Distinguishing left ventricular hypertrophy from hypertrophic cardiomyopathy in adolescents: a longitudinal observation study

Forså MI, Smedsrud MK, Haugaa KH, Bjerring AW, Früh A, Sarvari SI, Landgraff HW, Hallén J, Edvardsen T

Distinguishing exercise-induced cardiac left ventricular (LV) hypertrophy from hypertrophic cardiomyopathy (HCM) is important, as athletes with HCM may have an increased risk of sudden cardiac death. There is a lack of data on this distinction in adolescent athletes. We therefore performed a longitudinal observation study where we used echocardiography to compare development of LV hypertrophy during adolescence in 76 athletes and 55 HCM genotype positive patients. The study aimed to explore the phenotype, progression, and potential grey zone of LV hypertrophy. We used paediatric reference values (Z-scores) to evaluate echocardiographic parameters.

We found LV hypertrophy in a similar proportion of athletes and HCM patients in early adolescence. LV hypertrophy progressed only in the HCM genotype positive patients. We identified a potential grey zone of LV hypertrophy ranging from septum thickness Z-score 2.0-3.3. Athletes had larger LV volumes throughout the study period. Our results indicate that evaluating progression of wall thickness and volume may help clinicians distinguish physiological LV hypertrophy from early HCM.

The article was published in the high impact journal European Journal of Preventive Cardiology. An abstract was presented at the EACVI Congress in Barcelona in May 2023 and at the Norheart Symposium in Oslo in August 2023.