Novel diagnostic score accurately differentiates between athlete’s heart and ARVC

Patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) often present with atrial asymmetry which is not seen in athlete’s heart. Thus, the proportion of atrial dimensions could be used to differentiate between both entities. A novel diagnostic score including readily available clinical parameters demonstrated high diagnostic accuracy [1].

The 2010 Task Force Criteria are the current gold standard to diagnose ARVC [2]. However, these criteria have not been tested to differentiate ARVC from athlete’s heart. In addition, they are not easy to assess in clinical practice as they require myocardial biopsy, genetic testing, morphology of ventricular tachycardia, and right-ventricular regional wall-motion abnormalities.

Dr Valentina Rossi (University Hospital Zurich, Switzerland) and colleagues evaluated whether atrial dimensions could be used to differentiate between both conditions, since the right atrium is often larger than the left atrium in patients with ARVC, even at an early stage, while atria enlargement follows a more symmetrical pattern in athlete’s heart [1].

This observational study included 21 ARVC patients and 42 athletes matched for age, gender, and BMI. The following echocardiographic, laboratory, and electrocardiographic parameters were included in the final score: indexed right/left atrial volumes (RAVI/LAVI ratio), serum NT-proBNP, RVOT measurements (i.e. PLAX and PSAX adjusted for BSA) on TTE, tricuspid annular motion velocity (TAM) on TTE, precordial electrocardiographic T-wave inversions, and depolarisation abnormalities according to the 2010 Task Force Criteria. A score ranging from 0 to 12 to differentiate ARVC and athlete’s heart was developed, with higher values suggesting ARVC (see Figure) [1].

 

Figure: Novel diagnostic score to differentiate between athlete’s heart and ARVC [1]

ARVC, arrhythmogenic right ventricular cardiomyopathy; AUC, area under the curve for a ROC curve; BSA< body surface area; LAVI, left atrial volume index; PLAX, parasternal long axis; RAVI, right atrial volume index; RVOT, right ventricular outflow tract; TAM, tricuspid annular motion.
Parameters used in 2010 Task Force Criteria used the same cut-off. For newly introduced parameters (RAVI/LAVI, TAM mm, and NT-proBNP), cut-off values were calculated based on the ROC curves.
Figure kindly provided by Dr Rossi.

 

As per study design, the 2010 Task Force Criteria had the highest specificity (98%) and sensitivity (88%) to diagnose ARVC. However, those 2010 Task Force Criteria that are available in daily clinical practice (i.e. imaging, ECG) alone had a low sensitivity (41%; specificity 98%). In comparison, the proposed novel diagnostic score showed a sensitivity of 67% (specificity 91%) and thus outperformed the 2010 Task Force Criteria available in clinical routine (P<0.001).

The results from this study also showed that ARVC patients had a higher RAVI/LAVI ratio (1.78 vs 0.95; P<0.001), lower right-ventricular function (fractional area change 28 vs 42.18%; P<0.001; TAM 17.9 vs 23.3mm; P<0.001), and higher serum NT-proBNP levels (491 vs 44.8 ng/L; P<0.001).

Dr Rossi concluded: “Our diagnostic score including readily available clinical parameters improves sensitivity and can refine diagnostic work-up in daily clinical practice.” Due to the relatively small number of patients included, validation in larger cohorts should be sought.

1. 
   
   1. Rossi V. A novel diagnostic score to differentiate between athlete’s heart and ARVC. EHRA 2021 Congress, 23-25 April.
   2. Marcus FI, et al. Eur Heart J. 2010 Apr;31(7):806-14.

 

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Posted on 16 June 202123 June 2021