The use of 2-D speckle tracking echocardiography in differentiating healthy adolescent athletes with right ventricular outflow tract dilation from patients with arrhythmogenic cardiomyopathy

https://doi.org/10.1016/j.ijcard.2023.04.001Get rights and content
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Highlights

  • Training induced right ventricular outflow dilation is frequent in athletes and can raise suspicion of cardiomyopathy

  • These athletes have normal right ventricular myocardial mechanics, in contrast with confirmed and borderline non-athlete cases.

  • Speckle tracking echocardiography can improve current screening criteria in athletes with right ventricular outflow dilation

Abstract

Aims

Echocardiographic assessment of adolescent athletes for arrhythmogenic cardiomyopathy (ACM) can be challenging owing to right ventricular (RV) exercise-related remodelling, particularly RV outflow tract (RVOT) dilation. The aim of this study is to evaluate the role of RV 2-D speckle tracking echocardiography (STE) in comparing healthy adolescent athletes with and without RVOT dilation to patients with ACM.

Methods and results

A total of 391 adolescent athletes, mean age 14.5 ± 1.7 years, evaluated at three sports academies between 2014 and 2019 were included, and compared to previously reported ACM patients (n = 38 definite and n = 39 borderline). Peak systolic RV free wall (RVFW-Sl), global and segmental strain (Sl), and corresponding strain rates (SRl) were calculated. The participants meeting the major modified Task Force Criteria (mTFC) for RVOT dilation were defined as mTFC+ (n = 58, 14.8%), and the rest as mTFC- (n = 333, 85.2%). Mean RVFW-Sl was −27.6 ± 3.4% overall, −28.2 ± 4.1% in the mTFC+ group and − 27.5 ± 3.3% in the mTFC- group. mTFC+ athletes had normal RV-FW-Sl when compared to definite (−29% vs −19%, p < 0.001) and borderline ACM (−29% vs −21%, p < 0.001) cohorts. In addition, all mean global and regional Sl and SRl values were no worse in the mTFC+ group compared to the mTFC- (p values range < 0.0001 to 0.1, inferiority margin of 2% and 0.1 s−1 respectively).

Conclusions

In athletes with RVOT dilation meeting the major mTFC, STE evaluation of the RV can demostrate normal function and differentiate physiological remodelling from pathological changes found in ACM, improving screening in grey-area cases.

Graphical abstract

The use of 2D speckle tracking echocardiography in the assessment of the athlete RV.

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Keywords

Arrhythmogenic cardiomyopathy
Paediatric athlete
Preparticipation screening
Speckle tracking echocardiography
Right ventricle longitudinal strain

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This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.