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Athlete'sHeartorCardiomyopathy?NBAHelpsFindDifference
PamHarrison

March01,2016

NEWYORK,NYArobustdatabasehasbeengeneratedfromeliteUSbasketballplayersthatwillallowsports
cardiologiststodifferentiatebetweenwhatisexercise-inducedcardiacremodelingandwhatmightbepathologyin
exceptionallargeathletes,thefirststudyofitskindindicates[1].
"BasketballisaleadingsportwithintheUnitedStates...andadetailedunderstandingofnormalandexpected
cardiacremodelinginUSbasketballplayershassignificantclinicalimportancegiventhattheincidenceofsportrelatedsuddencardiacdeath(SCD)intheUnitedStatesishighestamongbasketballplayers,andthemost
commoncauseofSCDinthispopulationishypertrophiccardiomyopathy,"DrDavidEngel(ColumbiaUniversity
MedicalCenter,NewYork,NY)andcolleagueswriteinJAMA Cardiology.ThestudywaspublishedonlineFebruary
24,2016.
Thestudy,theysay,is"thefirsttodatetoprovidelarge-scalenormativedataforUSbasketballplayers,anathletic
groupwithgreateranthropometrythananypreviouslystudiedathletegroup."
"Differentiating[exercise-inducedcardiacremodeling]fromthediseasesassociatedwiththeriskforadverseevents
duringathleticparticipationisamongthemostchallengingandimportanttasksforthesportscardiologist,"agreesDr
AaronBaggish(MassachusettsGeneralHospital,Boston)inanaccompanyingeditorial[2].
"Atthemostbasiclevel,differentiatingadaptivephysiologicdevelopmentfromoccultpathologicchangesrequiresa
comprehensiveunderstandingofwhatconstitutesnormal foragivenathletesubtype."
Annual Stress Echo
TheNationalBasketballAssociation(NBA)mandatesthateachplayerundergoanannualpreseasonstress
echocardiogramaspartoftheirpreseasonevaluation.
Boththe2013and2014preseasonechocardiogramsdonebyNBAteamaffiliatedphysiciansalongwiththe
echocardiogramsdoneduringthe2014NBApredraftevaluationwereevaluatedatacorelaboratory.The526
athletesincludedinthestudyrepresentthetotalnumberofathleteswithechocardiogramsavailableforreview.
Overthree-quartersoftheathleteswereAfricanAmerican,andapproximately20%werewhite,withameanageof
25.7years.Themeanheightofthegroupwas200.2cmwhilethemeanbodysurfacearea(BSA)was2.38m2.
Measurementsoftheleftheartstructure,includingleftventricular(LV)capacitysize,LVwallthickness,andLV
mass,exceedednormalcutpointsproposedforuseinthegeneralpopulationinasignificantnumberofathletes,as
Baggishobserves.ThemeanLVenddiastolicdiameter(LVEDD)was56.8mmandLVcavitydilationwasseenin
36.5%oftheathletesanalyzed.
However,whenLVEDDwasindexedtoheightandBSA,"LVcavitysizeswerenormalcomparedwithreference
maleadults,evenamongthelargestathletes,withameanLVEDDperunitofbodysurfaceareaof2.40cm/m2vs
referenceadults(range2.33.0cm/m2)andameanLVEDDperunitofheightof2.84cm/m2vsreferenceadults
(range2.43.3cm/m),"accordingEngelandcolleagues.
Similarly,measurementsofLVwallthicknessandLVmassindexagainexceedednormalcutpointsforamore
sedentarypopulationatameanof11.04mmforLVwallthicknessandameanof105.4g/m2forLVmassindex.

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07-Mar-16

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Again,however,afterappropriatescalingfortheirphysicalsize,neitherofthesemetricswassignificantlydifferent
fromthoseinthegeneralpopulation.
"LVhypertrophy(LVH),thehallmarkoftheathlete'sheart,wasobservedin144(27.4%)of526NBAathletes,with
ethnicityidentifiedasakeydeterminantoftheprevalenceandgeometricpatternofLVH,"Baggishobserved.
Asassessedbyejectionfraction,LVfunctionwasmildlydepressedat<50%inasmallsubjectofplayers.However,
theseplayersalsohadlargerventriclesthanathleteswithhigherejectionfractions,asBaggishpointsout,andall
athleteswithmildlyreducedejectionfractionshadappropriateejectionfractionaugmentationswhenprovokedby
exercise.
Noathletehadevidenceofdiastolicdysfunction.
Aortic-Root Dimension
AsEngelemphasizes,aortic-rootdiameterisofparticularimportanceintheevaluationofNBAathletes,giventhe
extremeheightoftheaverageNBAplayerandthepotentialforoverlapwithindividualswhohaveMarfansyndrome.
Themaximumaortic-rootdiametermeasuredintheentirecohortwas42mm,withfewerthan5%oftheathletes
havinganaorticrootof40mmormore.
"Thesedatahaveimportantimplicationsintheevaluationofexceptionallylargeathletes,"Engelsobserves,"and
questiontheapplicabilityinindividualswithsignificantlyincreasedbiometricsofthetraditionalformulatoestimate
aortic-rootdiameterthatassumesalinearassociationbetweenaorticdiameterandBSA."
Baggishnotesthatthefindings"underscoretheneedforphysicianswhocareforcompetitivebasketballplayersand
perhapsothertallathletesfromalternativesportingdisciplinestoconsiderbodysizeduringtheinterpretationof
cardiacimagingdataasamatterofroutine."
The study was funded by the NBA. The study authors and Baggish have no relevant financial relationships.
References

1. DavidEngel,AllanSchwartz,ShunichiHomma.AthleticcardiacremodelinginUSprofessionalbasketball
players.JAMA Cardiol2015;DOI:10.1001/jamacardio.2015.0252.Article
2. AaronBaggish.Cardiacvariablesinprofessionalbasketballpayers.Lookingcloselyatthenormal big athlete
(NBA).JAMA Cardiol2016;DOI:10.1001/jamacardio.2015.0289.Editorial
HeartwirefromMedscape2016Medscape,LLC
Citethisarticle:Athlete'sHeartorCardiomyopathy?NBAHelpsFindDifference.Medscape.Mar01,2016.

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http://www.medscape.com/viewarticle/859676_print

07-Mar-16