{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T11:47:23Z","timestamp":1778932043913,"version":"3.51.4"},"reference-count":23,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2012,11,20]],"date-time":"2012-11-20T00:00:00Z","timestamp":1353369600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2013,2]]},"abstract":"<jats:p>Left ventricular hypertrophy (<jats:styled-content style=\"fixed-case\">LVH<\/jats:styled-content>) with intraventricular septum thickness (<jats:styled-content style=\"fixed-case\">IVST<\/jats:styled-content>) between 1.2 and 1.5\u00a0cm in athletes represents a \u201cgray zone\u201d between physiologic adaptation and mild hypertrophic cardiomyopathy (<jats:styled-content style=\"fixed-case\">HCM<\/jats:styled-content>). Various echo and laboratory parameters have been reported till now in the literature to discriminate the \u201cgray zone\u201d entities. Aim of this study was to assess the efficacy of these \u201cclassic\u201d parameters in differentiating physiologic <jats:styled-content style=\"fixed-case\">LVH<\/jats:styled-content> in athletes from mild <jats:styled-content style=\"fixed-case\">HCM<\/jats:styled-content> in a highly selected population. Nine highly trained athletes with <jats:styled-content style=\"fixed-case\">IVST<\/jats:styled-content> (1.28\u00a0\u00b1\u00a00.07\u00a0cm), 9 patients with mild <jats:styled-content style=\"fixed-case\">HCM<\/jats:styled-content> (1.38\u00a0\u00b1\u00a00.11\u00a0cm), and 26 athletes without <jats:styled-content style=\"fixed-case\">LVH<\/jats:styled-content> (1.06\u00a0\u00b1\u00a00.09\u00a0cm; P\u00a0&lt;\u00a00.0005) underwent echocardiographic study, cardiopulmonary treadmill exercise stress test, and brain natriuretic peptide (<jats:styled-content style=\"fixed-case\">BNP<\/jats:styled-content>) measurement before and after exercise. Among all parameters tested, 7 were found to significantly differ between \u201cgray zone\u201d groups. After bootstrapping analysis, it was found that athletes with left ventricular end\u2010diastolic diameter &lt;4.74\u00a0cm, mitral deceleration time &gt;200\u00a0ms, isovolumic relaxation time &gt;94\u00a0ms, tricuspid E\/A\u00a0&lt;\u00a01.63, septum Em\u00a0&lt;\u00a09.5\u00a0cm\/sec, relative wall thickness &gt;0.445, and a BNP value at rest &gt;9.84\u00a0pg\/mL had a greater possibility for having underlying cardiomyopathy. A 10\u2010point score based on these parameters showed accuracy (area under the curve\u00a0=\u00a00.958 [95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 0.738\u20131.0; P\u00a0=\u00a00.00005, standard error\u00a0=\u00a00.0342]) for revealing HCM in a gray zone athletic population. Differentiation of adaptive <jats:styled-content style=\"fixed-case\">LVH<\/jats:styled-content> versus <jats:styled-content style=\"fixed-case\">HCM<\/jats:styled-content> in a gray zone population could be facilitated by recognition of certain features referring to <jats:styled-content style=\"fixed-case\">LV<\/jats:styled-content> dimensions, diastolic function, and <jats:styled-content style=\"fixed-case\">BNP<\/jats:styled-content>.<\/jats:p>","DOI":"10.1111\/echo.12014","type":"journal-article","created":{"date-parts":[[2012,11,20]],"date-time":"2012-11-20T13:33:21Z","timestamp":1353418401000},"page":"131-139","source":"Crossref","is-referenced-by-count":15,"title":["Efficacy of Various \u201cClassic\u201d Echocardiographic and Laboratory Indices in Distinguishing the \u201cGray Zone\u201d between Athlete's Heart and Hypertrophic Cardiomyopathy: A Pilot Study"],"prefix":"10.1111","volume":"30","author":[{"given":"Efstathios D.","family":"Pagourelias","sequence":"first","affiliation":[{"name":"Third Cardiology Department Hippokration Hospital, Medical School, Aristotle University of Thessaloniki Thessaloniki Greece"},{"name":"First Cardiology Department AHEPA Hospital, Medical School, Aristotle University of Thessaloniki Thessaloniki Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georgios K.","family":"Efthimiadis","sequence":"additional","affiliation":[{"name":"First Cardiology Department AHEPA Hospital, Medical School, Aristotle University of Thessaloniki Thessaloniki Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evangelia","family":"Kouidi","sequence":"additional","affiliation":[{"name":"Sports Medicine Laboratory Department of Physical Education and Sport Science Aristotle University of Thessaloniki Thessaloniki Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paraskevi","family":"Zorou","sequence":"additional","affiliation":[{"name":"First Laboratory of Microbiology Medical School, Aristotle University of Thessaloniki Thessaloniki Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georgios","family":"Giannoglou","sequence":"additional","affiliation":[{"name":"First Cardiology Department AHEPA Hospital, Medical School, Aristotle University of Thessaloniki Thessaloniki Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asterios","family":"Deligiannis","sequence":"additional","affiliation":[{"name":"Sports Medicine Laboratory Department of Physical Education and Sport Science Aristotle University of Thessaloniki Thessaloniki Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vasilis G","family":"Athyros","sequence":"additional","affiliation":[{"name":"Second Propedeutic Department of Internal Medicine 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