An Atlas-Based Approach to Improve Differentiation Between Adolescent Athletes and Adolescent Hypertrophic Cardiomyopathy Patients
Differentiation between primary and secondary myocardial hypertrophy is often problematic but is most notably difficult for athletes and patients with hypertrophic cardiomyopathy (HCM). Primary hypertrophy is caused by HCM, the most common genetic disease of the heart. Secondary hypertrophy in athletes is caused by cardiac remodeling to accommodate intense exercise regimens that raise the required amount of oxygen needed by tissues. In many cases, this remodeling causes changes that appear similar to the pathologic hypertrophy in HCM. Although HCM is usually first expressed in adolescence, HCM and athlete’s heart have only been studied extensively in adult populations. As a result, neither the standard morphology for the adolescent athlete’s heart nor the standard morphology for the adolescent HCM patient has been determined, causing some cases of HCM amongst young people to go undiagnosed. The objective of this research was to use an atlas-based approach to quantify differences between pathologic and physiologic hypertrophy in adolescents in order to mitigate the risks associated with both a false positive and a false negative diagnosis of HCM. This study found that the atlas-based method is more effective at differentiating between adolescent athletes and adolescent HCM patients than the currently used parameters. The addition of atlas-based parameters improved predictive ability for left ventricular (LV), right ventricular (RV), and biventricular (Bi-V) parameters. Additionally, Bi-V parameters were more effective than LV parameters alone, which is noteworthy because current methods exclude RV parameters in the differential diagnosis of these two groups.