Table 1.
Comparison of Typical Athletic Remodeling Versus “Red Flag” Findings That Increase Suspicion for COVID-19–Related Myocardial Disease on Echocardiography
| Athletic Remodeling∗ | “Red Flags” That Increase Suspicion for Pathology |
|---|---|
| LV | |
| Symmetric dilation of all 4 cardiac chambers | Disproportionate or severe LV dilation (LVEDD >70 mm in men and >60 mm in women) |
| No regional structural or functional wall motion abnormalities | Segmental wall motion abnormality |
| Symmetric wall thickening <12 mm (<15 mm in black male athletes) | Asymmetric regional wall thickening |
| Normal or low-normal EF | LVEF <50% |
| Normal or supranormal tissue-Doppler myocardial velocities | Low tissue-Doppler e′ myocardial velocities for age or raised E/e′ |
| Augmentation of low-normal LVEF ≥10% with exercise | Failure to augment low-normal LVEF with exercise |
| Global longitudinal strain ranges from –16% to –22%. | Abnormal global longitudinal strain† |
| Compliant LA with normal reservoir function | Increased atrial stiffness |
| RV | |
| Similar degree of RV dilation to that of the LV | RV-to-LV basal end-diastolic diameter ratio (apical view) >1.0 |
| Usually no more than moderate dilation | RV end-diastolic area >15 cm2/m2 or RV end-diastolic volumes >260 ml |
| Coordinated and consistent regional wall motion and deformation | Segmental wall motion abnormalities |
| Normal or low-normal systolic function | Fractional area change <35% or 3-dimensional RVEF <44% |
| Good augmentation of RV function with exercise | Reduced RV augmentation with exercise (RV fractional area change or strain) |
| Coordinated RV contraction | RV mechanical dyssynchrony >40 ms |
COVID-19 = coronavirus disease 2019; LA = left atrium; LV = left ventricle/ventricular; LVEDD = left ventricular end-diastolic diameter; LVEF = left ventricular ejection fraction; RV = right ventricle/ventricular; RVEF = right ventricular ejection fraction.
∗
See text regarding how athletic remodeling may vary based on sport, gender, ethnicity, and body size.
†
Ensure good image quality with appropriate tracking. Normal ranges may vary—see text for further details.