Atlet kalbine çoklu modaliteli kardiyak görüntüleme yaklaşımı: Avrupa Kardiyovasküler Görüntüleme Derneği Uzman Uzlaşısı
Maurizio Galderisi1, Nuno Cardim2, Antonello D’andrea3, Oliver Bruder4, Bernard Cosyns5, Laurent Davin6, Erwan Donal7, Thor Edvardsen8, Antonio Freitas9, Gilbert Habib10, Anastasia Kitsiou11, Sven Plein12, Steffen E. Petersen13, Bogdan A. Popescu14, Stephen Schroeder151Department of Advanced Biomedical Sciences, Federico II Universite Hastanesi, Napoli, Italya2Cardiac Imaging Department, HospitalDaLuz, Lisbon, Portugal
3Department of Cardiology, Second University of Naples, AORN dei Colli, Monaldi Hospital, Naples, Italy
4Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth Hospital Essen, Essen, Germany
5Department of Cardiology, Universtair Ziekenhuis Brussel, Centrum Voor Hart-en Vaatziekten and CHIREC, Brussels, Belgium
6Department of Cardiology, Interventional and Cardiovascular Imaging, University of Liege Hospital, Liege, Belgium
7Department of Cardiology, Hospital Pontchaillou – University Medical Center, Rennes, France
8Department of Cardiology, Center of Cardiologic Innovation, Oslo University Hospital & University of Oslo, Oslo, Norway
9Cardiology Department, Hospital Fernando Fonseca, Amadora, Portugal
10Cardiology Department, APHM, La Timone Hospital and Aix-Marseille Universite`, Marseille, France
11Cardiology Department, Sismanoglio Hospital, Athens, Greece
12Multidisciplinary Cardiovascular Research Center & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
13NIHR Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, QueenMary University of London, London, UK
14University of Medicine and Pharmacy“Carol Davila” - Euroecolab, Institute of Cardiovascular Diseases “Prof.Dr. C. C. Iliescu”, Bucharest, Romania
15Department of Cardiology, Alb-Fils-Kliniken Goeppingen, Germany
Atlet kalbi’ terimi yavaş kalp hızı ve kalbin genişlemesiyle karakterize klinik bir tablodur. Atlet kalbine çoklu modaliteli görüntüleme yaklaşımı, atlet kalbindeki yoğun egzersize bağlı fizyolojik değişiklikleri, benzer morfolojik özellikleri olan ciddi kardiyak
hastalıklardan ayırt etmeyi amaçlar. Atlet kalbinin görüntüleme değerlendirmesi tam bir ekokardiyografik incelemeyle başlamalıdır. Ekokardiyografi ile ölçülen sol ventrikül (SlV) duvar kalınlığı, atlet kalbinin SlV hipertrofisi ve hipertrofik kardiyomiyopati (HKM) arasındaki farklılığa katkıda bulunabilir. SlV diyasyol sonu çapı, sadece SlV ejeksiyon fraksiyonu <%50 olduğunda son dönem HKM hastalarında normal sınırlardan daha geniştir (>55 mm). Atletlerin diyastolik işlevu normal iken HKM’li hastalar SlV diyastolik işlevlarında erken bozulma da gösterir. Ekokardiyografi net bir ayırıcı tanı sağlayamadığında kardiyak manyetik rezonans (KMR) görüntüleme uygulanmalıdır. KMR ile doğru morfolojik ve işlevel değerlendirme yapılabilir. Geç gadolinyum artışı ile doku karakterizasyonu, HKM ve idiyopatik dilate kardiyomiyopati veya miyokardit gibi çeşitli diğer miyokardiyal durumlarda ayırt edici, noniskemik bir patern gösterebilir. Koroner arter hastalığı şüphesi olan atletlerin incelemesi egzersiz EKG ile başlamalıdır. Egzersiz
EKG sonucu yetersiz olan atletlerde egzersiz gerilim ekokardiyografi düşünülmelidir. Nükleer kardiyoloji teknikleri, koroner kardiyak tomografi (KKTKKT) ve/veya KMR seçilmiş hastalarda uygulanabilir. Radyasyon maruziyeti ve çoğu atletin genç yaşından dolayı, KKT ve nükleer kardiyoloji tekniklerinin kullanımı belirsiz gerilim ekokardiyografi veya KMR’lı atletlere sınırlandırılmalıdır.
The multi-modality cardiac imaging approach to the Athlete's heart: an expert consensus of the European Association of Cardiovascular Imaging
Maurizio Galderisi1, Nuno Cardim2, Antonello D’andrea3, Oliver Bruder4, Bernard Cosyns5, Laurent Davin6, Erwan Donal7, Thor Edvardsen8, Antonio Freitas9, Gilbert Habib10, Anastasia Kitsiou11, Sven Plein12, Steffen E. Petersen13, Bogdan A. Popescu14, Stephen Schroeder151Department of Advanced Biomedical Sciences, Federico II Universite Hastanesi, Napoli, Italya2Cardiac Imaging Department, HospitalDaLuz, Lisbon, Portugal
3Department of Cardiology, Second University of Naples, AORN dei Colli, Monaldi Hospital, Naples, Italy
4Department of Cardiology and Angiology, Contilia Heart and Vascular Center, Elisabeth Hospital Essen, Essen, Germany
5Department of Cardiology, Universtair Ziekenhuis Brussel, Centrum Voor Hart-en Vaatziekten and CHIREC, Brussels, Belgium
6Department of Cardiology, Interventional and Cardiovascular Imaging, University of Liege Hospital, Liege, Belgium
7Department of Cardiology, Hospital Pontchaillou – University Medical Center, Rennes, France
8Department of Cardiology, Center of Cardiologic Innovation, Oslo University Hospital & University of Oslo, Oslo, Norway
9Cardiology Department, Hospital Fernando Fonseca, Amadora, Portugal
10Cardiology Department, APHM, La Timone Hospital and Aix-Marseille Universite`, Marseille, France
11Cardiology Department, Sismanoglio Hospital, Athens, Greece
12Multidisciplinary Cardiovascular Research Center & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
13NIHR Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, QueenMary University of London, London, UK
14University of Medicine and Pharmacy“Carol Davila” - Euroecolab, Institute of Cardiovascular Diseases “Prof.Dr. C. C. Iliescu”, Bucharest, Romania
15Department of Cardiology, Alb-Fils-Kliniken Goeppingen, Germany
The term ‘athlete's heart’ refers to a clinical picture characterized by a slow heart rate and enlargement of the heart. A multi-modality imaging approach to the athlete's heart aims to differentiate physiological changes due to intensive training in the athlete's heart from serious cardiac diseases with similar morphological features. Imaging assessment of the athlete's heart should begin with a thorough echocardiographic examination. Left ventricular (LV) wall thickness by echocardiography can contribute to the distinction between athlete's LV hypertrophy and hypertrophic cardiomyopathy (HCM). LV end-diastolic diameter becomes larger (>55 mm) than the normal limits only in end-stage HCM patients when the LV ejection fraction is <50%. Patients with HCM also show early impairment of LV diastolic function, whereas athletes have normal diastolic function. When echocardiography cannot provide a clear differential diagnosis, cardiac magnetic resonance (CMR) imaging should be performed. With CMR, accurate morphological and functional assessment can be made. Tissue characterization by late gadolinium enhancement may show a distinctive, non-ischaemic pattern in HCM and a variety of other myocardial conditions such as idiopathic dilated cardiomyopathy or myocarditis. The work-up of athletes with suspected coronary artery disease should start with an exercise ECG. In athletes with inconclusive exercise ECG results, exercise stress echocardiography should be considered. Nuclear cardiology techniques, coronary cardiac tomography (CCT) and/or CMR may be performed in selected cases. Owing to radiation exposure and the young age of most athletes, the use of CCT and nuclear cardiology techniques should be restricted to athletes with unclear stress echocardiography or CMR.
Keywords: Athlete's heart, Left ventricular hypertrophy, Hypertrophic cardiomyopathy, Idiopathic dilated cardiomyopathy, Arrhythmogenic right ventricular cardiomyopathy, Echocardiography, Cardiac magnetic resonance, Coronary cardiac CT, Nuclear cardiologySorumlu Yazar: Maurizio Galderisi
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