St George's University of London, Division of Cardiac and Vascular Sciences, London, United Kingdom
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Purpose: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is the cause of sudden death in a significant proportion of young athletes, particularly in the Mediterranean region. Modified Task Force Criteria (TFC) for diagnosis of ARVC include echocardiographic measures of right ventricular (RV) dimensions, with quoted specificity for ARVC of between 80 and 95%. Several studies have demonstrated RV enlargement as a result of systematic training. The use of transthoracic echo (TTE) to differentiate ARVC from physiological RV enlargement is an essential component of cardiovascular assessment in athletes. We investigated the prevalence of echocardiographic TFC in healthy, male elite athletes (EA). We also assessed the influence of training intensity and left ventricular (LV) dimensions on the presence of TFC in EA.Methods: TTE was performed in 167 healthy, male EA after prior evaluation of personal and family history, and 12-lead electrocardiography (ECG). EA from 11 different sporting disciplines were included. Mean age was 21.8 years. In each case, RV outflow tract diameter was measured in parasternal long-axis and short-axis views and indexed for body surface area (BSA), as per TFC. LV end-diastolic diameter indexed for BSA (LVEDD/BSA) and hours of training per week were also recorded.Results: RV dimensions fulfilling TFC were present in 52.7% of EA, with 10.8% meeting major criteria. Compared to EA without TFC, those exhibiting TFC had significantly greater LV cavity dimensions, and spent more time training per week (Table 1).Conclusions: Echocardiographic TFC for ARVC are common in healthy male EA, particularly in athletes training at the highest intensities, and in those with concomitant LV enlargement. This supports the concept of a balanced physiological enlargement of both sides of the heart as a result of training. Echocardiographic components of the TFC should be used with caution in elite athletes, and must be interpreted in the context of the history, ECG, gender, training intensity and LV dimensions.