Рекомендации ESC по спортивной кардиологии и физическим тренировкам у пациентов с сердечно-сосудистыми заболеваниями 2020Рабочая группа Европейского кардиологического общества (ESC) по спортивной кардиологии и физическим тренировкам у пациентов с сердечно-сосудистыми заболеваниями Авторы/члены Рабочей группы: Antonio Pelliccia* (Председатель) (Италия), Sanjay Sharma* (Председатель) (Соединенное Королевство), Sabiha Gati (Соединенное Королевство), Maria Bäck (Швеция), Mats Börjesson (Швеция),

Background-Recent efforts have focused on improving the specificity of the European Society of Cardiology (ESC) criteria for ECG interpretation in athletes. These criteria are derived predominantly from white athletes (WAs) and do not account for the effect of Afro-Caribbean ethnicity or novel research questioning the relevance of several isolated ECG patterns. We assessed the impact of the ESC criteria, the newly published Seattle criteria, and a group of proposed refined criteria in a large cohort of black athletes (BAs)

SCD in the family Echocardiography Cardiomyopathies Clinical and genetic family screening in selected cases Known cardiomyopathy in the family CMR Mitral valve prolapse Palpitations Echocardiography Cardiomyopathies Consider 24-h and/or long-term ambulatory ECG monitoring and/or electrophysiological study in selected cases Syncope CMR Coronary artery disease/ anomalies CT according to clinical suspicion Consider stress echo to rule out LV outflow obstruction Chest pain Echocardiography Coronary artery disease/ anomalies Consider the risk profile, age and radiation exposure CMR Consider exercise stress imaging CT Nuclear imaging Physical examination Imaging tests of choice Heart disease Additional testing Cardiac murmurs Echocardiography Valvular heart disease Additional tests on the basis of echocardiographic findings and clinical suspicion (e.g. CMR) Abnormal cardiac sound Congenital heart defects Marfanoid habitus Echocardiography Marfan disease Clinical and genetic family screening CT Accurate evaluation of thoracic aorta CMR 12-leads electrocardiogram Imaging tests of choice Heart disease Additional testing T-wave inversion Echocardiogram Cardiomyopathies Clinical and genetic family screening CMR Myocarditis Annual follow-up with imaging tests in athletes with normal findings at initial evaluation ST-segment depression Echocardiogram Cardiomyopathies Consider exercise stress imaging CMR Myocarditis Coronary CT or nuclear imaging in athletes with clinical suspicion of coronary artery disease Coronary artery disease Valve disease Pathologic Q-waves Echocardiogram Cardiomyopathies Consider exercise stress imaging CMR Myocarditis Coronary CT or nuclear imaging in athletes with clinical suspicion of coronary artery disease Coronary artery disease Complete LBBB Echocardiogram Cardiomyopathies Comprehensive cardiac evaluation for exclusion CMR Myocarditis of heart disease CT Cardiac sarcoidosis Consider exercise stress imaging Nuclear imaging Valve disease Coronary artery disease/ anomalies Bifascicular block (RBBB and left anterior hemiblock) Echocardiogram Cardiomyopathies Additional tests on the basis of echocardiographic findings and clinical suspicion Myocarditis Cardiac sarcoidosis Coronary artery disease Non-specific intraventricular conduction delay Echocardiogram Cardiomyopathies Additional tests on the basis of echocardiographic findings and clinical suspicion Coronary artery disease/ anomalies Minor non-voltage criteria for LV or RV hypertrophy (atrial enlargement and QRS axis deviation) Echocardiogram Cardiomyopathies Additional tests on the basis of echocardiographic findings and clinical suspicion Valve disease Congenital heart disease Pulmonary hypertension Abnormal exercise testing (repolarization abnormalities/ symptoms/arrhythmias) Echocardiography Coronary artery disease/ anomalies Consider the cardiovascular risk profile and age CMR Consider also exercise stress imaging CT Cardiomyopathies Low-radiation examinations advised in young individuals Nuclear imaging Myocarditis CMR, cardiac magnetic re...

A high proportion of young athletes exhibit conventional criteria for LVNC highlighting the non-specific nature of current diagnostic criteria if applied to elite athletic populations. Further assessment of such athletes should be confined to the small minority that demonstrate low indices of systolic function and marked repolarisation changes.

Diseases that are associated with sudden cardiac death were identified in 0.38% of adolescent soccer players in a cohort that underwent cardiovascular screening. The incidence of sudden cardiac death was 1 per 14,794 person-years, or 6.8 per 100,000 athletes; most of these deaths were due to cardiomyopathies that had not been detected on screening. (Funded by the English Football Association and others.).

Background-Regular, intensive exercise results in physiological biventricular cardiac adaptation. Ethnicity is an established determinant of left ventricular remodeling; black athletes (BAs) exhibit more profound LV hypertrophy than white athletes (WAs). Right ventricular (RV) remodeling has not been characterized in BAs, although the issue is pertinent because BAs commonly exhibit ECG anomalies that resemble arrhythmogenic RV cardiomyopathy. Methods and Results-Between 2006 and 2012, 300 consecutive BAs (n=243 males) from 25 sporting disciplines were evaluated by use of ECG and echocardiography. Results were compared with 375 WAs and 153 sedentary control subjects (n=69 blacks). There were no ethnic differences between RV parameters in control subjects. Both BAs and WAs exhibited greater RV dimensions than control subjects. RV dimensions were marginally smaller in BAs than in WAs (proximal outflow tract, 30.9±5.5 versus 32.8±5.3 mm, P<0.001; longitudinal dimension, 86.6±9.5 versus 89.8±9.6 mm, P<0.001), although only 2.3% of variation was attributable to ethnicity. RV enlargement compatible with diagnostic criteria for arrhythmogenic RV cardiomyopathy was frequently observed (proximal outflow tract ≥32 mm; 45.0% of BAs, 58.5% of WAs). Anterior T-wave inversion was present in 14.3% of BAs versus 3.7% of WAs (P<0.001). Marked RV enlargement with concomitant anterior T-wave inversion was observed in 3.0% of BAs versus 0.3% of WAs (P=0.005). Further investigation did not diagnose arrhythmogenic RV cardiomyopathy in any athlete. Conclusions-Physiological RV enlargement is commonly observed in both black and white athletes. The impact of ethnicity is minimal, which obviates the need for race-specific RV reference values. However, in the context of frequent ECG repolarization anomalies in BAs, the potential for erroneous diagnosis of arrhythmogenic RV cardiomyopathy is considerably greater in this ethnic group. (Circulation. 2013;127:1783-1792.)Key Words: cardiomyopathy ◼ echocardiography ◼ electrocardiographic screening ◼ ethnicity ◼ exercise © 2013 American Heart Association, Inc.Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIRCULATIONAHA.112.000270Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz. Received December 6, 2012; accepted March 4, 2013. From St. George's University of London, London, United Kingdom (A.Z., S. Ghani, R.S., N.S., S. Gati, M.P., S.S.); University Hospital Lewisham, London, United Kingdom (A.Z., S. Ghani, N.S., S. Gati, S.S.); Liverpool John Moores University, Liverpool, United Kingdom (D.O.); and Imperial College Healthcare NHS Trust, London, United Kingdom (V.F.P. [WAs]). 10,11 The influence of ethnicity on athletic RV remodeling has never been characterized, even though healthy BAs frequently reveal ECG repolarization anomalies that resemble those observed in ARVC.12 Furthermore, BAs comprise a growing number of elite sports participants worldwide, and for reasons that remain incompletely under...

Athletic training has a pronounced effect on adolescent BA. Black athletes as young as 14 years of age may exhibit left ventricular wall thicknesses of 15 mm and marked repolarisation changes resembling HCM. Male and female BA demonstrate a high prevalence of T-wave inversions.

TWI and balanced biventricular dilation are likely to represent benign manifestations of training in asymptomatic athletes without relevant family history. Diagnostic criteria for ARVC are nonspecific in such individuals. Comprehensive testing using widely available techniques can effectively differentiate borderline cases.