Sports-related sudden cardiac death due to myocardial diseases on a population from 1–35 years: a multicentre forensic study in Spain

Abstract

This is a multicentre forensic study that identifies all sports-related sudden deaths (SRSDs) in young people, due to myocardial diseases (MDs) that occurred in a large area of Spain. The aim of the study is to assess the epidemiology, causes of death, and sport activities associated with these fatalities. This is a retrospective study based on forensic autopsies performed in the provinces of Biscay, Seville, Valencia and in the jurisdiction covered by the National Institute of Toxicology and Forensic Sciences in Madrid (Spain). The retrospective study encompasses from 2010 to 2017. All sudden cardiac deaths (SCDs) in persons 1-35 years old were selected. The total number of SCDs were divided into death occurred during exercise (SRSD) and death during rest, sleep or normal activities (non-SRSD). Each of these two groups was subdivided according to the cause of death into MD (primary cardiomyopathies and myocarditis) and non-MD. Clinic-pathological, toxicological and genetic characteristics of SRSD due to MD were analysed. Over the 8-year study period, we identified 645 cases of SCD in the young: 75 SRSD (11.6%) and 570 non-SRSD (88.4%). MD was diagnosed in 33 (44.0%) of the SRSD and in 112 (19.6%) of the non-SRSD cases. All cases of SRSD due to MD were males (mean age (24.0 ± 7.6) years) practicing recreational sports (85%). SRSDs were more frequent in arrhythmogenic cardiomyopathy (ACM) (37%) and hypertrophic cardiomyopathy (HCM) (24%), followed by myocarditis (15%) and idiopathic left ventricular hypertrophy (ILVH) (9%). Only in five cases of SRSD the MD responsible of death (HCM) had been diagnosed in life. Cardiovascular symptoms related to the disease were present in other seven patients (six of them with ACM). Postmortem genetic studies were performed in 15/28 (54%) primary cardiomyopathies with positive results in 12 (80%) cases. The most frequent sports disciplines were football (49%) followed by gymnastics (15%) and running (12%). In Spain, SRSD in young people due to MDs occurs in males who perform a recreational activity. Compared with control group we observed a strong association between MDs and exertion. One in three SRSDs are due to cardiomyopathy, especially ACM, which reinforces the need for preparticipation screening to detect these pathologies in recreational sport athletes. Further studies are warranted to understand the causes and circumstances of sudden death to facilitate the development of preventive strategies.

The Adverse Effects of Prenatal METH Exposure on the Offspring: A Review

“…In adult individuals, METH-dependency has been associated with significantly reduced heart rate variability, reduced parasympathetic activity, diminished heartbeat complexity Henry et al (2012), reduced stroke volume, and left ventricular end-diastolic volume, relative to healthy adults (Freeling and Mcfadden, 2020). Besides, other histopathological changes like cardiomyocyte hypertrophy and myocardial interstitial fibrosis were observed Sun et al (2019), which might advance to cardiac ischemia, myocardial infarction, and cardiomyopathy Panenka et al (2013), that may be lifethreatening (Li et al, 2012;Zamanian et al, 2018;Lucena, 2019;Morentin et al, 2019). However, the mechanism remains undetermined.…”

Sudden Cardiac Death in Athletes: From the Basics to the Practical Work-Up

“…Myocardial disease was diagnosed in 33 patients, arrhythmogenic cardiomyopathy being the leading cause (37%), followed by hypertrophic cardiomyopathy (24%) and myocarditis (15%). Only five had a previous cardiomyopathy diagnosis, and 85% were practicing recreational sports [ 4 ].…”

Sudden Cardiac Death—A New Insight Into Potentially Fatal Genetic Markers

“…The etiology of SCD varies and is highly dependent on the demographic characteristics of the patients included in the studies ( 7 ). A large number of SCDs at a younger age (<35 years old) have an unexplained etiology and potential underlying genetic basis ( 1 , 8 ). Furthermore, the etiology of SCD in this group includes hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), myocarditis, and different kinds of arrhythmogenic disorders including Brugada syndrome (BrS), congenital long-QT syndrome (LQTS), and catecholaminergic polymorphic ventricular tachycardia (CPVT) ( 6 , 9 ).…”

“…Screening in that age group is much easier because CAD develops gradually throughout one's lifetime and is manifested by specific cardiac symptoms that alert the athlete. The situation is completely different among athletes under the age of 35 where most SCDs are caused by underlying heart disease triggered by intense exertion ( 8 , 11 ).…”