Athletic physical conditioning results in changes in cardiac anatomy and function that make it challenging to distinguish normal physiological changes from a pathological process in athletes with left ventricular (LV) dilation or a reduced ejection fraction. Millar and colleagues1 propose an approach for identifying athletes with dilated cardiomyopathy (DCM) based on sequential evaluation using N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement, resting ECG, ambulatory ECG monitoring, exercise echocardiography and cardiac magnetic resonance (CMR) imaging. In 25 male athletes with LV dilation and an ejection fraction <55% compared with 35 asymptomatic active male patients with DCM, a failure to increase ejection fraction >11% compared with baseline on exercise echocardiography had the highest sensitivity, with a high specificity, for prediction of DCM. (figure 1)
The figure demonstrates the utility of the stepwise clinical algorithm for differentiating between physiological adaptation and morphologically mild DCM in...