601
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Snoek JA, Jongman JK, Brandon T, van Berkel S, van’t Hof AWJ. Performance of the Lausanne questionnaire and the 2010 European Society of Cardiology criteria for ECG interpretation in athletes. Eur J Prev Cardiol 2013; 22:397-405. [DOI: 10.1177/2047487313506827] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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602
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Cardiac Imaging and Stress Testing Asymptomatic Athletes to Identify Those at Risk of Sudden Cardiac Death. JACC Cardiovasc Imaging 2013; 6:993-1007. [DOI: 10.1016/j.jcmg.2013.06.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 05/24/2013] [Accepted: 06/13/2013] [Indexed: 11/19/2022]
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603
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Marijon E, Bougouin W, Celermajer DS, Perier MC, Benameur N, Lamhaut L, Karam N, Dumas F, Tafflet M, Prugger C, Mustafic H, Rifler JP, Desnos M, Le Heuzey JY, Spaulding CM, Avillach P, Cariou A, Empana JP, Jouven X. Major regional disparities in outcomes after sudden cardiac arrest during sports. Eur Heart J 2013; 34:3632-40. [DOI: 10.1093/eurheartj/eht282] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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604
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Cardiac Arrhythmias in Standardbreds During and After Racing—Possible Association Between Heart Size, Valvular Regurgitations, and Arrhythmias. J Equine Vet Sci 2013. [DOI: 10.1016/j.jevs.2012.09.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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605
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Gawroński W, Sobiecka J, Malesza J. Fit and healthy Paralympians—medical care guidelines for disabled athletes: a study of the injuries and illnesses incurred by the Polish Paralympic team in Beijing 2008 and London 2012. Br J Sports Med 2013; 47:844-9. [DOI: 10.1136/bjsports-2013-092298] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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606
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Abstract
We aimed to review the literature to explore the magnitude of sudden cardiac death (SCD) in young athletes. Although SCD in athletes is not a common event, it represents a tragedy of the apparently fit young population. SCD varies according to countries, age groups, and sex. In addition, it varies in the underlying causes and the screening tool. Therefore, we are in need for further research efforts. Guidelines, public and physician awareness, and education regarding the warning signs are integral part in the strategy to reduce SCD tragedy. However, all these requirements raise concern for cost-effectiveness in some countries for proper implementation.
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607
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James CA, Bhonsale A, Tichnell C, Murray B, Russell SD, Tandri H, Tedford RJ, Judge DP, Calkins H. Exercise increases age-related penetrance and arrhythmic risk in arrhythmogenic right ventricular dysplasia/cardiomyopathy-associated desmosomal mutation carriers. J Am Coll Cardiol 2013; 62:1290-1297. [PMID: 23871885 DOI: 10.1016/j.jacc.2013.06.033] [Citation(s) in RCA: 464] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 06/02/2013] [Accepted: 06/18/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This study sought to determine how exercise influences penetrance of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) among patients with desmosomal mutations. BACKGROUND Although animal models and anecdotal evidence suggest that exercise is a risk factor for ARVD/C, there have been no systematic human studies. METHODS Eighty-seven carriers (46 male; mean age, 44 ± 18 years) were interviewed about regular physical activity from 10 years of age. The relationship of exercise with sustained ventricular arrhythmia (ventricular tachycardia/ventricular fibrillation [VT/VF]), stage C heart failure (HF), and meeting diagnostic criteria for ARVD/C (2010 Revised Task Force Criteria [TFC]) was studied. RESULTS Symptoms developed in endurance athletes (N = 56) at a younger age (30.1 ± 13.0 years vs. 40.6 ± 21.1 years, p = 0.05); they were more likely to meet TFC at last follow-up (82% vs. 35%, p < 0.001) and have a lower lifetime survival free of VT/VF (p = 0.013) and HF (p = 0.004). Compared with those who did the least exercise per year (lowest quartile) before presentation, those in the second (odds ratio [OR]: 6.64, p = 0.013), third (OR: 16.7, p = 0.001), and top (OR: 25.3, p < 0.0001) quartiles were increasingly likely to meet TFC. Among 61 individuals who did not present with VT/VF, the 13 subjects experiencing a first VT/VF event over a mean follow-up of 8.4 ± 6.7 years were all endurance athletes (p = 0.002). Survival from a first VT/VF event was lowest among those who exercised most (top quartile) both before (p = 0.036) and after (p = 0.005) clinical presentation. Among individuals in the top quartile, a reduction in exercise decreased VT/VF risk (p = 0.04). CONCLUSIONS Endurance exercise and frequent exercise increase the risk of VT/VF, HF, and ARVD/C in desmosomal mutation carriers. These findings support exercise restriction for these patients.
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Affiliation(s)
- Cynthia A James
- Department of Medicine, Division of Cardiology, The Johns Hopkins University, Baltimore, Maryland.
| | - Aditya Bhonsale
- Department of Medicine, Division of Cardiology, The Johns Hopkins University, Baltimore, Maryland
| | - Crystal Tichnell
- Department of Medicine, Division of Cardiology, The Johns Hopkins University, Baltimore, Maryland
| | - Brittney Murray
- Department of Medicine, Division of Cardiology, The Johns Hopkins University, Baltimore, Maryland
| | - Stuart D Russell
- Department of Medicine, Division of Cardiology, The Johns Hopkins University, Baltimore, Maryland
| | - Harikrishna Tandri
- Department of Medicine, Division of Cardiology, The Johns Hopkins University, Baltimore, Maryland
| | - Ryan J Tedford
- Department of Medicine, Division of Cardiology, The Johns Hopkins University, Baltimore, Maryland
| | - Daniel P Judge
- Department of Medicine, Division of Cardiology, The Johns Hopkins University, Baltimore, Maryland
| | - Hugh Calkins
- Department of Medicine, Division of Cardiology, The Johns Hopkins University, Baltimore, Maryland
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608
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Roberts WO, Stovitz SD. Incidence of sudden cardiac death in Minnesota high school athletes 1993-2012 screened with a standardized pre-participation evaluation. J Am Coll Cardiol 2013; 62:1298-1301. [PMID: 23850929 DOI: 10.1016/j.jacc.2013.05.080] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 05/16/2013] [Accepted: 05/28/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study sought to determine the incidence of sudden cardiac death (SCD) during Minnesota State High School League (MSHSL) games and practices for high school (HS) athletes (12 to 19 years of age, with most age 15 to 18 years of age) using a uniform statewide pre-participation health screening examination (PPE) form every 3 years on a defined population across 19 academic years. BACKGROUND Adding electrocardiographic screening is being considered by some to reduce cardiac death rates in athletes, but the death rates in defined groups screened by the current U.S. PPE recommendations are unknown. METHODS MSHSL participation records were surveyed to determine the number of unduplicated athletes for 1993/1994 through 2011/2012 academic years, and catastrophic insurance records were used to find cardiac deaths. RESULTS There were 4 SCDs (2 cross country, 1 basketball, 1 wrestling), all male, during practice or games in 1,666,509 unduplicated athletes participating in ≥ 1 sports. The incidence of SCD in athletes screened every 3 years with a history and physical during MSHSL activities is 0.24 per 100,000 athlete-years over 19 years and 0.11 per 100,000 athlete-years over the past decade. CONCLUSIONS The incidence of SCD in athletes screened every 3 years with standard PPE during MSHSL activities is 0.24 per 100,000 athlete-years in 19 academic years. This incidence is much lower than that observed in studies of Division 1 National Collegiate Athletic Association and Italian athletes (ages 18 to 25 and mean age 24 years, respectively). Our data do not warrant screening HS athletes with electrocardiography to prevent SCD episodes. The decision to screen athletes with electrocardiography should consider age, training intensity, and genetic predisposition.
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Affiliation(s)
- William O Roberts
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota.
| | - Steven D Stovitz
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota
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609
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Lawless CE. Minnesota high school athletes 1993-2012: evidence that American screening strategies and sideline preparedness are associated with very low rates of sudden cardiac deaths. J Am Coll Cardiol 2013; 62:1302-1303. [PMID: 23850926 DOI: 10.1016/j.jacc.2013.06.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 06/25/2013] [Indexed: 11/19/2022]
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610
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Valente-Dos-Santos J, Coelho-e-Silva MJ, Vaz V, Figueiredo AJ, Castanheira J, Leite N, Sherar LB, Baxter-Jones A, Elferink-Gemser MT, Malina RM. Ventricular mass in relation to body size, composition, and skeletal age in adolescent athletes. Clin J Sport Med 2013; 23:293-9. [PMID: 23377353 DOI: 10.1097/jsm.0b013e318280ac63] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the contribution of chronological age (CA), skeletal age (SA), stature, sitting stature, fat-free mass (FFM), and fat mass (FM) to interindividual variability in left ventricular mass (LVM) in male adolescent roller hockey players using allometric models. DESIGN Cross sectional. SETTING Training and competitive sport during adolescence. PARTICIPANTS Seventy-three Portuguese male roller hockey players aged 14.5 to 16.5 years. INDEPENDENT VARIABLES Stature, sitting stature, body mass, estimated FM and FFM, and SA assessed by the Fels method. MAIN OUTCOME MEASURES Allometric modeling of LVM assessed in accordance with recommendations of the American Society of Echocardiography. RESULTS Hockey players (CA: 15.4 ± 0.6 years; SA: 16.4 ± 1.5 years) showed an eccentric remodeling of LV structure within the reference range (ie, 0.24-0.42), a dilated LV chamber, but no LVM increase. Exponents for body size descriptors were 2.69 for stature (R(2) = 27%; P < 0.001), 2.49 for sitting stature (R(2) = 37%; P < 0.001), 0.76 for FFM (R(2) = 31%; P < 0.001), and 0.22 for FM (R(2) = 26%; P < 0.001). The combination of size descriptors with CA and SA increased the explained variance in LVM slightly (26%-45%). CONCLUSIONS When stature and FM are used for indexing LVM in a sample of adolescent athletes, biological maturity status should also be considered.
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611
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Biffi A, Delise P, Zeppilli P, Giada F, Pelliccia A, Penco M, Casasco M, Colonna P, D’Andrea A, D’Andrea L, Gazale G, Inama G, Spataro A, Villella A, Marino P, Pirelli S, Romano V, Cristiano A, Bettini R, Thiene G, Furlanello F, Corrado D. Italian Cardiological Guidelines for Sports Eligibility in Athletes with Heart Disease. J Cardiovasc Med (Hagerstown) 2013; 14:477-99. [DOI: 10.2459/jcm.0b013e32835f6a21] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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612
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Screening for sudden cardiac death before participation in high school and collegiate sports: American College of Preventive Medicine position statement on preventive practice. Am J Prev Med 2013; 45:130-133. [PMID: 23790999 DOI: 10.1016/j.amepre.2013.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 03/23/2013] [Accepted: 04/03/2013] [Indexed: 11/23/2022]
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613
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Mezzani A, Giannuzzi P. The Italian cardiological guidelines for eligibility in competitive sports. J Cardiovasc Med (Hagerstown) 2013; 14:518-9. [DOI: 10.2459/jcm.0b013e328362069e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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614
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Brosnan M, La Gerche A, Kalman J, Lo W, Fallon K, MacIsaac A, Prior D. The Seattle Criteria increase the specificity of preparticipation ECG screening among elite athletes. Br J Sports Med 2013; 48:1144-50. [DOI: 10.1136/bjsports-2013-092420] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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615
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Abstract
Physical activity and exercise have been associated with reduced cardiovascular risk, morbidity, and mortality, as well as all-cause mortality, both in the general population and in patients with various forms of cardiovascular disease. Increasing amounts of exercise are associated with incremental reductions in mortality, but considerable benefits have been found even with a low level of exercise. Exercise is beneficial for most individuals, but risks exist. Exercise is associated with reduced long-term morbidity and mortality, but acute exercise can transiently increase the risk of fatal or nonfatal cardiovascular events. Although tragic, these events are very rare, and even to some extent preventable with screening programmes. Low-intensity physical activity is important and beneficial to all individuals, including those with a high risk of adverse cardiovascular events. In individuals who are physically fit and who do not have genetic predisposition to, or signs of, cardiovascular disease, the greater the intensity and amount of exercise, the greater the health benefits. Nevertheless, effective strategies to encourage exercise in the population are lacking. A sustained increase in physical activity is likely to require more than individual advice, and needs to include urban planning and possibly even legislation.
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616
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Zaidi A, Sharma S. Exercise and heart disease: from athletes and arrhythmias to hypertrophic cardiomyopathy and congenital heart disease. Future Cardiol 2013; 9:119-36. [PMID: 23259479 DOI: 10.2217/fca.12.81] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The beneficial effects of regular physical activity on cardiovascular health are well established, with convincing evidence of improvements in blood pressure, lipid profile and overall mortality. Conversely, individuals with pre-existing congenital, inherited or acquired heart conditions may experience functional cardiac deterioration or sudden death during even moderate exertion. Exclusion from high-level sporting activity may be mandated in some cases, and pre-participation screening of competitive athletes plays an important role in the identification of such individuals. The issue of screening is complicated by the fact that physiological cardiovascular adaptation in healthy athletes, including modest left ventricular hypertrophy and biventricular cavity dilatation, may create a diagnostic overlap with pathological conditions such as hypertrophic cardiomyopathy. Furthermore, much interest has focused recently on the possibility of irreversible cardiac remodeling in a proportion of veteran endurance athletes, with the potential for arrhythmogenesis and adverse cardiac events.
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Affiliation(s)
- Abbas Zaidi
- Department of Cardiovascular Sciences, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
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617
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Affiliation(s)
- Philipp Bohm
- a Institute of Sports and Preventive Medicine , Saarland University , Saarbrücken , Germany
| | | | - Tim Meyer
- a Institute of Sports and Preventive Medicine , Saarland University , Saarbrücken , Germany
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618
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Bohm P, Ditzel R, Ditzel H, Urhausen A, Meyer T. Resting ECG findings in elite football players. J Sports Sci 2013; 31:1475-80. [DOI: 10.1080/02640414.2013.796067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Philipp Bohm
- a Institute of Sports and Preventive Medicine , Saarland University , Saarbrücken , Germany
| | - Roman Ditzel
- b Medical Office (for internal medicine) Mönchengladbach , Mönchengladbach , Germany
| | - Heribert Ditzel
- b Medical Office (for internal medicine) Mönchengladbach , Mönchengladbach , Germany
| | - Axel Urhausen
- c Center of Locomotor System, Sports Medicine and Prevention, Centre Hospitalier de Luxembourg et CRP-santé , Luxembourg
| | - Tim Meyer
- a Institute of Sports and Preventive Medicine , Saarland University , Saarbrücken , Germany
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619
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Deac M, Alpendurada F, Fanaie F, Vimal R, Carpenter JP, Dawson A, Miller C, Roussin I, di Pietro E, Ismail TF, Roughton M, Wong J, Dawson D, Till JA, Sheppard MN, Mohiaddin RH, Kilner PJ, Pennell DJ, Prasad SK. Prognostic value of cardiovascular magnetic resonance in patients with suspected arrhythmogenic right ventricular cardiomyopathy. Int J Cardiol 2013; 168:3514-21. [PMID: 23701935 DOI: 10.1016/j.ijcard.2013.04.208] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 04/26/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Early recognition and accurate risk stratification are important in the management of arrhythmogenic right ventricular cardiomyopathy (ARVC). Identification of predictors of outcome by cardiovascular magnetic resonance (CMR) in patients undergoing evaluation for ARVC is limited. We investigated the predictive value of morphological abnormalities detected by CMR for major clinical events in patients with suspected ARVC. METHODS We performed a longitudinal study on 369 consecutive patients with at least one criterion for ARVC. Abnormal CMR was defined by the presence of one of the following: increased right ventricular (RV) volumes, reduced RV ejection fraction, RV regional wall motion abnormalities, myocardial fatty infiltration, and myocardial fibrosis. The end-point was a composite of cardiac death, sustained ventricular tachycardia, ventricular fibrillation, and appropriate ICD discharge. RESULTS Twenty patients met the composite end-point over a mean follow-up of 4.3±1.5 years. An abnormal CMR was an independent predictor of outcomes (p<0.001). The presence of multiple abnormalities heralded a particular high risk of events (HR 23.0, 95% CI 5.7-93.2, p<0.001 for 2 abnormalities; HR 35.8, 95% CI 9.7-132.6, p<0.001 for 3 or more abnormalities). The positive predictive value of an abnormal CMR study was 21.0% for an adverse event, whilst the negative predictive value of a normal CMR study was 98.8% over the follow-up period. CONCLUSIONS CMR provides important prognostic information in patients under evaluation for ARVC. A normal study portends a good prognosis. Conversely, the presence of multiple abnormalities identifies a high risk group of patients who may benefit from ICD implantation.
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Affiliation(s)
- Monica Deac
- Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom; Centre d'Imagerie de Morges, Morges, Switzerland
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620
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Olympia RP, Brady J. Emergency preparedness in high school-based athletics: a review of the literature and recommendations for sport health professionals. PHYSICIAN SPORTSMED 2013; 41:15-25. [PMID: 23703513 DOI: 10.3810/psm.2013.05.2008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Approximately 7.6 million high school students in the United States participate in sports. Although most sport-related injuries in adolescents are considered minor emergencies, life-threatening illnesses or injuries may occur, such as sudden cardiac arrest, heat stroke, status asthmaticus and exercise-induced asthma, catastrophic brain injuries, cervical spine injuries, heat- and cold-related illness, blunt chest/abdominal injuries, and extremity fractures resulting in compartment syndrome. Emergency preparedness in athletics involves the identification of and planning for medical services to promote the safety of the athlete, to limit injury, and to provide medical care at the site of practice or competition. Several national organizations have published guidelines for emergency preparedness in school-based athletics. Our article reviews guidelines for emergency preparedness put forth by the Sideline Preparedness collaboration (comprised of 6 major professional associations, including the American Academy of Family Physicians, American Academy of Orthopedic Surgeons, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine), the National Athletic Trainers' Association, the American Academy of Pediatrics' Committee on School Health, and the American Heart Association. Additionally, we review published data examining compliance of US high schools with these recommendations for emergency preparedness in school-based athletics, determine deficiencies, and provide recommendations for improvement based on these deficiencies.
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Affiliation(s)
- Robert P Olympia
- Department of Emergency Medicine and Pediatrics, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center/Penn State Milton S. Hershey Children's Hospital, Hershey, PA 17033-0850, USA.
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621
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Schmied C, Drezner J, Kramer E, Dvorak J. Cardiac events in football and strategies for first-responder treatment on the field. Br J Sports Med 2013; 47:1175-8. [DOI: 10.1136/bjsports-2012-091918] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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622
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Redon C, Coudreuse JM, Pruvost J, Viton JM, Delarque A, Gentile G. Le médecin généraliste face au certificat médical de non contre-indication à la pratique sportive : à propos d’une enquête de pratique. Sci Sports 2013. [DOI: 10.1016/j.scispo.2012.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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623
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Abstract
Sudden cardiac death is a rare but socially devastating event. The most common causes of sudden cardiac death are congenital electrical disorders and structural heart diseases. The majority of these diseases have an incomplete penetrance and variable expression; therefore, patients may be unaware of their illness. In several cases, physical activity can be the trigger for sudden cardiac death as first symptom. Our purpose is to review the causes of sudden cardiac death in sportive children and young adults and its genetic background. Symptomatic individuals often receive an implantable cardioverter-defibrillator, the preventive treatment for sudden cardiac death in most of cases due to channelopathies, which can become a challenging option in young and active patients. The identification of one of these diseases in asymptomatic patients has similarly a great impact on their everyday life, especially on their ability to undertake competitive physical activities, and the requirement of prophylactic treatment. We review main causes of sudden cardiac death in relation to its genetics and diagnostic work-up
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624
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The True Incremental Cost of ECG Screening: The Price Is Not Right, But the Cost Appears Effective. J Am Coll Cardiol 2013; 61:1553-4. [DOI: 10.1016/j.jacc.2013.01.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 01/03/2013] [Indexed: 12/29/2022]
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625
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Pilmer CM, Porter B, Kirsh JA, Hicks AL, Gledhill N, Jamnik V, Faught BE, Hildebrandt D, McCartney N, Gow RM, Goodman J, Krahn AD. Scope and nature of sudden cardiac death before age 40 in Ontario: A report from the Cardiac Death Advisory Committee of the Office of the Chief Coroner. Heart Rhythm 2013; 10:517-23. [DOI: 10.1016/j.hrthm.2012.12.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Indexed: 10/27/2022]
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626
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Viskin S, Halkin A, Steinvil A, Rosso R. Reply. J Am Coll Cardiol 2013; 61:1554. [DOI: 10.1016/j.jacc.2013.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 01/15/2013] [Indexed: 10/27/2022]
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627
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Schmied C, Di Paolo FM, Zerguini AY, Dvorak J, Pelliccia A. Screening athletes for cardiovascular disease in Africa: a challenging experience. Br J Sports Med 2013; 47:579-84. [DOI: 10.1136/bjsports-2012-091803] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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628
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629
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Guenancia C, Loffroy R, Chagué F, Cottin Y, Cochet A. Sudden cardiac death: Beware of hasty diagnosis! J Cardiol Cases 2013; 7:e68-e70. [DOI: 10.1016/j.jccase.2012.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 10/16/2012] [Indexed: 11/26/2022] Open
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630
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Chandra N, Bastiaenen R, Papadakis M, Sharma S. Sudden Cardiac Death in Young Athletes. J Am Coll Cardiol 2013; 61:1027-40. [DOI: 10.1016/j.jacc.2012.08.1032] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 07/17/2012] [Accepted: 08/13/2012] [Indexed: 01/02/2023]
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631
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632
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Niwa K. Coronary artery anomaly and sudden death-Especially focus on anomalous left coronary artery arising from the right sinus. J Cardiol Cases 2013; 7:e86-e88. [PMID: 30533130 PMCID: PMC6275240 DOI: 10.1016/j.jccase.2012.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Indexed: 12/02/2022] Open
Affiliation(s)
- Koichiro Niwa
- Department of Cardiology and Adult CHD Program, Cardiovascular Center, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan
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633
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634
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635
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Suárez-Mier MP, Aguilera B, Mosquera RM, Sánchez-de-León MS. Pathology of sudden death during recreational sports in Spain. Forensic Sci Int 2013; 226:188-96. [DOI: 10.1016/j.forsciint.2013.01.016] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 09/12/2012] [Accepted: 01/15/2013] [Indexed: 10/27/2022]
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636
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Kaltman JR, Burns KM, Pearson GD. Screening in pediatrics-more questions than answers? J Pediatr 2013; 162:454-6. [PMID: 23164312 DOI: 10.1016/j.jpeds.2012.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 08/08/2012] [Accepted: 10/05/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Jonathan R Kaltman
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD 20892, USA.
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637
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Arrhythmias in athletes: evidence-based strategies and challenges for diagnosis, management, and sports eligibility. Cardiol Rev 2013; 21:229-38. [PMID: 23422016 DOI: 10.1097/crd.0b013e31827fd9ab] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Assessment and management of cardiac rhythm disorders in athletes is particularly challenging. An accurate diagnosis and optimal risk-stratification are often limited because of substantial phenotypic overlap between pathological entities and adaptive cardiovascular responses that normally occur in athletes. An accurate diagnosis, however, is particularly important in this population, as 2 competing risks need to be cautiously balanced: the risk of under-diagnosis of an arrhythmogenic substrate that may trigger life-threatening events versus the risk of over-diagnosis that may result in an athlete's improper disqualification. Accordingly, the management of arrhythmias in athletes may pose therapeutic dilemmas, and often differs substantially compared with the general population. In this review, we present the most frequently observed arrhythmias in athletes and briefly discuss their pathophysiologic substrate. We further propose diagnostic and therapeutic strategies based upon current guidelines, official recommendations, and emerging evidence from relevant clinical investigations. We focus particularly on disparities in current guidelines regarding the management of certain rhythm disorders, as these areas of uncertainty may reflect the challenging nature of these disorders and may indicate the need for individualized approaches in every-day clinical practice. A better understanding of the normal electrophysiological responses to chronic exercise, and of the pathophysiological basis and the true clinical significance of arrhythmias in athletes, may enhance decision-making, and may allow for management strategies which more prudently weigh the risk-to-benefit ratio of each approach.
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638
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Steriotis AK, Nava A, Rigato I, Mazzotti E, Daliento L, Thiene G, Basso C, Corrado D, Bauce B. Noninvasive cardiac screening in young athletes with ventricular arrhythmias. Am J Cardiol 2013; 111:557-62. [PMID: 23219000 PMCID: PMC3569714 DOI: 10.1016/j.amjcard.2012.10.044] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 10/17/2012] [Accepted: 10/17/2012] [Indexed: 01/02/2023]
Abstract
The aim of this study was to analyze using noninvasive cardiac examinations a series of young athletes discovered to have ventricular arrhythmias (VAs) during the preparticipation screening program for competitive sports. One hundred forty-five athletes (mean age 17 ± 5 years) were evaluated. The study protocol included electrocardiography (ECG), exercise testing, 2-dimensional and Doppler echocardiography, 24-hour Holter monitoring, signal-averaged ECG, and in selected cases contrast-enhanced cardiac magnetic resonance imaging. Results of ECG were normal in most athletes (85%). VAs were initially detected prevalently during exercise testing (85%) and in the remaining cases on ECG and Holter monitoring. Premature ventricular complexes disappeared during exercise in 56% of subjects. Premature ventricular complexes during Holter monitoring averaged 4,700 per day, predominantly monomorphic (88%), single, and/or in couplets (79%). The most important echocardiographic findings were mitral valve prolapse in 29 patients (20%), congenital heart disease in 4 (3%), and right ventricular regional kinetic abnormalities in 5 (3.5%). On cardiac magnetic resonance imaging, right ventricular regional kinetic abnormalities were detected in 9 of 30 athletes and were diagnostic of arrhythmogenic right ventricular cardiomyopathy in only 1 athlete. Overall, 30% of athletes were judged to have potentially dangerous VAs. In asymptomatic athletes with prevalently normal ECG, most VAs can be identified by adding an exercise test during preparticipation screening. In conclusion, cardiac screening with noninvasive examinations remains a fundamental tool for the identification of a possible pathologic substrate and for the characterization of electrical instability.
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639
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640
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Halkin A, Steinvil A, Rosso R, Adler A, Rozovski U, Viskin S. Preventing sudden death of athletes with electrocardiographic screening: what is the absolute benefit and how much will it cost? J Am Coll Cardiol 2013. [PMID: 23194938 DOI: 10.1016/j.jacc.2012.09.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study sought to estimate the costs of a national electrocardiographic (ECG) screening of athletes in the United States and the number of lives that would be saved by that program. BACKGROUND A single study from Italy suggests that mandatory ECG screening of athletes reduces their risk of sudden cardiac death. Based on that study, ECG screening of athletes is endorsed by the European Society of Cardiology, though not by the American Heart Association. The widespread application of ECG screening remains controversial because the absolute reduction of sudden cardiac death risk provided, and its economic ramifications, have not been studied in detail. METHODS A cost-projection model was based on the Italian study, replicating its data in terms of athlete characteristics and physician performance. The size of the screening-eligible population was estimated from data provided by the National Collegiate Athletic Association and the National Federation of State High School Associations. The costs of diagnostic tests were obtained from Medicare reimbursement rates. RESULTS A 20-year program of ECG screening of young competitive athletes in the United States would cost between $51 and $69 billion and could be expected to save 4,813 lives. Accordingly, the cost per life saved is likely to range between $10.6 and $14.4 million. CONCLUSIONS Our cost-projection model suggests that replicating the Italian strategy of ECG screening in the United States would result in enormous costs per life saved.
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Affiliation(s)
- Amir Halkin
- Department of Cardiology, Sourasky Tel-Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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641
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Abstract
Hypertrophic cardiomyopathy is a common inherited cardiovascular disease present in one in 500 of the general population. It is caused by more than 1400 mutations in 11 or more genes encoding proteins of the cardiac sarcomere. Although hypertrophic cardiomyopathy is the most frequent cause of sudden death in young people (including trained athletes), and can lead to functional disability from heart failure and stroke, the majority of affected individuals probably remain undiagnosed and many do not experience greatly reduced life expectancy or substantial symptoms. Clinical diagnosis is based on otherwise unexplained left-ventricular hypertrophy identified by echocardiography or cardiovascular MRI. While presenting with a heterogeneous clinical profile and complex pathophysiology, effective treatment strategies are available, including implantable defibrillators to prevent sudden death, drugs and surgical myectomy (or, alternatively, alcohol septal ablation) for relief of outflow obstruction and symptoms of heart failure, and pharmacological strategies (and possibly radiofrequency ablation) to control atrial fibrillation and prevent embolic stroke. A subgroup of patients with genetic mutations but without left-ventricular hypertrophy has emerged, with unresolved natural history. Now, after more than 50 years, hypertrophic cardiomyopathy has been transformed from a rare and largely untreatable disorder to a common genetic disease with management strategies that permit realistic aspirations for restored quality of life and advanced longevity.
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Affiliation(s)
- Barry J Maron
- The Hypertrophic Cardiomyopathy Centers of Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
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642
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Sitges M, Gutiérrez JA, Brugada J, Balius R, Bellver M, Brotons D, Canal R, Comaposada J, Comellas C, Doñate M, Drobnic F, Escoda J, Ferrés P, Franco L, Galilea P, García Nieto JN, Garrido E, González Peris M, Mónaco M, Mont L, Peirau X, Pifarré F, Pons de Beristain C, Porcar C, Ribas J, Rodas G, Rubio FX, Sarquella-Brugada G, Sitjà J, Sitges I, Solanas X, Til L, Tintoré S, Turmo A, Valle X, Vives J, Vinuesa A, de Yzaguirre I. Consens per a la prevenció de la mort sobtada cardíaca en els esportistes. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.apunts.2012.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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643
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644
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AAGAARD PHILIP, SAHLÉN ANDERS, BERGFELDT LENNART, BRAUNSCHWEIG FRIEDER. Preparticipation Evaluation of Novice, Middle-Age, Long-Distance Runners. Med Sci Sports Exerc 2013; 45:130-7. [DOI: 10.1249/mss.0b013e31826c5552] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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645
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Elmaghawry M, Migliore F, Mohammed N, Sanoudou D, Alhashemi M. Science and practice of arrhythmogenic cardiomyopathy: A paradigm shift. Glob Cardiol Sci Pract 2013; 2013:63-79. [PMID: 24689002 PMCID: PMC3963726 DOI: 10.5339/gcsp.2013.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 03/06/2013] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Federico Migliore
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Nazar Mohammed
- The Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Despina Sanoudou
- Department of Pharmacology, Medical School, University of Athens, Greece
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646
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La Gerche A. Can Intense Endurance Exercise Cause Myocardial Damage and Fibrosis? Curr Sports Med Rep 2013; 12:63-9. [DOI: 10.1249/jsr.0b013e318287488a] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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647
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Bruschke AVG, Veltman CE, de Graaf MA, Vliegen HW. Myocardial bridging: what have we learned in the past and will new diagnostic modalities provide new insights? Neth Heart J 2012. [PMID: 23197048 DOI: 10.1007/s12471-012-0355-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The clinical significance of myocardial bridging has been a subject of discussion and controversy since the introduction of coronary arteriography (CAG) in the early 1960s. More recently computed tomography coronary angiography (CTCA) has made it possible to visualise the overlying muscular bands and appears to have a higher sensitivity for detecting myocardial bridging than CAG. Combining CTCA with invasive techniques such as CAG should make it possible to improve our understanding of the pathophysiology of myocardial bridging and to provide answers to hitherto unresolved questions. This paper critically reviews the outcomes of previous studies and defines remaining questions that should be answered to optimise the management of the presumably fast growing number of patients in whom a diagnosis of myocardial bridging has been made.
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Affiliation(s)
- A V G Bruschke
- Department of Cardiology -C5, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands,
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648
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649
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650
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Dougherty KR, Friedman RA, Link MS, Estes NAM. Prediction and prevention of sudden death in young populations: the role of ECG screening. J Interv Card Electrophysiol 2012. [DOI: 10.1007/s10840-012-9755-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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