Differentiating hypertrophic cardiomyopathy from athlete's heart: An electrocardiographic and echocardiographic approach

- Differential diagnosis of hypertrophic cardiomyopathy (HCM) from an athlete's heart with mild left ventricular hypertrophy is challenging.
- The best diagnostic criteria for HCM was the relative septal thickness ratio (2 x IVS/LV-EDD) > 0.54.
- The spatial QRS-T angle > 45 was also useful in the diagnosis of HCM.
- No improvement in diagnostic performance was obtained by combining both parameters.

Differential diagnosis of hypertrophic cardiomyopathy (HCM) vs athlete's heart is challenging in individuals with mild-moderate left-ventricular hypertrophy. This study aimed to assess ECG and echocardiographic parameters proposed for the differential diagnosis of HCM.The study included 75 men in three groups: control (n = 30), “gray zone” athletes with interventricular septum (IVS) measuring 13-15 mm (n = 25) and HCM patients with IVS of 13-18 mm (n = 20).The most significant differences were found in relative septal thickness (RST), calculated as the ratio of 2 x IVS to left ventricle end-diastolic diameter (LV-EDD) (0.37, 0.51, 0.71, respectively; p < 0.01) and in spatial QRS-T angle as visually estimated (9.8, 33.6, 66.2, respectively; p < 0.01). The capacity for differential HCM diagnosis of each of the 5 criteria was assessed using the area under the curve (AUC), as follows: LV-EDD < 54 (0.60), family history (0.61), T-wave inversion (TWI) (0.67), spatial QRS-T angle > 45 (0.75) and RST > 0.54 (0.92). Pearson correlation between spatial QRS-T angle > 45 and TWI was 0.76 (p 0.01). The combination of spatial QRS-T angle > 45 and RST > 0.54 for diagnosis of HCM had an AUC of 0.79.The best diagnostic criteria for HCM was RST > 0.54. The spatial QRS-T angle > 45 did not add sensitivity if TWI was present. No additional improvement in differential diagnosis was obtained by combining parameters.