Scholarlink

Background <p>Participation in regular endurance exercise may be associated with physiological left ventricular (LV) dilatation and concomitant low resting LV ejection fraction (LVEF), a phenotype indistinguishable from early dilated cardiomyopathy (DCM) on resting imaging alone and termed the “grey zone”. Stress echocardiography has emerged as a potential arbiter and has been proposed to resolve this dilemma.</p> Objectives <p>We evaluated the diagnostic accuracy of stress echocardiography in distinguishing physiological from pathological LV dilatation and assessed whether incorporating submaximal-to-peak contractile reserve improved discriminatory value in athletes in the grey zone.</p> Methods <p>Of the 182 athletic individuals, 62 control athletes with an enlarged LV and normal LVEF, 58 athletic DCM individuals, and 62 grey zone athletes underwent stress echocardiography using a semi-supine bicycle. In addition to the ability to augment LVEF ≥ 10% from rest to maximal exercise, we evaluated the ability to augment LVEF from submaximal exercise (80% of maximal heart rate) to peak exercise.</p> Results <p>Resting LV dimensions did not differ significantly amongst the groups. Control athletes had higher resting LVEF than grey zone athletes and DCM individuals (62.1% vs 52.1% and 53.1%; <i>p</i>=&lt;0.001). Control and grey zone athletes showed greater ΔLVEF from rest to peak exercise than DCM individuals (21% and 19.2% vs 4.9%; <i>p</i> &lt; 0.001). Most control (98.3%) and grey-zone athletes (90.3%) achieved a ΔLVEF ≥ 10% from rest to peak exercise compared with 20.6% of athletic DCM individuals. Control and grey zone athletes also revealed a mean increase in LVEF from submaximal to peak exercise of 7.5% and 3.8%, respectively, whereas DCM individuals showed a mean LVEF decline of −4.3% (<i>p</i> &lt; 0.001). Although 20.6% of DCM individuals demonstrated a ΔLVEF ≥ 10% from rest to peak, only a single DCM individual augmented LVEF from submaximal to peak exercise. Failure to increase LVEF ≥ 10% from rest to peak exercise identified DCM with 79.4% sensitivity and 98.3% specificity. Combining this inability with a failure to augment LVEF from submaximal to peak exercise improved the sensitivity to 98.2% and specificity to 98.4%.</p> Conclusion <p>Reliance on rest-to-peak augmentation of ≥10% alone risks misclassification. Introducing submaximal-to-peak augmentation enhances diagnostic precision by identifying virtually all individuals with DCM while preserving specificity.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Unravelling the grey zone: submaximal-to-peak stress echocardiography enhances diagnostic accuracy in differentiating early dilated cardiomyopathy from physiological adaptation

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年6月15日

查看全文
  • Sarandeep K. Marwaha,
  • Joyee Basu,
  • Raghav Bhatia,
  • Hamish Maclachlan,
  • Saad Fyyaz,
  • Maria Teresa Tome Esteban,
  • Elijah R. Behr,
  • Gherardo Finocchiaro,
  • Aneil Malhotra,
  • Sanjay Prasad,
  • Sabiha Gati,
  • Michael Papadakis,
  • Sanjay Sharma

摘要

Background

Participation in regular endurance exercise may be associated with physiological left ventricular (LV) dilatation and concomitant low resting LV ejection fraction (LVEF), a phenotype indistinguishable from early dilated cardiomyopathy (DCM) on resting imaging alone and termed the “grey zone”. Stress echocardiography has emerged as a potential arbiter and has been proposed to resolve this dilemma.

Objectives

We evaluated the diagnostic accuracy of stress echocardiography in distinguishing physiological from pathological LV dilatation and assessed whether incorporating submaximal-to-peak contractile reserve improved discriminatory value in athletes in the grey zone.

Methods

Of the 182 athletic individuals, 62 control athletes with an enlarged LV and normal LVEF, 58 athletic DCM individuals, and 62 grey zone athletes underwent stress echocardiography using a semi-supine bicycle. In addition to the ability to augment LVEF ≥ 10% from rest to maximal exercise, we evaluated the ability to augment LVEF from submaximal exercise (80% of maximal heart rate) to peak exercise.

Results

Resting LV dimensions did not differ significantly amongst the groups. Control athletes had higher resting LVEF than grey zone athletes and DCM individuals (62.1% vs 52.1% and 53.1%; p=<0.001). Control and grey zone athletes showed greater ΔLVEF from rest to peak exercise than DCM individuals (21% and 19.2% vs 4.9%; p < 0.001). Most control (98.3%) and grey-zone athletes (90.3%) achieved a ΔLVEF ≥ 10% from rest to peak exercise compared with 20.6% of athletic DCM individuals. Control and grey zone athletes also revealed a mean increase in LVEF from submaximal to peak exercise of 7.5% and 3.8%, respectively, whereas DCM individuals showed a mean LVEF decline of −4.3% (p < 0.001). Although 20.6% of DCM individuals demonstrated a ΔLVEF ≥ 10% from rest to peak, only a single DCM individual augmented LVEF from submaximal to peak exercise. Failure to increase LVEF ≥ 10% from rest to peak exercise identified DCM with 79.4% sensitivity and 98.3% specificity. Combining this inability with a failure to augment LVEF from submaximal to peak exercise improved the sensitivity to 98.2% and specificity to 98.4%.

Conclusion

Reliance on rest-to-peak augmentation of ≥10% alone risks misclassification. Introducing submaximal-to-peak augmentation enhances diagnostic precision by identifying virtually all individuals with DCM while preserving specificity.