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J Am Coll Cardiol, 2004; 44:469-470, doi:10.1016/j.jacc.2004.04.026
© 2004 by the American College of Cardiology Foundation
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LETTER TO THE EDITOR

Echocardiographic limits of left ventricular remodeling in athletes

Erdem Kasikcioglu, MD, PhDa and Hulya Akhan, MDa

a Istanbul University, Sports Medicine Department, Istanbul, Turkey

ekasikcioglu{at}yahoo.com

We read with great interest the recently published study by Nagashima et al. (1) in the November 5, 2003, issue of JACC. The investigators concluded that many Japanese ultramaraton runners have larger left ventricle (LV) diameters (LV diastolic diameter up to 75 mm; 33 participants had larger than 70 mm).

Nevertheless, some concern arose from previously published reports. First, the researchers did not mention how many investigators participated in the study. It is known that reproducibility of echocardiographic measurements is important and may be an effective factor for LV diameter ranges.

Second, LV diastolic diameter and interventricular septum thickness (up to 19 mm) in the study are higher than previously mentioned measures by some investigators. Maron et al. (2) reported that maximal LV end-diastolic dimension was 66 mm, and maximal ventricular septal thickness was 13 mm in 947 athletes. Furthermore, they concluded that athletes with a wall thickness more than 16 mm without LV dilation are likely to have primary forms of pathologic hypertrophy. Also, Douglas et al. (3) found that LV end-diastolic dimension was up to 65 mm and ventricular septal thickness was 14 mm in 235 athletes. The differentiation of physiologic and pathologic hypertrophy can be difficult, but it is important in determining the existence of cardiac disease in athletes in order to prevent exercise-related sudden cardiac death.

Hypertrophic cardiomyopathy has to be overcome, for it is a difficult and important problem in athletes. It is camouflaged by LV dilation due to volume overload in endurance athletes. However, pathologic hypertrophy and dilation are probably related to a known characteristic of diastolic dysfunction. Recently, an easily measured tissue Doppler index (TDI) was proposed as a potentially useful method for distinguishing athlete's heart from structural heart disease (4). We think that TDI should be routinely used for differentiating physiological hypertrophy from the pathologic.


   References
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 References
 

  1. Nagashima J, Musha H, Takada H, Murayama M. New upper limit of physiologic cardiac hypertrophy in Japanese participants in the 100-km ultramarathon. J Am Coll Cardiol. 2003;42:1617–1623[Abstract/Free Full Text]
  2. Maron BJ, Pelliccia A, Spirito P. Cardiac disease in young trained athletes: insights into methods for distinguishing athlete's heart from structural heart disease, with particular emphasis on hypertrophic cardiomyopathy. Circulation. 1995;91:1596–1601[Free Full Text]
  3. Douglas PS, O'Toole ML, Katz SE, et al. Left ventricular hypertrophy in athletes. Am J Cardiol. 1997;80:1384–1388[CrossRef][Medline]
  4. Palka P, Lange A, Fleming AD, et al. Differences in myocardial velocity gradient measured throughout the cardiac cycle in patients with hypertrophic cardiomyopathy: athletes and patients with left ventricular hypertrophy due to hypertension. J Am Coll Cardiol. 1997;30:760–768[Abstract]



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Eur J Echocardiogr, March 1, 2006; 7(2): 182 - 183.
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