Response to Letter Regarding Article, “Sudden Deaths in Young Competitive Athletes: Analysis of 1866 Deaths in the United States, 1980–2006”

Maron, Barry J.; Doerer, Joseph J.; Haas, Tammy S.; Tierney, David M.; Mueller, Frederick O.

doi:10.1161/circulationaha.109.884643

Cited by 401 publications

(672 citation statements)

References 5 publications

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“…Data from US retrospective autopsy studies in victims of sudden death in the athletic field have announced HCM as the most frequent cause of sudden deaths in this cohort, accounting for one third of deaths [17,21]. In a recently published analysis of 1,866 sudden death in young athletes in the USA by Maron et al, HCM was the major underlying cardiovascular disorder in confirmed cardiovascular events ( Figure 2) [24]. On the contrary, data from the Veneto region in Italy have reported ARVC as the main cause of sudden death in young athletes [16,22].…”

Section: Hypertrophic Cardiomyopathy and Sudden Death In Athletesmentioning

confidence: 91%

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Hypertrophic cardiomyopathy as a cause of sudden death

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Pfeiffer

et al. 2009

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Hypertrophic cardiomyopathy (HCM) is the main cause of sudden unexpected death in the young and especially in young athletes with an incidence up to 2.3 per 100,000 athletes and year. Risk stratification models including patient history (syncope, familial risk of sudden death) and findings in noninvasive tests (nonsustained ventricular tachycardia, abnormal blood pressure response during exercise, maximum left ventricular wall thickness > or = 30 mm) have been developed in order to estimate the risk of individual patients. Echocardiographic parameters are helpful in distinguishing HCM from athlete's heart. Definitive diagnosis of HCM implicates disqualification from competitive sports resulting in a significant reduction of sudden cardiac death due to HCM during sports competition. This positive development should lead to a widespread preparticipation screening of athletes including historical, clinical, and electrocardiographic examination. At least in borderline findings and symptomatic athletes, an additional echocardiogram should be performed in order to minimize or better exclude the risk of sudden cardiac death.

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Section: Hypertrophic Cardiomyopathy and Sudden Death In Athletesmentioning

confidence: 91%

“…Distribution of sudden death (SD) attributed to underlying cardiovascular disease in young competitive athletes in the USA 1980-2006 (adapted from[24]). Hypertrophic cardiomyopathy (HCM) is the most common primary cardiovascular disease leading to SD in this cohort.…”

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confidence: 99%

Hypertrophic cardiomyopathy as a cause of sudden death

Seggewiß

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Pfeiffer

et al. 2009

Herz

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“…2 Content of prescreening examinations in the German S1 guidelines 1 Biography of own and family diseases 1. [6], with permission, based on references [24,25] echocardiographic features [7,24,25]. It clearly shows the predominance of ascertained or suspected hypertrophic cardiomyopathies in the USA.…”

Section: Risks and Benefits Of Physical Exercise In Cardiac Patientsmentioning

confidence: 99%

Exercise and sports in cardiac patients and athletes at risk

Maisch

2015

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Physical training has a well-established role in the primary and secondary prevention of coronary artery disease. Moderate exercise has been shown to be beneficial in chronic stable heart failure. Competitive sports, however, is contraindicated in most forms of hypertrophic cardiomyopathy (HCM), in myocarditis, in pericarditis, and in right ventricular cardiomyopathy/dysplasia. In most European countries, the recommendations of medical societies or public bodies state that these diseases have to be ruled out by prescreening before an individual can take up competitive sports. But the intensity and quality of this health check vary considerably from country to country, from the type of sports activity, and from the individuals who want to participate in sports. Prescreening on an individual basis should also be considered for leisure sports, particularly in people who decide to start training in middle age after years of physical inactivity to regain physical fitness. In leisure sports the initiative for a medical check-up lies primarily in the hands of the "healthy" individual. If she or he plans to participate in extreme forms of endurance sports with excessive training periods such as a marathon or ultramarathon and competitive cycling or rowing, they should be aware that high-intensity endurance sports can lead to structural alterations of the heart muscle even in healthy individuals. Physical exercise in patients with heart disease should be accompanied by regular medical check-ups. Most rehabilitation programs in Europe perform physical activity and training schedules according to current guidelines. Little is known about athletes who are physically handicapped and participate in competitive sports or the Paralympics, and even less is known about individuals with intellectual disabilities (ID) who participate in local, regional, international competitions or the Special Olympics or just in leisure sport activities.

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“…Diese Variation liegt zum einen an der Art und Weise, wie die Daten erhoben worden sind, aber auch an der Auswahl der untersuchten Sportlerpopulation [4]. Die Prävalenz des PHT in US-HighSchool-und College-Athleten wurde mit weniger als 1/100.000 pro Jahr geschätzt [5], wohingegen eine prospektive Studie in Italien eine jährliche Inzidenz von annähernd 3/100.000 Athleten im Alter von bis zu 35 Jahren ergab [6]. Das Risiko des PHT bei Sportlern steigt mit dem Alter und ist bei Männern höher als bei Frauen.…”

Section: Inzidenz Des Plötzlichen Herztodesunclassified

“…Diese kann Folge einer strukturellen Herzerkrankungen und rein elektrischer Erkrankungen sein. Große US-amerikanische Beobachtungsstudien zeigten als häufigste Ursache bei Sportlern unter 35 Jahren eine hypertrophe Kardiomyopathie (HCM; [5]). In einem prospektiven italienischen Register fand sich hingegen der größte Anteil der PHT verursacht durch eine arrhythmogene rechtsventrikuläre Kardiomyopathie (ARVC).…”

Section: Ursachenunclassified

Plötzlicher Herztod bei Sportlern und dessen Prävention

Tönnis

Tack²,

Kuck

2015

Herz

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Athletes and especially elite athletes are predominantly young people and are not associated with high health risks, apart from traumatic injuries. Nevertheless, there is a significantly high incidence of sudden cardiac death (SCD), which ranges from 0.6 to 3.0/100,000 athletes per year. Often the SCD is the first manifestation of an underlying cardiac disease. Distinct structural cardiac disorders, such as hypertrophic cardiomyopathy, coronary artery anomalies (17 %), inflammatory disorders (6 %) and arrhythmogenic right ventricular cardiomyopathy as well as conditions without structural cardiac abnormalities, such as primary electrical diseases (channelopathies) are important causes of sudden death. A simple screening can help to identify athletes with these diseases and allow specific therapies or precautionary measures to be initiated.

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Response to Letter Regarding Article, “Sudden Deaths in Young Competitive Athletes: Analysis of 1866 Deaths in the United States, 1980–2006”

Cited by 401 publications

References 5 publications

Hypertrophic cardiomyopathy as a cause of sudden death

Hypertrophic cardiomyopathy as a cause of sudden death

Exercise and sports in cardiac patients and athletes at risk

Plötzlicher Herztod bei Sportlern und dessen Prävention

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