Coronary atherosclerosis in apparently healthy master athletes discovered during pre-PARTECIPATION screening. Role of coronary CT angiography (CCTA)

Gervasi, Salvatore Francesco; Palumbo, Laura; Cammarano, Michela; Orvieto, Sebastiano; Rocco, Arianna Di; Vestri, Annarita; Marano, Riccardo; Savino, Giancarlo; Bianco, Massimiliano; Zeppilli, Paolo; Palmieri, Vincenzo

doi:10.1016/j.ijcard.2018.11.099

Cited by 14 publications

(9 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Approximately onethird of patients with coronary artery disease show normal basal ECG findings and, most importantly, the vast majority of coronary events occur in the absence of prior ECG abnormalities. 22,23 Of note, current PPS does not include the use of Coronary CT Angiography (CCTA) for master with elevated moderate-high cardiovascular risk factors 24 and in our study was proposed only as a third-line investigation in selected cases. Given the relatively low number of master athletes diagnosed with ischemic heart diseases, new PPS guidelines should take into account the use of CCTA in the evaluation of master athletes with an abnormal stress test ECG and/or clinical symptoms engaged in competitive sports with a high cardiovascular involvement.…”

Section: Discussionmentioning

confidence: 98%

Age-dependent diagnostic yield of echocardiography as a second-line diagnostic investigation in athletes with abnormalities at preparticipation screening

Maurizi

Baldi

Castelletti

et al. 2021

Journal of Cardiovascular Medicine

View full text Add to dashboard Cite

Aims Systematic pre-participation screening of subjects practicing sports activity has the potential to identify athletes at risk of sudden cardiac death. However, limited evidence are present concerning the yield of echocardiography as a second-line exam in athletes with abnormal pre-participation screening.Methods Consecutive athletes were screened (2011)(2012)(2013)(2014)(2015)(2016)(2017) in a community-based sports medicine center in Tuscany, with familial history, physical examination and ECG. Patients with abnormal/>1 borderline ECG findings, symptoms/signs of cardiovascular diseases, cardiovascular risk factors or family history of juvenile/ genetic cardiac disease underwent echocardiography.Results A total of 30109 athletes (age 21 [15;31]) were evaluated. Of these, 6234 (21%) were aged 8-11 years, 18309 (61%) 12-18 years, 4442 (15%) 19-35 years, 1124 (4%) >35 years. A total of 2569 (9%) athletes were addressed to echocardiography. Referral rates increased significantly with age (5% in preadolescents to 38% in master athletes, P< 0.01). Subclinical heart diseases were found in 290/30109 (0.8%) and were common >35 years (135/1124, 11%), but rare at 19-35 years (91/4442, 2%), very rare <18 years (64/24 543, 0.2%; P< 0.01). Seventy-four (0.3%) athletes were disqualified because of the structural alterations identified, 29 (0.1%) with cardiac structural diseases at risk for sudden death.Conclusions Italian community-based pre-participation screening showed an age-dependent yield, with a three-fold increase in referral in athletes >35 years. Subclinical structural abnormalities potentially predisposing to sudden death were rare (0.01%), mostly in post-pubertal and senior athletes. Age-specific pre-participation screening protocols may help optimize resources and improve specificity.

show abstract

Section: Discussionmentioning

confidence: 98%

Age-dependent diagnostic yield of echocardiography as a second-line diagnostic investigation in athletes with abnormalities at preparticipation screening

Maurizi

Baldi

Castelletti

et al. 2021

Journal of Cardiovascular Medicine

View full text Add to dashboard Cite

show abstract

“…However, due to the lack of dedicated studies in athletes with long-term clinical outcomes, we currently recommend adding CCTA on an individual basis only. 29 , 30 …”

Section: Discussionmentioning

confidence: 99%

ECG criteria for the detection of high-risk cardiovascular conditions in master athletes

Panhuyzen‐Goedkoop

Wellens

Verbeek

et al. 2020

European Journal of Preventive Cardiology

View full text Add to dashboard Cite

Objective Structured electrocardiography (ECG) analysis is used to screen athletes for high-risk cardiovascular conditions (HRCC) to prevent sudden cardiac death. ECG criteria have been specified and recommended for use in young athletes ≤ 35 years. However, it is unclear whether these ECG criteria can also be applied to master athletes >35 years. Aim The purpose of this study was to test whether the existing ECG criteria for detecting HRCC in young athletes can be applied to master athletes. Methods We conducted a cross-sectional study among athletes >35 years screened for HRCC between 2006 and 2010. We performed a blinded retrospective analysis of master athletes’ ECGs, separately applying European Society of Cardiology (ESC)-2005, Seattle, and International criteria. HRCC were defined using recommendations from the international cardiac societies American Heart Association and American College of Cardiology, and ESC, based on ECG screening and cardiovascular evaluation (CVE). Results We included 2578 master athletes in the study, of whom 494 had initial screening abnormalities mandating CVE. Atrial enlargement (109, 4.1%) and left ventricular hypertrophy (98, 3.8%) were the most common ECG abnormalities found using the ESC-2005 or Seattle criteria. Applying the International criteria, ST-segment deviation (66, 2.6%), and T-wave inversion (58, 2.2%) were most frequent. The ESC-2005 criteria detected more HRCC (46, 1.8%) compared with the Seattle (36, 1.4%) and International criteria (33, 1.3%). The most frequently detected HRCC was coronary artery disease (24, 0.9%). Conclusion ECG criteria recommended for use in young athletes can be applied to master athletes’ ECGs to detect HRCC. The ESC-2005 criteria had the highest sensitivity for detecting HRCC among master athletes.

show abstract

“…Finally, some evidence suggests that CCTA could enhance screening in asymptomatic individuals in specific sporting (i.e., pre-participation screening of athletes aged > 35 years or in young athletes for the exclusion of significant CAD or coronary anomalies) [ 43 , 44 ] or working (i.e., aviation personnel) [ 45 ] settings (Table 2 ).…”

Section: Primary Prevention In Asymptomatic Patientsmentioning

confidence: 99%

SIRM–SIC appropriateness criteria for the use of Cardiac Computed Tomography. Part 1: Congenital heart diseases, primary prevention, risk assessment before surgery, suspected CAD in symptomatic patients, plaque and epicardial adipose tissue characterization, and functional assessment of stenosis

et al. 2021

View full text Add to dashboard Cite

In the past 20 years, Cardiac Computed Tomography (CCT) has become a pivotal technique for the noninvasive diagnostic work-up of coronary and cardiac diseases. Continuous technical and methodological improvements, combined with fast growing scientific evidence, have progressively expanded the clinical role of CCT. Recent large multicenter randomized clinical trials documented the high prognostic value of CCT and its capability to increase the cost-effectiveness of the management of patients with suspected CAD. In the meantime, CCT, initially perceived as a simple non-invasive technique for studying coronary anatomy, has transformed into a multiparametric “one-stop-shop” approach able to investigate the heart in a comprehensive way, including functional, structural and pathophysiological biomarkers. In this complex and revolutionary scenario, it is urgently needed to provide an updated guide for the appropriate use of CCT in different clinical settings. This manuscript, endorsed by the Italian Society of Medical and Interventional Radiology (SIRM) and by the Italian Society of Cardiology (SIC), represents the first of two consensus documents collecting the expert opinion of Radiologists and Cardiologists about current appropriate use of CCT.

show abstract

Coronary atherosclerosis in apparently healthy master athletes discovered during pre-PARTECIPATION screening. Role of coronary CT angiography (CCTA)

Cited by 14 publications

References 34 publications

Age-dependent diagnostic yield of echocardiography as a second-line diagnostic investigation in athletes with abnormalities at preparticipation screening

Age-dependent diagnostic yield of echocardiography as a second-line diagnostic investigation in athletes with abnormalities at preparticipation screening

ECG criteria for the detection of high-risk cardiovascular conditions in master athletes

SIRM–SIC appropriateness criteria for the use of Cardiac Computed Tomography. Part 1: Congenital heart diseases, primary prevention, risk assessment before surgery, suspected CAD in symptomatic patients, plaque and epicardial adipose tissue characterization, and functional assessment of stenosis

Contact Info

Product

Resources

About