Subepicardial delayed gadolinium enhancement in asymptomatic athletes: let sleeping dogs lie?

Schnell, Frédéric; Claessen, Guido; Gerche, André La; Bogaert, Jan; Lentz, Pierre-Axel; Claus, Piet; Mabo, Philippe; Carré, François; Heidbüchel, Hein

doi:10.1136/bjsports-2014-094546

Cited by 83 publications

(50 citation statements)

References 41 publications

(30 reference statements)

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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%

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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Section: Underlying Myocardial Substratesmentioning

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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“…130, 131 Benign and perhaps adaptive explanations for exercise induced troponin elevation and alternative pathogenic mechanisms for ventricular fibrosis among athletes have been proposed. 132 It is most likely that high dose exercise injures the heart muscle infrequently and only among athletes with an additional susceptibility factor such as subclinical myocarditis, surreptitious performance enhancing drug use, or occult genetic susceptibility.…”

Section: High Dose Exercise: “More May Not Be Better But Is Not Necesmentioning

confidence: 99%

Exercise Dose in Clinical Practice

2016

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There is wide variability in the physical activity patterns of the patients in contemporary clinical cardiovascular practice. This review is designed to address the impact of exercise dose on key cardiovascular risk factors and on mortality. We begin by examining the body of literature that supports a dose-response relationship between exercise and cardiovascular disease risk factors including plasma lipids, hypertension, diabetes mellitus, and obesity. We next explore the relationship between exercise dose and mortality by reviewing the relevant epidemiological literature underlying current physical activity guideline recommendations. We then expand this discussion to critically examine recent data pertaining to the impact of exercise dose at the lowest and highest ends of the spectrum. Finally, we provide a framework for how the key concepts of exercise dose can be integrated into clinical practice.

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“…Cardiac MRI provides an accurate assessment of both left and right ventricular size, function, and wall motion and is able to provide comprehensive myocardial tissue characterization and particularly to identify and quantify myocardial fibrosis. Cardiac MRI was able to detect structural abnormalities in a non‐negligible proportion of patients with apparently idiopathic ventricular arrhythmias of LV origin (Nucifora et al., ) and to identify subepicardial delayed gadolinium enhancement and non‐ischemic myocardial scars in athletes with pathological ECG findings (Muser et al., ; Schnell et al., ). Accordingly, this imaging technique may be particularly useful in athletes presenting with unexplained ventricular arrhythmias, particularly with a RBBB morphology and wide QRS, suggesting a LV origin.…”

Section: Imaging In Athletes With Ventricular Arrhythmias: Findings Fmentioning

confidence: 99%

The prevalence and clinical significance of premature ventricular beats in the athlete

D’Ascenzi

Zorzi

Alvino

et al. 2016

Scandinavian Med Sci Sports

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Adolescents and adults with cardiovascular disease who are engaged in sports activity have an increased risk of sudden cardiac death (SCD) that is three times greater than that of their non-athletic counterparts. Sport acts as a trigger for cardiac arrest in the presence of underlying cardiovascular diseases predisposing to life-threatening ventricular arrhythmias. Frequent and complex premature ventricular beats (PVBs) detected during the cardiovascular screening of the athletic population may be a sign of an underlying cardiovascular disease at risk of SCD, but are also often recorded in trained athletes without cardiovascular abnormalities. Thus, the interpretation of PVBs could represent a clinical dilemma, particularly in the athlete. However, while some characteristics of PVBs can be considered common and benign, others occur uncommonly in the athletic population and raise the suspicion of an underlying cardiovascular disease. This review discusses the prevalence and clinical significance of PVBs in the athlete, with a focus on exercise-induced PVBs, on the analysis of PVB's morphology at 12-lead ECG, and on the morphological substrates identified by imaging techniques. The implications on eligibility for competitive sports participation are also discussed, according to the relevance of PVB detection for disqualifying athletes from competitions.

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Subepicardial delayed gadolinium enhancement in asymptomatic athletes: let sleeping dogs lie?

Abstract: Isolated large areas of subepicardial DGE in an asymptomatic athlete are not benign and require a careful evaluation at exercise and a strict follow-up. These findings question whether extreme exercise during silent myocarditis may facilitate fibrosis generation and adverse remodelling.

Cited by 83 publications

References 41 publications

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

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

Exercise Dose in Clinical Practice

The prevalence and clinical significance of premature ventricular beats in the athlete

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