The role of cardiac computed tomography in sports cardiology: back to the future!

Abstract

In recent years, the role of pre-participation evaluation (PPE) in the prevention of sudden cardiac death in competitive athletes has become evident. Most physicians routinely supplement assessment by resting electrocardiogram with imaging techniques, such as echocardiography. The primary goal of imaging in the clinical assessment of competitive athletes is to exclude cardiovascular conditions associated with adverse outcomes. Cardiac computed tomography is emerging as an important technique for stratifying cardiovascular risk and assessing coronary artery disease (CAD), particularly in master athletes. Conversely, in young athletes, this technique has the best non-invasive coronary artery resolution and provides valuable details on coronary artery anatomy. Recent technical developments have brought about a dramatic reduction in radiation exposure, a major drawback of this diagnostic method; nowadays cardiac computed tomography may be performed at a dose of barely one millisievert. The present review provides a practical guide for the use of cardiac computed tomography in the PPE of competitive athletes, with a specific focus on its value for detecting congenital coronary anomalies and CAD in young and master athletes, respectively.

Athlete's Heart: A Cardiovascular Step-By-Step Multimodality Approach

“…In the last years, it is spreading the use of stress CMR that has the advantages to assess biventricular function, wall motion and valve function during exercise, even if it requires high levels of training, dedicated devices, and long-scan times [ 136 ].…”

“…CCT shows high accuracy in evaluating coronary atherosclerosis and coronary origin and course [ 121 ]. The assessment of coronary arteries by CCT is non-invasively performed and requires a very low radiation dose, thanks to the latest generation scanners (from 0.7 to 1 mSv with optimized acquisition parameters and protocols [ 136 ]). Therefore, depending on the local availability and expertise, CCT may be considered in athletes with symptoms suggestive of CAD and in older, asymptomatic athletes with risk factors for CV disease or equivocal exercise stress test.…”

“…Indeed, it has been recently theorized the use of CCT in the screening process of mature athletes increases the negative predictive value for excluding coronary artery disease [ 137 ]. Moreover, CCT should be considered when a precise definition of proximal coronary anatomy or characterization of great vessel morphology is indicated [ 136 ]. When dilatation of the aortic root or ascending aorta is suspected, at least one comprehensive aortic tomographic assessment by CT angiography or angio-MR should be performed [ 73 ].…”

Cardiac imaging in athlete’s heart: current status and future prospects

“…In young athletes, this technique offers the highest level of non-invasive resolution for coronary arteries and allows for determining the morphological changes in the coronary arteries (coronary origin and course anomalies). Based on this evidence, predictive information may be provided [ 37 ].…”