LAUSR

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 11% compared with baseline on exercise echocardiography had the highest sensitivity, with a high specificity, for prediction of DCM. (figure 1) Figure 1 The figure demonstrates the utility of the stepwise clinical algorithm for differentiating between physiological adaptation and morphologically mild DCM in apparently healthy individuals with LV dilatation and LVEF <55%. The number and percentages of both cohorts with abnormal investigations is shown with the cumulative TN and TP results on the extreme right and left, respectively. The overall sensitivity of the algorithm is 94.1% with a specificity of 83.3%. The PPV is 90.3% with an NPV of …