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J Am Coll Cardiol, 2000; 36:864-870
© 2000 by the American College of Cardiology Foundation
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CLINICAL STUDY

Utility of metabolic exercise testing in distinguishing hypertrophic cardiomyopathy from physiologic left ventricular hypertrophy in athletes

Sanjay Sharma, BSc, MRCPa*, Perry M. Elliott, MRCPa*, Greg Whyte, PhD*, Niall Mahon, MD, MRCP(I)a*, Mohan S. Virdee, MRCPa*, Brian Mist, PhDa* and William J. McKenna, FRCP, FACC, FESCa*

a St. George’s Hospital Medical School, London, United Kingdom
* University of Wolverhampton, Walsall Campus, Walsall, United Kingdom

Manuscript received July 29, 1999; revised manuscript received February 22, 2000, accepted April 11, 2000.

Reprint requests and correspondence: Dr. Sanjay Sharma, Department of Cardiological Sciences, St. George’s Hospital Medical School, Cranmer Terrace, London SW17 ORE, United Kingdom
ssharma21{at}hotmail.com

OBJECTIVES

This study evaluated the role of metabolic (cardiopulmonary gas exchange) exercise testing in differentiating physiologic LVH in athletes from HCM.

BACKGROUND

Regular intensive training may cause mild increases in left ventricular wall thickness (LVWT). Although the degree of left ventricular hypertrophy (LVH) is typically less than that seen in hypertrophic cardiomyopathy (HCM), genetic studies have shown that a substantial minority of patients with HCM have an LVWT in the same range. The differentiation of physiologic and pathologic LVH in this "gray zone" can be problematic using echocardiography and electrocardiography alone.

METHODS

Eight athletic men with genetically proven HCM and mild LVH (13.9 ± 1.1 mm) and eight elite male athletes matched for age, size and LVWT (13.4 ± 0.9 mm) underwent symptom limited metabolic exercise stress testing. Peak oxygen consumption (pVO2), anaerobic threshold, oxygen pulse and respiratory exchange ratios were measured in both groups and compared with those observed in 12 elite and 12 recreational age- and size-matched athletes without LVH.

RESULTS

Elite athletes with LVH had significantly greater pVO2 (66.2 ± 4.1 ml/kg/min vs. 34.3 ± 4.1 ml/kg/min; p < 0.0001), anaerobic threshold (61.6 ± 1.8% of the predicted maximum VO2 vs. 41.4 ± 4.9% of the predicted maximum VO2; p < 0.001) and oxygen pulse (27.1 ± 3.2 ml/beat vs. 14.3 ± 1.8 ml/beat; p < 0.0001) than individuals with HCM. A pVO2 >50 ml/kg/min or >20% above the predicted maximum VO2 differentiated athlete’s heart from HCM.

CONCLUSIONS

Metabolic exercise testing facilitates the differentiation between physiologic LVH and HCM in individuals in the "gray zone."

Abbreviations and Acronyms
  AT = anaerobic threshold
  A-V = systemic arteriovenous oxygen difference
  BP = blood pressure
  ECG = electrocardiogram
  HCM = hypertrophic cardiomyopathy
  HR = heart rate
  LV = left ventricular
  LVH = left ventricular hypertrophy
  LVWT = left ventricular wall thickness
  O2P = oxygen pulse
  pVO2 = peak oxygen consumption
  RER = respiratory exchange ratio
  SV = stroke volume
  VCO2 = carbon dioxide production
  VO2 = oxygen consumption
  VO2 max = maximal oxygen consumption




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