Characteristics and Outcomes of Sudden Cardiac Arrest During Sports in Women

Marijon, Éloi; Bougouin, Wulfran; Celermajer, David S.; Perier, Marie‐Cécile; Dumas, Florence; Benameur, Neïla; Karam, Nicole; Lamhaut, Lionel; Tafflet, Muriel; Mustafić, Hazrije; Deus, Natalia Machado de; Heuzey, Jean‐Yves Le; Desnos, Michel; Avillach, Paul; Spaulding, Christian; Cariou, Alain; Prugger, Christof; Empana, Jean‐Philippe; Jouven, Xavier

doi:10.1161/circep.113.000651

Cited by 46 publications

(33 citation statements)

References 54 publications

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“…[5,7,8,11,16,17]. We previously reported that malefemale ratio in SCD cases was 4.3:1 [18], and interestingly, in this series the ratio in sport-related SCD cases was even higher (7.1:1).…”

Section: Discussionsupporting

confidence: 57%

The forensic pathological analysis of sport-related sudden cardiac death in Southern China

Ai²,

Bardeesi

et al. 2017

Forensic Sciences Research

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Studies regarding sport-related sudden cardiac death (SCD) mainly focus on competitive athletes; similar data are rare in the general population, especially in China. We conducted a retrospective study (from September 1998 to August 2013) to investigate the aetiological distribution and epidemiological features of sport-related SCD in Southern China. Selections of the cases are based on details, and two subgroups were established: one was the sport-related SCD group, and the other was the disease-free accident victims group which was matched with the sport-related SCD group in gender, age and year of death. Among the 3 770 sudden-death cases, 1 656 cases were SCD cases. A total of 65 cases (57 male) out of 1 656 SCD cases were sport-related. The age range of the 65 sport-related SCD cases was from 12 to 68 years old with a mean (35.92 § 14.23) years old. Only two of these cases were competitive athletes. The most common circumstances of the 65 sport-related SCD cases were heavy physical labour (46.15%) and running (30.77%). The three leading forensic diagnoses were the coronary atherosclerotic disease (CAD, 28 cases), cardiomyopathy (CM, 14 cases) and sudden unexplained death (7 cases). CM was the most common forensic diagnosis in those 35 years old, while CAD was the most common one in those >35 years old. Left anterior descending in which atherosclerotic plaques was most commonly found was the principal artery branch associated with sport-related SCD. There was a statistically significant difference in the weight of hearts between the 65 sport-related SCD cases and 65 diseases-free accidental cases. This study highlights the need to attract public attention to sport-related SCD and to issue a prevention strategy to the public, and to make the SCD-related genetic sequencing a routine tool in both forensic pathological examination and clinic screening.

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“…[5,7,8,11,16,17]. We previously reported that malefemale ratio in SCD cases was 4.3:1 [18], and interestingly, in this series the ratio in sport-related SCD cases was even higher (7.1:1).…”

Section: Discussionsupporting

confidence: 57%

The forensic pathological analysis of sport-related sudden cardiac death in Southern China

Ai²,

Bardeesi

et al. 2017

Forensic Sciences Research

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“…In our sample, despite having more women with nonischemic cardiomyopathy, the overall reduction in arrhythmic burden was still present even after adjustment for baseline differences. Several mechanisms have been proposed for sex differences regarding the risk of ventricular arrhythmia: higher resting heart rate, different autonomic response to stress, degree of vagal activation, differences in cardiac repolarization, hormonal differences affecting arrhythmic vulnerability, genetic variants influencing QT interval length or adrenergic receptors, and even nutritional factors, adherence to a low‐risk lifestyle, and behavorial and psychological factors 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31. Overall, the interplay between vulnerable substrate (underlying structural and electric heart substrate), triggers, and autonomic tone may be slightly different 30…”

Section: Discussionmentioning

confidence: 99%

Primary Prevention Implantable Cardioverter Defibrillator (ICD) Therapy in Women—Data From a Multicenter French Registry

Providência

Marijon

Lambiase

et al. 2016

JAHA

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BackgroundThere are limited data describing sex specificities regarding implantable cardioverter defibrillators (ICDs) in the real‐world European setting.Methods and ResultsUsing a large multicenter cohort of consecutive patients referred for ICD implantation for primary prevention (2002–2012), in ischemic and nonischemic cardiomyopathy, we examined the sex differences in subjects' characteristics and outcomes. Of 5539 patients, only 837 (15.1%) were women and 53.8% received cardiac resynchronization therapy. Compared to men, women presented a significantly higher proportion of nonischemic cardiomyopathy (60.2% versus 36.2%, P<0.001), wider QRS complex width (QRS >120 ms: 74.6% versus 68.5%, P=0.003), higher New York Heart Association functional class (≥III in 54.2%♀ versus 47.8%♂, P=0.014), and lower prevalence of atrial fibrillation (18.7% versus 24.9%, P<0.001). During a 16 786 patient‐years follow‐up, overall, fewer appropriate therapies were observed in women (hazard ratio=0.59, 95% CI 0.45–0.76; P<0.001). By contrast, no sex‐specific interaction was observed for inappropriate shocks (odds ratio ♀=0.84, 95% CI 0.50–1.39, P=0.492), early complications (odds ratio=1.00, 95% CI 0.75–1.32, P=0.992), and all‐cause mortality (hazard ratio=0.87 95% CI 0.66–1.15, P=0.324). Analysis of sex‐by‐ cardiac resynchronization therapy interaction shows than female cardiac resynchronization therapy recipients experienced fewer appropriate therapies than men (hazard ratio=0.62, 95% CI 0.50–0.77; P<0.001) and lower mortality (hazard ratio=0.68, 95% CI 0.47–0.97; P=0.034).ConclusionsIn our real‐life registry, women account for the minority of ICD recipients and presented with a different clinical profile. Whereas female cardiac resynchronization therapy recipients had a lower incidence of appropriate ICD therapies and all‐cause death than their male counterparts, the observed rates of inappropriate shocks and early complications in all ICD recipients were comparable.Clinical Trial RegistrationURL: https://www.clinicaltrials.gov/. Unique identifier: NCT01992458.

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“…1,2,6,117,[120][121][122][125][126][127] Similarly, SD risk was 30-fold less in females than males during recreational sports in a national study from France. 128 Notably, the pathology of SD reported in trained athletes from the Veneto region of Italy 4,18 differs substantially from the experience elsewhere.…”

Section: Cardiovascular Causes and Epidemiology Of Sd In The Youngmentioning

confidence: 94%

“…SDs occur in a wide variety of sports, most commonly football and basketball in the United States and soccer in European countries. There is considerable gender bias in these events, with a male to female ratio of ≈9:1 at all levels of competition, 1,2,7,37,117,[125][126][127][128][129] and with occurrence reported in a number of racial/ethnic groups, including whites, blacks, Asians and Hispanics. 1,2,6,117,[120][121][122][125][126][127] Similarly, SD risk was 30-fold less in females than males during recreational sports in a national study from France.…”

Section: Cardiovascular Causes and Epidemiology Of Sd In The Youngmentioning

confidence: 99%

“…First is the ethical and fairness issue of confining mass screening ECGs to any one particular segment of society (eg, competitive athletes, or college students who are athletes), which can be regarded as narrow in scope and in effect exclusionary (if not discriminatory and elitist), and therefore ethically unjustifiable. For example, it would not be sustainable to limit preparticipation screening to male athletes just because SD rates are much lower in female participants (1:9), 1,2,6,7,37,128 or to athletes in sports such as basketball and football because those sports are associated with higher risk than others.…”

Section: Practical and Logistical Considerationsmentioning

confidence: 99%

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Assessment of the 12-Lead ECG as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12–25 Years of Age)

Maron¹,

Friedman²,

Kligfield³

et al. 2014

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Characteristics and Outcomes of Sudden Cardiac Arrest During Sports in Women

Cited by 46 publications

References 54 publications

The forensic pathological analysis of sport-related sudden cardiac death in Southern China

The forensic pathological analysis of sport-related sudden cardiac death in Southern China

Primary Prevention Implantable Cardioverter Defibrillator (ICD) Therapy in Women—Data From a Multicenter French Registry

Assessment of the 12-Lead ECG as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12–25 Years of Age)

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