Predictive value of exercise testing in athletes with ventricular ectopy evaluated by cardiac magnetic resonance

Cipriani, Alberto; Zorzi, Alessandro; Sarto, Patrizio; Donini, Martino; Rigato, Ilaria; Bariani, Riccardo; Lazzari, Manuel De; Pilichou, Kalliopi; Thiene, Gaetano; Iliceto, Sabino; Basso, Cristina; Corrado, Domenico; Marra, Martina Perazzolo; Bauce, Barbara

doi:10.1016/j.hrthm.2018.08.029

Cited by 48 publications

(31 citation statements)

References 24 publications

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“…On the contrary, other morphologies of PVBs such as LBBB/intermediate or superior axis or RBBB/intermediate or superior axis and wide QRS are uncommon in the athlete, and when present are usually less numerous, complex (repetitive, polymorphic, short-coupled) and/or exercise-induced and may be associated with an underlying myocardial disease. Studies on athletes undergoing CMR for evaluation of VAs demonstrate that PVBs with an RBBB-like morphology and wide QRS (>130 ms) more often predict myocardial lesions (particularly non-ischaemic LV myocardial scar as evidenced by LGE) 8 20 38 39…”

Section: Which Characteristics Of Pvbs Confer a Worse Prognosis?mentioning

confidence: 99%

“…PVBs induced by exercise raise clinical warning because VAs associated with heart diseases such as cardiomyopathy, myocarditis and ion channel diseases are often worsened by adrenergic stimulation 1 8 20 38 41–43. On the other hand, PVBs that become less frequent or disappear with increasing exercise load are usually idiopathic and benign VAs and often have an infundibular origin (ie, from the RV or LV outflow tract) 44 45.…”

Section: Which Characteristics Of Pvbs Confer a Worse Prognosis?mentioning

confidence: 99%

“…Compared with resting ECG, exercise testing has the potential to increase the diagnostic sensitivity for identification of clinically silent arrhythmogenic heart diseases because of its ability to induce adrenergic-dependent VAs 46. In a cohort of athletes who underwent CMR for evaluation of PVBs, a higher prevalence of pathological myocardial substrates was found among athletes with exercise-induced PVBs compared with those with exercise-suppressed VAs 38. In particular, exercise-induced complex VAs with an RBBB morphology and QRS >130 ms were the strongest predictors of pathological findings on CMR (OR=5.3) (figure 3).…”

Section: Which Characteristics Of Pvbs Confer a Worse Prognosis?mentioning

confidence: 99%

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How to evaluate premature ventricular beats in the athlete: critical review and proposal of a diagnostic algorithm

et al. 2019

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Although premature ventricular beats (PVBs) in young people and athletes are usually benign, they may rarely mark underlying heart disease and risk of sudden cardiac death during sport. This review addresses the prevalence, clinical meaning and diagnostic/prognostic assessment of PVBs in the athlete. The article focuses on the characteristics of PVBs, such as the morphological pattern of the ectopic QRS and the response to exercise, which accurately stratify risk. We propose an algorithm to help the sport and exercise physician manage the athlete with PVBs. We also address (1) which athletes need more indepth investigation, including cardiac MRI to exclude an underlying pathological myocardial substrate, and (2) which athletes can remain eligible to competitive sports and who needs to be excluded.

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Section: Which Characteristics Of Pvbs Confer a Worse Prognosis?mentioning

confidence: 99%

Section: Which Characteristics Of Pvbs Confer a Worse Prognosis?mentioning

confidence: 99%

Section: Which Characteristics Of Pvbs Confer a Worse Prognosis?mentioning

confidence: 99%

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How to evaluate premature ventricular beats in the athlete: critical review and proposal of a diagnostic algorithm

et al. 2019

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“…Echocardiography was also normal in most cases because of the segmental nature of the lesion confined to the subepicardial LV wall layers. [17][18][19][20][21][22][23] Previous outcome studies provided evidence that the non-ischaemic LV scar may be associated with lifethreatening VA and SCD. [17][18][19][20] In particular, we found in a previous investigation that, during a mean 3-year follow-up, 22% of athletes with non-ischaemic LV scars and VA experienced ICD shock, sustained ventricular tachycardia or SCD; in 5 of 6 cases the event occurred during exercise.…”

Section: Underlying Myocardial Substratesmentioning

confidence: 99%

“…Because echocardiography may not be sensitive enough to exclude the presence of segmental myocardial fibrosis as a potential substrate of malignant VA, CMR should be considered in the diagnostic work-up of athletes with VA at EST. 23 However, because of the limited availability and high costs, CMR should be reserved to a subset of athletes with a high pre-test probability of abnormal findings. In this regard, our study showed that variables significantly associated with LV LGE were the presence of PVBs with RBBB/ wide QRS at 12-lead 24-hour ambulatory ECG monitoring (either in isolation or associated with LBBB PVBs) and couplets/non-sustained ventricular tachycardia at EST.…”

Section: Work-up Of Exercise-induced Vamentioning

confidence: 99%

Screening young athletes for diseases at risk of sudden cardiac death: role of stress testing for ventricular arrhythmias

Zorzi

Vessella

Lazzari

et al. 2019

Eur J Prev Cardiolog

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Aims: The athletic preparticipation evaluation (PPE) protocol proposed by the European Society of Cardiology includes history, physical examination and resting electrocardiogram (ECG). The aim of this study was to assess the results of adding constant-load ECG stress testing (EST) to the protocol for the evaluation of ventricular arrhythmias (VA) inducibility. Methods: We evaluated a consecutive cohort of young athletes with history, physical examination, resting ECG and EST. Athletes with VA induced by EST underwent 24-hour 12-lead Holter monitoring and echocardiography. Cardiac magnetic resonance (CMR) was reserved for those with frequent, repetitive or exercise-worsened VA, and for athletes with echocardiographic abnormalities. Results: Of 10,985 athletes (median age 15 years, 66% males), 451 (4.1%) had an abnormal history, physical examination or resting ECG and 31 (0.28%) were diagnosed with a cardiac disease and were at risk of sudden cardiac death. Among the remaining 10,534 athletes, VA at EST occurred in 524 (5.0%) and a previously missed at-risk condition was identified in 23 (0.22%); the most common (N ¼ 10) was an echocardiographically silent non-ischaemic left-ventricular fibrosis evidenced by CMR. The addition of EST increased the diagnostic yield of PPE by 75% (from 0.28% to 0.49%) and decreased the positive predictive value by 20% (from 6.9% to 5.5%). During a 32 AE 21 months follow-up, no cardiac arrests occurred among either eligible athletes or non-eligible athletes with cardiovascular disease. Conclusions: The addition of exercise testing for the evaluation of VA inducibility to history, physical examination and ECG resulted in an increase of the diagnostic yield of PPE at the expense of an increase in false-positive findings.

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Myocardial fibrosis in athletes—Current perspective

Małek

Bucciarelli-Ducci

2020

Clinical Cardiology

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Several previous studies suggested that prolonged and extensive physical activity might lead to increased prevalence of myocardial fibrosis in athletes. The review summarizes these studies focusing on common patterns of myocardial fibrosis observed in athletes, their potential causes and significance. It also presents recent research on parametric imaging shedding new light on diffuse myocardial fibrosis in athletes. Finally, it reviews how these traditional and novel cardiac magnetic resonance (CMR) techniques can be incorporated in the diagnostic work up to differentiate athlete's heart from cardiomyopathies.

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Predictive value of exercise testing in athletes with ventricular ectopy evaluated by cardiac magnetic resonance

Cited by 48 publications

References 24 publications

How to evaluate premature ventricular beats in the athlete: critical review and proposal of a diagnostic algorithm

How to evaluate premature ventricular beats in the athlete: critical review and proposal of a diagnostic algorithm

Screening young athletes for diseases at risk of sudden cardiac death: role of stress testing for ventricular arrhythmias

Myocardial fibrosis in athletes—Current perspective

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