determined dilated cardiomyopathy from athlete's heart. 2022

Denise Zaffalon, and Efstathios Papatheodorou, and Ahmed Merghani, and Harshil Dhutia, and Eleonora Moccia, and Aneil Malhotra, and Christopher J Miles, and Virginia Attard, and Tessa Homfray, and Rajan Sharma, and Marta Gigli, and Matteo Dal Ferro, and Marco Merlo, and Michael Papadakis, and Gianfranco Sinagra, and Sanjay Sharma, and Gherardo Finocchiaro
Cardiovascular Department, Azienda Sanitaria Giuliano-Isontina, University of Trieste, Trieste, Italy.

BACKGROUND Physiological cardiac remodelling in highly trained athletes may overlap with dilated cardiomyopathy (DCM). OBJECTIVE The aim of this study was to investigate the role of the electrocardiogram (ECG) in differentiating between physiological and pathological remodelling. METHODS The study population consisted of 30 patients with DCM who revealed a pathogenic variant at genetic testing and 30 elite athletes with significant cardiac remodelling defined by a left ventricular (LV) end-diastolic diameter >62 mm and/or LV ejection fraction between 45% and 50%. RESULTS The ECG was abnormal in 22 (73%) patients with DCM. The most common abnormalities were low voltages (n = 14, 47%), lateral T-wave inversion (TWI) (n = 6, 20%), ventricular ectopic beats (n = 5, 17%) and anterior TWI (n = 4, 13). Two athletes revealed an abnormal ECG: complete left bundle branch block (LBBB) in one case and atrial flutter in the other. The sensitivity, specificity and accuracy of the ECG in differentiating DCM from physiological adaptation to exercise in athletes was 73% (confidence interval [CI]: 54%-88%), 93% (CI: 78%-99%) and 0.83 (CI: 0.71-0.92) respectively. CONCLUSIONS While the ECG is usually normal in athletes exhibiting significant LV dilatation and/or systolic dysfunction, this test is often abnormal in patients with DCM harbouring a pathogenic variant. Low voltages in the limb leads and lateral TWI are the most common abnormalities.

UI MeSH Term Description Entries
D002037 Bundle-Branch Block A form of heart block in which the electrical stimulation of HEART VENTRICLES is interrupted at either one of the branches of BUNDLE OF HIS thus preventing the simultaneous depolarization of the two ventricles. Fascicular Block,Anterior Fascicular Block,Bundle Branch Block,Left Bundle-Branch Block,Posterior Fascicular Block,Right Bundle-Branch Block,Anterior Fascicular Blocks,Block, Anterior Fascicular,Block, Bundle Branch,Block, Bundle-Branch,Block, Fascicular,Block, Left Bundle-Branch,Block, Posterior Fascicular,Block, Right Bundle-Branch,Blocks, Anterior Fascicular,Blocks, Bundle Branch,Blocks, Bundle-Branch,Blocks, Fascicular,Blocks, Left Bundle-Branch,Blocks, Posterior Fascicular,Blocks, Right Bundle-Branch,Branch Block, Bundle,Branch Blocks, Bundle,Bundle Branch Blocks,Bundle-Branch Block, Left,Bundle-Branch Block, Right,Bundle-Branch Blocks,Bundle-Branch Blocks, Left,Bundle-Branch Blocks, Right,Fascicular Block, Anterior,Fascicular Block, Posterior,Fascicular Blocks,Fascicular Blocks, Anterior,Fascicular Blocks, Posterior,Left Bundle Branch Block,Left Bundle-Branch Blocks,Posterior Fascicular Blocks,Right Bundle Branch Block,Right Bundle-Branch Blocks
D002311 Cardiomyopathy, Dilated A form of CARDIAC MUSCLE disease that is characterized by ventricular dilation, VENTRICULAR DYSFUNCTION, and HEART FAILURE. Risk factors include SMOKING; ALCOHOL DRINKING; HYPERTENSION; INFECTION; PREGNANCY; and mutations in the LMNA gene encoding LAMIN TYPE A, a NUCLEAR LAMINA protein. Cardiomyopathy, Congestive,Congestive Cardiomyopathy,Dilated Cardiomyopathy,Cardiomyopathy, Dilated, 1a,Cardiomyopathy, Dilated, Autosomal Recessive,Cardiomyopathy, Dilated, CMD1A,Cardiomyopathy, Dilated, LMNA,Cardiomyopathy, Dilated, With Conduction Defect 1,Cardiomyopathy, Dilated, with Conduction Deffect1,Cardiomyopathy, Familial Idiopathic,Cardiomyopathy, Idiopathic Dilated,Cardiomyopathies, Congestive,Cardiomyopathies, Dilated,Cardiomyopathies, Familial Idiopathic,Cardiomyopathies, Idiopathic Dilated,Congestive Cardiomyopathies,Dilated Cardiomyopathies,Dilated Cardiomyopathies, Idiopathic,Dilated Cardiomyopathy, Idiopathic,Familial Idiopathic Cardiomyopathies,Familial Idiopathic Cardiomyopathy,Idiopathic Cardiomyopathies, Familial,Idiopathic Cardiomyopathy, Familial,Idiopathic Dilated Cardiomyopathies,Idiopathic Dilated Cardiomyopathy
D004562 Electrocardiography Recording of the moment-to-moment electromotive forces of the HEART as projected onto various sites on the body's surface, delineated as a scalar function of time. The recording is monitored by a tracing on slow moving chart paper or by observing it on a cardioscope, which is a CATHODE RAY TUBE DISPLAY. 12-Lead ECG,12-Lead EKG,12-Lead Electrocardiography,Cardiography,ECG,EKG,Electrocardiogram,Electrocardiograph,12 Lead ECG,12 Lead EKG,12 Lead Electrocardiography,12-Lead ECGs,12-Lead EKGs,12-Lead Electrocardiographies,Cardiographies,ECG, 12-Lead,EKG, 12-Lead,Electrocardiograms,Electrocardiographies, 12-Lead,Electrocardiographs,Electrocardiography, 12-Lead
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001145 Arrhythmias, Cardiac Any disturbances of the normal rhythmic beating of the heart or MYOCARDIAL CONTRACTION. Cardiac arrhythmias can be classified by the abnormalities in HEART RATE, disorders of electrical impulse generation, or impulse conduction. Arrhythmia,Arrythmia,Cardiac Arrhythmia,Cardiac Arrhythmias,Cardiac Dysrhythmia,Arrhythmia, Cardiac,Dysrhythmia, Cardiac
D056352 Athletes Individuals who have developed skills, physical stamina and strength or participants in SPORTS or other physical activities. College Athletes,Elite Athletes,Professional Athletes,Athlete,Athlete, College,Athlete, Elite,Athlete, Professional,Athletes, College,Athletes, Elite,Athletes, Professional,College Athlete,Elite Athlete,Professional Athlete
D059267 Cardiomegaly, Exercise-Induced Non-pathological heart enlargement and other remodeling in cardiac morphology and electrical circuitry found in individuals who participate in intense repeated exercises. Athlete's Heart,Athletic Bradycardia,Athlete's Heart Syndrome,Heart Enlargement, Physiological,Athlete Heart,Athlete Heart Syndrome,Athlete's Heart Syndromes,Athletes Heart,Athletes Heart Syndrome,Bradycardia, Athletic,Cardiomegaly, Exercise Induced,Enlargement, Physiological Heart,Exercise-Induced Cardiomegalies,Exercise-Induced Cardiomegaly,Heart, Athlete's,Physiological Heart Enlargement,Physiological Heart Enlargements
D020257 Ventricular Remodeling The geometric and structural changes that the HEART VENTRICLES undergo, usually following MYOCARDIAL INFARCTION. It comprises expansion of the infarct and dilatation of the healthy ventricle segments. While most prevalent in the left ventricle, it can also occur in the right ventricle. Cardiac Remodeling, Ventricular,Left Ventricular Remodeling,Myocardial Remodeling, Ventricular,Left Ventricle Remodeling,Ventricle Remodeling,Cardiac Remodelings, Ventricular,Left Ventricle Remodelings,Left Ventricular Remodelings,Myocardial Remodelings, Ventricular,Remodeling, Left Ventricle,Remodeling, Left Ventricular,Remodeling, Ventricle,Remodeling, Ventricular,Remodeling, Ventricular Cardiac,Remodeling, Ventricular Myocardial,Remodelings, Left Ventricle,Remodelings, Left Ventricular,Remodelings, Ventricle,Remodelings, Ventricular,Remodelings, Ventricular Cardiac,Remodelings, Ventricular Myocardial,Ventricle Remodeling, Left,Ventricle Remodelings,Ventricle Remodelings, Left,Ventricular Cardiac Remodeling,Ventricular Cardiac Remodelings,Ventricular Myocardial Remodeling,Ventricular Myocardial Remodelings,Ventricular Remodeling, Left,Ventricular Remodelings,Ventricular Remodelings, Left

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