Cardiovascular pre-participation screening in the young athlete: addressing concerns

Raukar, Neha P.; Arciero, Emily; Noyes, Adam; Drezner, Jonathan A.; Weiss, John H.

doi:10.1080/00913847.2017.1363622

Cited by 5 publications

(5 citation statements)

References 55 publications

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“…[24,25] since the so called "athletes heart" shares some similarity with that of the compensated hypertrophy studied by Vo lders at al. [24] The main findings of this study can therefore be summarized as following: In elite athletes, there is an increased incidence of unexpected sudden death [6] the exact cause of which is poorly defined and as such is actually an open issue [7]. Our working hypothesis was that these relate to changes in ventricular repolarization and also in fibrosis which may occur in competitive athletes [26,27].…”

Section: Discussionmentioning

confidence: 99%

“…In elite athletes, there is an increased incidence of unexpected sudden death [6] the exact cause of which is poorly defined and as such is actually an open issue [7]. Our working hypothesis was that these relate to changes in ventricular repolarization and also in fibrosis which may occur in competitive athletes [26, 27].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, SCD seems to be 2.8 times more frequent in elite athletes than in age-matched populations [6] who do not engage in sporting activity. It has to be mention that SCD incidence was found much higher than that in certain young athletes population such as male college basketball players [7]. In addition, in only few cases has cause of death been satisfactory established by autopsy findings; part of the remaining cases SCD has been attributed to ventricular fibrillation of ischemic origin.…”

Section: Introductionmentioning

confidence: 99%

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Cardiac electrophysiological remodeling associated with enhanced arrhythmia susceptibilty in a canine model of elite exercise

Polyák

Topál

Prorok

et al. 2022

Preprint

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The health benefits of regular physical exercise are well known. Even so, there is increasing evidence that the exercise regimes of elite athletes can evoke cardiac arrhythmias including ventricular fibrillation and even sudden cardiac death (SCD). The mechanism of exercise-induced arrhythmia and SCD is poorly understood. While some studies after endurance training have been performed in small animals these have limited translation value.Here, we show that chronic training in a canine model (12 sedentary and 12 trained dogs) that mimics the regime of elite athletes induces electrophysiological remodeling (measured by ECG, patch-clamp and immunocytochemical techniques) resulting in increases of both the trigger and the substrate for ventricular arrhythmias. Thus, 4 months sustained training lengthened ventricular repolarization (QTc: 213.6±2.8 ms vs. 237.1±3.4 ms, n=12; APD90: 370.1±32.7 ms vs. 472.8±29.6 ms, n=25 vs. 29), decreased transient outward potassium current (8.8±0.9 pA/pF vs. 6.4±0.5 pA/pF at 50 mV, n=42 vs. 54) and increased the short term variability of repolarization (17.5±4.0 ms vs. 29.5±3.8 ms, n=18 vs. 27). Left ventricular fibrosis and HCN4 protein expression were also enhanced. These changes were associated with enhanced ectopic activity (number of extrasystoles: 4/hour vs. 366/hour) in vivo and arrhythmia susceptibility (elicited ventricular fibrillation: 3 of 10 sedentary dogs vs. 6 of 10 trained dogs).Our findings provide in vivo, cellular electrophysiological and molecular biological evidence for the enhanced susceptibility to ventricular arrhythmia in an experimental large animal model of endurance training.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cardiac electrophysiological remodeling associated with enhanced arrhythmia susceptibilty in a canine model of elite exercise

Polyák

Topál

Prorok

et al. 2022

Preprint

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“…Molecularly, exercise inhibits CaMKII-dependent RyR2 hyperphosphorylation to reduce the calcium leak during diastole, with a result of decreased afterdepolarization and suppressed VAs [ 35 , 36 ]. On the other hand, contradictory evidence increasingly reported that high-intensity chronic exercise might, in fact, be harmful, with evidence of the increased sudden cardiac death incidence in a certain modality of sport, i.e., basketball players [ 37 ]. The possible underlying mechanisms include a prolonged QTc interval and actional potential duration resulting from a reduction in I to current, increased ventricular fibrosis, and enhanced HCN4 expression [ 38 ].…”

Section: Situational Conditions Related To Sympathoexcitation and Ven...mentioning

confidence: 99%

Sympathetic Modulation in Cardiac Arrhythmias: Where We Stand and Where We Go

Chung

Lin

et al. 2023

JPM

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The nuance of autonomic cardiac control has been studied for more than 400 years, yet little is understood. This review aimed to provide a comprehensive overview of the current understanding, clinical implications, and ongoing studies of cardiac sympathetic modulation and its anti-ventricular arrhythmias’ therapeutic potential. Molecular-level studies and clinical studies were reviewed to elucidate the gaps in knowledge and the possible future directions for these strategies to be translated into the clinical setting. Imbalanced sympathoexcitation and parasympathetic withdrawal destabilize cardiac electrophysiology and confer the development of ventricular arrhythmias. Therefore, the current strategy for rebalancing the autonomic system includes attenuating sympathoexcitation and increasing vagal tone. Multilevel targets of the cardiac neuraxis exist, and some have emerged as promising antiarrhythmic strategies. These interventions include pharmacological blockade, permanent cardiac sympathetic denervation, temporal cardiac sympathetic denervation, etc. The gold standard approach, however, has not been known. Although neuromodulatory strategies have been shown to be highly effective in several acute animal studies with very promising results, the individual and interspecies variation between human autonomic systems limits the progress in this young field. There is, however, still much room to refine the current neuromodulation therapy to meet the unmet need for life-threatening ventricular arrhythmias.

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“…However, PPE has not been proven to significantly reduce the burden of morbidity/mortality associated with athletic activities (1). This may potentially be attributed to the inability of currently employed PPE clinical algorithms and/or diagnostic modalities to adequately detect patients at high risk for SCD (6).…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular magnetic resonance clarifies arrhythmogenicity in asymptomatic young athletes with ventricular arrhythmias undergoing pre‑participation evaluation

et al. 2020

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Pre-participation sports examination (PPE) is a frequent reason for consultation. However, the exact role of cardiovascular magnetic resonance (CMR) in PPE remains undefined. The additive value of CMR in adolescent athletes with ventricular rhythm disturbances (VRDs) was investigated. We prospectively recruited and evaluated with CMR 50 consecutive, asymptomatic young athletes referred to our tertiary center after identification of VRDs on electrocardiogram (ECG) with otherwise normal standard PPE and echocardiography, and 20 age-and sex-matched healthy volunteer athletes who underwent the same evaluations. The primary outcome was case-control status and the secondary outcome was the discrimination between athletes with VRDs with and without non-sustained ventricular tachycardia (VT). CMR identified arrhythmogenic substrates in all athletes with VRDs. The predominant condition was myocarditis and arrhythmogenic right ventricular cardiomyopathy in patients with and without VT, respectively. Based on penalized regression analysis, late gadolinium enhancement (LGE), early gadolinium enhancement (EGE), extracellular volume fraction (ECV), and T2-mapping, best distinguished between case-control status. The aforementioned indices predicted case-control status independent of age and sex: EGE [Odds ratio (95% confidence interval): 6.89 (2.19-21.62) per 0.5-unit, P<0.001], LGE (perfect prediction), ECV [1.66 (1.25-2.22), P<0.001] and T2 mapping [1.40 (1.13-1.72), P=0.002], among other independent CMR-derived predictors. Only indexed ventricular volumes independently discriminated between VRD patients with and without VT. In this study, asymptomatic young athletes with VRDs and normal PPE/echocardiography were optimally discriminated from healthy control athletes by CMR-derived indices, and CMR allowed for the identification of arrhythmogenic substrates in all cases.

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Cardiovascular pre-participation screening in the young athlete: addressing concerns

Cited by 5 publications

References 55 publications

Cardiac electrophysiological remodeling associated with enhanced arrhythmia susceptibilty in a canine model of elite exercise

Cardiac electrophysiological remodeling associated with enhanced arrhythmia susceptibilty in a canine model of elite exercise

Sympathetic Modulation in Cardiac Arrhythmias: Where We Stand and Where We Go

Cardiovascular magnetic resonance clarifies arrhythmogenicity in asymptomatic young athletes with ventricular arrhythmias undergoing pre‑participation evaluation

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