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Left ventricular non compaction or hypertrabeculation: distinguishing between physiology and pathology in top-level athletes

Session Poster session 2

Speaker Assistant Professor Flavio D'Ascenzi

Event : EuroEcho 2015

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Myocardial Disease: Clinical, Other
  • Session type : Poster Session

Authors : F D'ascenzi (Siena,IT), A Pelliccia (Rome,IT), BM Natali (Siena,IT), M Cameli (Siena,IT), M Focardi (Siena,IT), M Bonifazi (Siena,IT), S Mondillo (Siena,IT)

Authors:
F D'ascenzi1 , A Pelliccia2 , BM Natali1 , M Cameli1 , M Focardi1 , M Bonifazi3 , S Mondillo1 , 1University of Siena, Department of Medical Biotechnologies, Division of Cardiology - Siena - Italy , 2Institute of Sport Medicine and Science CONI - Rome - Italy , 3University of Siena, Department of Medicine, Surgery, and NeuroScience - Siena - Italy ,

Citation:
Eur Heart J Cardiovasc Imaging Abstracts Supplement ( 2015 ) 16 ( Supplement 2 ), ii89

Purpose: In the last years, an increasing diagnosis of left ventricular non compaction (LVNC) has been observed. It is not completely clear whether it reflects the real incidence of this pathology or an erroneous interpretation of an extreme, physiological remodeling. Therefore, distinguishing between LVNC and LV physiologic hypertrabeculation is becoming extremely important, also considering that a high proportion of athletes, and particularly black athletes, fulfilled the conventional criteria for LVNC. While a longitudinal study demonstrated in pregnant women that temporary changes in cardiac preload can cause LV hypertrabeculation, in athletes no longitudinal data are yet available.

Methods: We studied a case series of 4 top-level black athletes, competing in an international level. Athletes were evaluated before the beginning of the season and after 6 months of training by 2D, 3D and speckle-tracking echocardiography.

Results: We observed a significant training-induced increase in LV hypertrabeculation, as assessed by 2D and 3D echocardiography (fig.1). We found also marked exercise-induced ECG changes, representing a further challenge for the differential diagnosis between athlete's heart and cardiomyopathies. However, all the indices of diastolic and systolic function were normal and normal values of LV strain were found both before and after training.

Conclusions: According to these preliminary data, exercise conditioning is able to stimulate in predisposed subjects a hypertrabeculation that should be interpreted as a peculiar, benign adaption. In contrast to LV functional abnormalities observed in LVNC, neither LV diastolic function nor LV myocardial deformation were abnormal in athletes, suggesting that these parameters are helpful to distinguish between LVNC and hypertrabeculation.

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