{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T22:46:15Z","timestamp":1790289975471,"version":"4.1.0"},"reference-count":37,"publisher":"BMJ","issue":"21","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Sports Med"],"accepted":{"date-parts":[[2013,5,18]]},"published-print":{"date-parts":[[2015,11]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Differentiating physiological left ventricular hypertrophy (LVH) in athletes from pathological hypertrophic cardiomyopathy (HCM) can be challenging. This study assesses the ability of cardiac MRI (CMR) to distinguish between physiological LVH (so-called athlete's heart) and HCM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>45 patients with HCM (71% men and 20% athletic) and 734 healthy control participants (60% men and 75% athletic) underwent CMR. Quantitative ventricular parameters were used for multivariate logistic regression with age, gender, sport status and left ventricular (LV) end-diastolic volume (EDV) to ED ventricular wall mass (EDM) ratio as covariates. A second model added the LV EDV\u2009:\u2009right ventricular (RV) EDV ratio. The performance of the model was subsequently tested.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>LV EDM was greater in patients with HCM (74\u2005g\/m<jats:sup>2<\/jats:sup>) compared with healthy athletes\/non-athletes (53\/41\u2005g\/m<jats:sup>2<\/jats:sup>), while LV EDV was largest in athletes (114\u2005ml\/m<jats:sup>2<\/jats:sup>) as compared with non-athletes (94\u2005ml\/m<jats:sup>2<\/jats:sup>) and patients with HCM (88\u2005ml\/m<jats:sup>2<\/jats:sup>). The LV EDV\u2009:\u2009EDM ratio was significantly lower in patients with HCM compared with healthy controls and athletes (1.30\/2.39\/2.25, p&lt;0.05). The LV EDV\u2009:\u2009RV EDV ratio was significantly greater in patients with HCM (1.10) than in healthy participants (non-athletes\/athletes 0.94\/0.93). The regression model resulted in high sensitivity and specificity levels in all and borderline-LVH participants (as defined by septal wall thickness). Corresponding areas under the receiver operator characteristic (ROC) curves were 0.995 (all participants) and 0.992 (borderline-LVH participants only). Adding the LV EDV\u2009:\u2009RV EDV ratio yielded no additional improvement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A model incorporating the LV EDV\u2009:\u2009EDM ratio can help distinguish HCM from physiological hypertrophy in athletes. This also applies to cases with borderline LVH, which present the greatest diagnostic challenge in clinical practice.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bjsports-2013-092360","type":"journal-article","created":{"date-parts":[[2013,6,15]],"date-time":"2013-06-15T00:56:10Z","timestamp":1371257770000},"page":"1404-1409","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Unravelling the grey zone: cardiac MRI volume to wall mass ratio to differentiate hypertrophic cardiomyopathy and the athlete's heart"],"prefix":"10.1136","volume":"49","author":[{"given":"Tim","family":"Luijkx","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten J","family":"Cramer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constantinus F","family":"Buckens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abbas","family":"Zaidi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rienk","family":"Rienks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arend","family":"Mosterd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niek HJ","family":"Prakken","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Dijkman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willem PThM","family":"Mali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birgitta K","family":"Velthuis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2013,6,14]]},"reference":[{"key":"2024051403432369000_49.21.1404.1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.804617"},{"key":"2024051403432369000_49.21.1404.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.917211"},{"key":"2024051403432369000_49.21.1404.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.10.055"},{"key":"2024051403432369000_49.21.1404.4","doi-asserted-by":"publisher","DOI":"10.12968\/hmed.2011.72.5.275"},{"key":"2024051403432369000_49.21.1404.5","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-008-0721-2"},{"key":"2024051403432369000_49.21.1404.6","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.613562"},{"key":"2024051403432369000_49.21.1404.7","doi-asserted-by":"crossref","first-page":"2304","DOI":"10.1093\/eurheartj\/ehr140","article-title":"The prevalence, distribution, and clinical outcomes of electrocardiographic repolarization patterns in male athletes of African\/Afro-Caribbean origin","volume":"18","author":"Papadakis","year":"2011","journal-title":"Eur Heart J"},{"key":"2024051403432369000_49.21.1404.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.05.006"},{"key":"2024051403432369000_49.21.1404.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0195-668X(03)00479-2"},{"key":"2024051403432369000_49.21.1404.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.06.011"},{"key":"2024051403432369000_49.21.1404.11","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.101.3.336"},{"key":"2024051403432369000_49.21.1404.12","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(94)90439-1"},{"key":"2024051403432369000_49.21.1404.13","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(49)90562-1"},{"key":"2024051403432369000_49.21.1404.14","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2011-090520"},{"key":"2024051403432369000_49.21.1404.15","doi-asserted-by":"publisher","DOI":"10.1097\/HJR.0b013e3283347fdb"},{"key":"2024051403432369000_49.21.1404.16","doi-asserted-by":"crossref","first-page":"104","DOI":"10.2174\/1874769800801010104","article-title":"Cardiac MRI: standardized right and left ventricular quantification by briefly coaching inexperienced personnel","volume":"1","author":"Prakken","year":"2008","journal-title":"Open Magn Reson J"},{"key":"2024051403432369000_49.21.1404.17","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-007-0556-2"},{"key":"2024051403432369000_49.21.1404.18","unstructured":"Team TRDC R . 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