Severe Left Ventricular Dilation With Preserved Contractile Reserve in an Adolescent Elite Athlete
Abstract
Background: Distinguishing physiologic athletic remodeling from early cardiomyopathy is particularly challenging when structural abnormalities coexist with elite functional performance and electrical instability.
Case summary: An 18-year-old competitive male basketball athlete presented with exertional palpitations and atrial fibrillation. Multimodality cardiovascular evaluation demonstrated severe left ventricular dilation (indexed end-diastolic volume: 156 mL/m2) with moderately reduced systolic function (left ventricular ejection fraction: 35% to 40%) and supraphysiologic tissue Doppler diastolic velocities. Cardiac magnetic resonance confirmed marked ventricular dilation without late gadolinium enhancement. Stress echocardiography demonstrated augmentation of ejection fraction to 65% to 70%, and cardiopulmonary exercise testing confirmed elite aerobic capacity (peak VO2: 52.5 mL/kg/min) without inducible arrhythmias.
Discussion: This case highlights the physiologic-pathologic overlap between athlete's heart and early nonischemic cardiomyopathy complicated by electrical instability.
Take-home messages: Elite performance does not exclude cardiomyopathy. Return-to-play decisions in gray-zone phenotypes require shared decision-making, multidisciplinary input, and robust emergency action planning.
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