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Sollazzo F, Palmieri V, Gervasi SF, Cuccaro F, Modica G, Narducci ML, Pelargonio G, Zeppilli P, Bianco M. Sudden Cardiac Death in Athletes in Italy during 2019: Internet-Based Epidemiological Research. ACTA ACUST UNITED AC 2021; 57:medicina57010061. [PMID: 33445447 PMCID: PMC7827560 DOI: 10.3390/medicina57010061] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/04/2021] [Accepted: 01/08/2021] [Indexed: 02/02/2023]
Abstract
Background and objectives: An Italian nationwide pre-participation screening approach for prevention of sudden cardiac death in athletes (SCD-A) in competitive sportspeople showed promising results but did not achieve international consensus, due to cost-effectiveness and the shortfall of a monitoring plan. From this perspective, we tried to provide an epidemiological update of SCD-A in Italy through a year-long internet-based search. Materials and Methods: One year-long Google search was performed using mandatory and non-mandatory keywords. Data were collected according to prevalent SCD-A definition and matched with sport-related figures from Italian National Institute of Statistics (ISTAT) and Italian National Olympic Committee (CONI). Results: Ninety-eight cases of SCD-A in 2019 were identified (48.0% competitive, 52.0% non-competitive athletes). Male/female ratio was 13:1. The most common sports were soccer (33.7%), athletics (15.3%) and fitness (13.3%). A conclusive diagnosis was achieved only in 37 cases (33 of cardiac origin), with the leading diagnosis being coronary artery disease in 27 and a notably higher occurrence among master athletes. Combining these findings with ISTAT and CONI data, the SCD-A incidence rate in the whole Italian sport population was found to be 0.47/100,000 persons per year (1.00/100,000 in the competitive and 0.32/100,000 in the non-competitive population). The relative risk of SCD-A is 3.1 (CI 2.1–4.7; p < 0.0001) for competitive compared to non-competitive athletes; 9.9 for male (CI 4.6–21.4; p < 0.0001) with respect to female. Conclusions: We provided an updated incidence rate of SCD-A in both competitive and non-competitive sport in Italy. A higher risk of SCD-A among competitive and male athletes was confirmed, thus corroborating the value of Italian pre-participation screening in this population.
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Affiliation(s)
- Fabrizio Sollazzo
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.S.); (S.F.G.); (F.C.); (G.M.); (P.Z.); (M.B.)
| | - Vincenzo Palmieri
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.S.); (S.F.G.); (F.C.); (G.M.); (P.Z.); (M.B.)
- Correspondence: ; Tel.: +39-06-3015-4078; Fax: +39-06-3015-6656
| | - Salvatore Francesco Gervasi
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.S.); (S.F.G.); (F.C.); (G.M.); (P.Z.); (M.B.)
| | - Francesco Cuccaro
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.S.); (S.F.G.); (F.C.); (G.M.); (P.Z.); (M.B.)
| | - Gloria Modica
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.S.); (S.F.G.); (F.C.); (G.M.); (P.Z.); (M.B.)
| | - Maria Lucia Narducci
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Istituto di Cardiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.L.N.); (G.P.)
| | - Gemma Pelargonio
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Istituto di Cardiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.L.N.); (G.P.)
| | - Paolo Zeppilli
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.S.); (S.F.G.); (F.C.); (G.M.); (P.Z.); (M.B.)
| | - Massimiliano Bianco
- Unità Operativa Complessa di Medicina dello Sport e Rieducazione Funzionale, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.S.); (S.F.G.); (F.C.); (G.M.); (P.Z.); (M.B.)
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Stormholt ER, Svane J, Lynge TH, Tfelt-Hansen J. Symptoms Preceding Sports-Related Sudden Cardiac Death in Persons Aged 1-49 Years. Curr Cardiol Rep 2021; 23:8. [PMID: 33409809 DOI: 10.1007/s11886-020-01438-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Sports-related sudden cardiac death (Sr-SCD) is a leading natural cause of death in young athletes. To prevent Sr-SCD in athletes, it is important to identify individuals at risk. This review sought to summarize the current knowledge of symptoms prior to Sr-SCD in athletes aged 1-49 years. RECENT FINDINGS Cardiovascular screening of athletes is a subject of interest. However, the cost of ECG screening in a young population is relatively high compared to potential benefits, and systematic screening of athletes is heavily debated. In the background population, both cardiac and non-specific symptoms are often present prior to SCD. Both cardiac and non-specific symptoms are present in up to 74% prior to Sr-SCD. The main symptoms are syncope, chest pain, palpitations and dizziness. Knowledge of symptoms could potentially be used in combination with non-invasive prediction models to prevent Sr-SCD and treat athletes at risk.
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Affiliation(s)
- Emma Ritsmer Stormholt
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Jesper Svane
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
- Section of Forensic Pathology, Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark
| | - Thomas Hadberg Lynge
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
- Section of Forensic Pathology, Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark
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153
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Zogović B, Stašević M, Radić I. The role of the electrocardiogram in identifying the risk of sudden cardiac death. PRAXIS MEDICA 2021. [DOI: 10.5937/pramed2104001z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Introduction: Sudden cardiac death (SCD) represents the unexpected and sudden death of young apparently healthy people. Alarge number of examined cases referred to professional athletes. There is not enough data in the literature related to those who performed sports in a sporadic and recreational manner. In order to prevent SCD, a screening protocol was determined, in which, an ECG performed at rest plays a important role. Based on the established criteria, changes on the ECG can be treated as normal, borderline and abnormal. An abnormal result indicates a risk of SCD. Objective: The aim of this study was to determine the risk of SCD in students who practice physical activity recreationally. Methods: The research involved 500 students (both sexes) of the 1st and 3rd year of study on the University of Pristina situated in Kosovska Mitrovica. As part of the regular systematic examination, an ECG was performed at rest. The risk of SCD was determined by analyzing the changes on the ECG and grouping them based on screening recommendations. Results: The obtained results show that 44% of students had changes on the ECG and that 8% of students had an abnormal result indicated a possible risk of sudden cardiac death. Conclusion: Therefore, timely recognizing and interpreting ECG changes in accordance with screening recommendations is an imperative for identification and possible prevention of SCD.
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Mauskopf J, Masaquel C, Huang L. Evaluating Vaccination Programs That Prevent Diseases With Potentially Catastrophic Health Outcomes: How Can We Capture the Value of Risk Reduction? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:86-90. [PMID: 33431158 PMCID: PMC7550269 DOI: 10.1016/j.jval.2020.06.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/12/2020] [Accepted: 06/28/2020] [Indexed: 05/22/2023]
Abstract
In the last 5 years, guidelines have been developed for performing cost-effectiveness analyses (CEAs) for the economic evaluation of vaccination programs against infectious diseases. However, these cost-effectiveness guidelines do not provide specific guidance for including the value of reducing the risk of rare but potentially catastrophic health outcomes, such as mortality or long-term sequelae. Alternative economic evaluation methods, including extended CEA, the impact inventory, cost-benefit analyses, willingness to pay or the value of a statistical life, to capture the value of this risk reduction could provide more complete estimates of the value of vaccination programs for diseases with potentially catastrophic health and nonhealth outcomes. In this commentary, using invasive meningococcal disease as an example, we describe these alternative approaches along with examples to illustrate how the benefits of vaccination in reducing risk of catastrophic health outcomes can be valued. These benefits are not usually captured in CEAs that only include population benefits estimated as the quality-adjusted life-years gained and reduced costs from avoided cases.
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155
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Beffagna G, Sommariva E, Bellin M. Mechanotransduction and Adrenergic Stimulation in Arrhythmogenic Cardiomyopathy: An Overview of in vitro and in vivo Models. Front Physiol 2020; 11:568535. [PMID: 33281612 PMCID: PMC7689294 DOI: 10.3389/fphys.2020.568535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/19/2020] [Indexed: 01/09/2023] Open
Abstract
Arrhythmogenic Cardiomyopathy (AC) is a rare inherited heart disease, manifesting with progressive myocardium degeneration and dysfunction, and life-threatening arrhythmic events that lead to sudden cardiac death. Despite genetic determinants, most of AC patients admitted to hospital are athletes or very physically active people, implying the existence of other disease-causing factors. It is recognized that AC phenotypes are enhanced and triggered by strenuous physical activity, while excessive mechanical stretch and load, and repetitive adrenergic stimulation are mechanisms influencing disease penetrance. Different approaches have been undertaken to recapitulate and study both mechanotransduction and adrenergic signaling in AC, including the use of in vitro cellular and tissue models, and the development of in vivo models (particularly rodents but more recently also zebrafish). However, it remains challenging to reproduce mechanical load stimuli and physical activity in laboratory experimental settings. Thus, more work to drive the innovation of advanced AC models is needed to recapitulate these subtle physiological influences. Here, we review the state-of-the-art in this field both in clinical and laboratory-based modeling scenarios. Specific attention will be focused on highlighting gaps in the knowledge and how they may be resolved by utilizing novel research methodology.
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Affiliation(s)
- Giorgia Beffagna
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy.,Department of Biology, University of Padua, Padua, Italy
| | - Elena Sommariva
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Milena Bellin
- Department of Biology, University of Padua, Padua, Italy.,Veneto Institute of Molecular Medicine, Padua, Italy.,Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
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156
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Niederseer D, Rossi VA, Kissel C, Scherr J, Caselli S, Tanner FC, Bohm P, Schmied C. Role of echocardiography in screening and evaluation of athletes. Heart 2020; 107:heartjnl-2020-317996. [PMID: 33203709 DOI: 10.1136/heartjnl-2020-317996] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/19/2022] Open
Abstract
The term athlete's heart describes structural, functional and electrical adaptations of the cardiovascular system due to repetitive intense exercise. Physiological cardiac adaptations in athletes, however, may mimic features of cardiac diseases and therefore make it difficult to distinguish physiological adaptions from disease. Furthermore, regular exercise may also lead to pathological adaptions that can promote or worsen cardiac disease (eg, atrial dilation/atrial fibrillation, aortic dilation/aortic dissection and rhythm disorders). Sudden cardiac death (SCD) is a major concern in sports cardiology, and preparticipation screening (PPS) has demonstrated to be effective in identifying athletes at risk for SCD. In Europe, PPS is advocated to include personal and family history, physical examination and ECG, with further workup including echocardiography only if the initial screening investigations show abnormal findings. We review the current available evidence for echocardiography as a screening tool for conditions associated with SCD in recreational and professional athletes and advocate to include screening echocardiography to be performed at least twice in an athlete's career. We recommend that the first echocardiography is performed during adolescence to rule out structural heart conditions associated with SCD that cannot be detected by ECG, especially mitral valve prolapse, coronary artery anomalies, bicuspid aortic valve and dilatation of the aorta. A second echocardiography could be performed from the age of 30-35 years, when athletes age and become master athletes, to especially evaluate pathological cardiac remodelling to exercise (eg, atrial and/or right ventricular dilation), late onset cardiomyopathies and wall motion abnormalities due to myocarditis or coronary artery disease.
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Affiliation(s)
- David Niederseer
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Valentina Alice Rossi
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christine Kissel
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Johannes Scherr
- University Center for Prevention and Sports Medicine, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Stefano Caselli
- Cardiovascular Center Zurich, Hirslanden, Klinik im Park, Zurich, Switzerland
| | - Felix C Tanner
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp Bohm
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian Schmied
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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157
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Schöffl I, Wüstenfeld J, Jones G, Dittrich S, Lutter C, Schöffl V. Athlete's Heart in Elite Sport Climbers: Cardiac Adaptations Determined Using ECG and Echocardiography Data. Wilderness Environ Med 2020; 31:418-425. [PMID: 33189521 DOI: 10.1016/j.wem.2020.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Sudden cardiac death in a young athlete is the leading cause of mortality in athletes during sport. Specific knowledge about cardiac adaptations are necessary for a better understanding of the underlying causes of such events. METHODS A retrospective analysis of the electrocardiogram and echocardiographic data obtained during the yearly medical examination of the entire German junior national climbing team was undertaken. First, data from 1 examination were used. In a second step, data from 2 examinations spaced 2 y apart were analyzed for a selected subgroup to gain more knowledge about adaptations to climbing. The data from the subgroup were compared to an age- and sex-matched control group of Nordic skiers from the German junior national Nordic skiing team. RESULTS Forty-seven young climbers (20 girls, 27 boys) were examined once. There were no pathological findings in the electrocardiogram or echocardiography. The left ventricular (LV) measurements fell between those for athletes and nonathletes. Eight boys and 6 girls from this group were tested twice over a timeframe of 27.5 mo. All LV measurements increased over time. After 2 y, the measurements from the climbers were comparable to those of the Nordic skiers. CONCLUSIONS Hypertrophic cardiomyopathy (hypertrophy of the LV) is the leading cause of sudden cardiac death in athletes. An increase in LV dimensions was observed in the young climbers in this study. LV dimensions being comparable to high-level Nordic skiers after 2 y in the national team imply structural changes over time in this cohort.
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Affiliation(s)
- Isabelle Schöffl
- Department of Pediatric Cardiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany; Section of Sportsmedicine and Sports Orthopaedics, Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany; School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom.
| | - Jan Wüstenfeld
- Insitute for Applied Exercise Science, University Leipzig, Leipzig, Germany
| | - Gareth Jones
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom
| | - Sven Dittrich
- Department of Pediatric Cardiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany
| | - Chris Lutter
- Department of Orthopaedics, University Hospital Rostock, Rostock, Germany
| | - Volker Schöffl
- Section of Sportsmedicine and Sports Orthopaedics, Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, Germany; School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, United Kingdom; Department of Emergency Medicine, Section Wilderness Medicine, University of Colorado School of Medicine, Denver, CO
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158
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Hallak YO, Battistin U, Al-Masaeed AM. Cardiac Screening to Mitigate the Risk of Sudden Cardiac Death in Middle Eastern and African Competitive Athletes. A Systematic Review. J Saudi Heart Assoc 2020; 32:174-185. [PMID: 33154912 PMCID: PMC7640562 DOI: 10.37616/2212-5043.1047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/05/2020] [Accepted: 04/15/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The study aims to review the literature regarding abnormalities predisposing to Sudden Cardiac Death (SCD) in young Middle Eastern and African competitive athletes between the years 2009-2019 and aims to assess cardiac pre-participation screening methods. METHODS A PubMed search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search targeted articles that reported the prevalence of cardiac abnormalities found in Middle Eastern and African athletes, and it also focused on comparing cardiac screening methods for assessment of athletes. RESULTS our studies fell within the inclusion criteria and were included in the study. Results identified a shortage in the literature regarding prevalence rates of SCD in the Middle East and Africa. Additionally, there seems to be a lack of ethnicity-specific cardiac pre-participation screening programs in the region. Nevertheless, the prevalence of SCD-related abnormalities (HCM, ARVC, etc …) ranged from 0.47 to 4.29%. Included studies conveyed only male athletes with no reports on the female athletic population. CONCLUSION The present study highlights a need to develop an efficient cardiac pre-participation screening program specific to Arab and African athletes due to their high false-positive rates in contrast to Caucasian athletes. Significant evidence proves that an adequate cardiac screening program can prevent SCD in young competitive athletes. Therefore, it is imperative that future studies highlight the prevalence of abnormalities directly related to SCD in order to create a valid screening program that can be implemented in the region to mitigate the risk of shocking events.
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Affiliation(s)
- Yusuf Omar Hallak
- College of Medicine, Mohammad Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Umberto Battistin
- College of Medicine, Mohammad Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Tso J, Turner CG, Kim JH. A Hidden Threat: Anomalous Aortic Origins of the Coronary Arteries in Athletes. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020; 22. [PMID: 34177246 DOI: 10.1007/s11936-020-00859-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose of Review Anomalous aortic origins of the coronary arteries (AAOCA) are a primary cause of sudden cardiac death in athletes. This review will detail the epidemiology, pathophysiology, and risk stratification of AAOCA, while also highlighting return-to-play considerations for athletes. Recent Findings Sport pre-participation cardiovascular screening methods lack sensitivity and specificity in the identification of AAOCA. For the symptomatic athlete, clinicians must maintain a heightened clinical suspicion for AAOCA in order to proceed with appropriate cardiac imaging and functional assessments. Anomalous origin of the left coronary artery with an interarterial course is considered high-risk and requires sport restriction until surgical correction. In contrast, risks associated with anomalous origin of the right coronary artery are controversial, thus management and sports eligibility decisions may incorporate principles of shared-decision making. Summary Management options for athletes with AAOCA are complex, requiring a comprehensive clinical evaluation. While advances in multimodality cardiovascular imaging and physiologic functional assessments have improved AAOCA risk stratification, best practice treatment strategies for some AAOCA subtypes remain uncertain. As such, clinical management and sport eligibility decisions require an individualized approach. Future prospective data will guide optimization of treatment strategies for athletes with AAOCA.
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Affiliation(s)
- Jason Tso
- Division of Cardiology, Emory Clinical Cardiology Research Institute, Atlanta, GA
| | - Casey G Turner
- Division of Cardiology, Emory Clinical Cardiology Research Institute, Atlanta, GA
| | - Jonathan H Kim
- Division of Cardiology, Emory Clinical Cardiology Research Institute, Atlanta, GA
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160
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Bowman TG, Boergers RJ, Lininger MR, Kilmer AJ, Ardente M, D'Amodio G, Hughes C, Murphy M. The Effect of Lacrosse Protective Equipment on Cardiopulmonary Resuscitation and Automated External Defibrillator Shock. J Athl Train 2020; 57:446991. [PMID: 33150371 PMCID: PMC9661938 DOI: 10.4085/437-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
CONTEXT In the event of an acute cardiac event, on-field equipment removal is suggested, although it remains unknown how lacrosse equipment removal may alter time to first chest compression and time to first AED shock. OBJECTIVE To determine time to first chest compression and first AED shock in 2 chest exposure procedures with 2 different pad types. DESIGN Crossover study Setting: Simulation laboratory Participants: Thirty-six athletic trainers (21 females, 15 males; age=30.58±7.81) Main Outcome Measures: Participants worked in pairs to provide 2 rescuer CPR intervention on a simulation manikin (QCPR manikin, Laerdal Medical, Wappingers Falls, NY) outfitted with lacrosse pads and helmet. Participants completed a total of 8 trials per pair (2 chest exposure procedures X 2 pad types X 2 participant roles). The dependent variables were time to first compression (s) and time to first AED shock (s). The independent variables were chest exposure procedure with 2 levels (procedure 1: removal of helmet while initiating CPR over the pads followed by pad retraction and AED application; procedure 2: removal of helmet and removal of pads followed by CPR and AED application) and pad type (Warrior Burn Hitman shoulder pads; Warrior Nemesis chest protector). RESULTS We found a statistically significant interaction between chest exposure procedure and pad type for time to first compression (F1,35=4.66, P=0.04, ω2p=0.10) with significantly faster times during procedure 1 for both the Nemesis pads (16.1±3.4 s) and the Hitman pads (16.1±4.5 s) compared to procedure 2 (Nemesis pads: 49.6±12.9 s, P<0.0001; Hitman pads: 53.8±14.5 s, P<0.0001). CONCLUSIONS Completing the initial cycle of chest compressions over either shoulder pads or a chest protector hastens time to first chest compression without diminishing CPR quality which may improve patient outcomes. Time to first AED shock was not different between equipment procedure or pad type.
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161
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Lawrenz W. Keine ausreichende Evidenz für das EKG als obligater Bestandteil der sportmedizinischen Vorsorgeuntersuchung bei Kindern und Jugendlichen. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-00955-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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162
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Valentini F, Anselmi F, Metra M, Cavigli L, Giacomin E, Focardi M, Cameli M, Mondillo S, D'Ascenzi F. Diagnostic and prognostic value of low QRS voltages in cardiomyopathies: old but gold. Eur J Prev Cardiol 2020; 29:1177-1187. [PMID: 33624098 DOI: 10.1093/eurjpc/zwaa027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/13/2020] [Accepted: 07/30/2020] [Indexed: 02/06/2023]
Abstract
The interpretation of 12-lead resting electrocardiogram (ECG) in patients with a definitive diagnosis or with the suspicion of a cardiomyopathy represents a cornerstone for the diagnostic work up and management of patients. Although low electrocardiographic QRS voltages (LQRSV) detected by 12-lead resting ECG have historically been acknowledged by physicians, in view of recent evidence on the demonstration of myocardial scar by cardiac magnetic resonance and its relevance as a cause of sudden cardiac death even in young individuals, a new interest has been raised about the utility of LQRSV in the clinical practice. Beyond their diagnostic value, LQRSV have also demonstrated a prognostic role in different cardiomyopathies. The present review summarizes the diagnostic and prognostic value of LQRSV in cardiomyopathies, reporting the new evidence, primarily based on advanced imaging studies, supporting the clinical utility of this parameter.
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Affiliation(s)
- Francesca Valentini
- Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Francesca Anselmi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Marco Metra
- Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Elisa Giacomin
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale M. Bracci, 16, 53100 Siena, Italy
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Fabre JB, Grelot L, Vanbiervielt W, Mazerie J, Manca R, Martin V. Managing the combined consequences of COVID-19 infection and lock-down policies on athletes: narrative review and guidelines proposal for a safe return to sport. BMJ Open Sport Exerc Med 2020; 6:e000849. [PMID: 33194223 PMCID: PMC7610250 DOI: 10.1136/bmjsem-2020-000849] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/04/2020] [Accepted: 10/03/2020] [Indexed: 01/08/2023] Open
Abstract
COVID-19 pandemic is a global health matter. The disease spread rapidly across the globe and brought the world of sports to an unprecedented stoppage. Usual symptoms of the disease are fever, cough, myalgia, fatigue, slight dyspnoea, sore throat and headache. In more severe cases, dyspnoea, hypoxaemia, respiratory failure, shock and multiorgan failure occur. This appears to be a self-limiting phenomenon related to individuals with coexisting medical conditions, such as hypertension, diabetes and cardiovascular disorders. Nevertheless, cases have been reported in professional soccer players in extremely good fitness condition, demonstrating that athletes are not spared by the disease. Despite COVID-19 clinical manifestations are mainly respiratory, major cardiac complications are being reported, leading to acute myocarditis. One difficulty is that symptoms of COVID-19 vary among individuals, with athletes being affected with no apparent sign of the disease. This could be a real danger for amateur or professional athletes when returning to their usual training and thus to play. Another threat is that the lock-down policies did not allow most athletes to follow their usual training routines. There is thus a need for a careful approach by the sports medicine community to ensure safety of all athletes before they return to sport. Here, we propose evaluation guidelines of fitness and health of athletes to (1) reduce any lethal risk of practice, especially myocarditis and sudden cardiac death; (2) evaluate the combined consequences of the disease and detraining on the physical abilities and biological profile of athletes; and (3) monitor postinfection fatigue symptoms.
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Affiliation(s)
| | - Laurent Grelot
- Health and Safety Department, Aix-Marseille-University,Marseille, France
| | | | | | - Raphael Manca
- Institut Universitaire de France (IUF), Paris, France
| | - Vincent Martin
- Université Clermont Auvergne, AME2P, Clermont-Ferrand,France
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164
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Dagradi F, Spazzolini C, Castelletti S, Pedrazzini M, Kotta MC, Crotti L, Schwartz PJ. Exercise Training-Induced Repolarization Abnormalities Masquerading as Congenital Long QT Syndrome. Circulation 2020; 142:2405-2415. [PMID: 33073610 DOI: 10.1161/circulationaha.120.048916] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The diagnosis of long QT syndrome (LQTS) is rather straightforward. We were surprised by realizing that, despite long-standing experience, we were making occasional diagnostic errors by considering as affected subjects who, over time, resulted as not affected. These individuals were all actively practicing sports-an observation that helped in the design of our study. METHODS We focused on subjects referred to our center by sports medicine doctors on suspicion of LQTS because of marked repolarization abnormalities on the ECG performed during the mandatory medical visit necessary in Italy to obtain the certificate of eligibility to practice sports. They all underwent our standard procedures involving both a resting and 12-lead ambulatory ECG, an exercise stress test, and genetic screening. RESULTS There were 310 such consecutive subjects, all actively practicing sports with many hours of intensive weekly training. Of them, 111 had a normal ECG, different cardiac diseases, or were lost to follow-up and exited the study. Of the remaining 199, all with either clear QTc prolongation and/or typical repolarization abnormalities, 121 were diagnosed as affected based on combination of ECG abnormalities with positive genotyping (QTc, 482±35 ms). Genetic testing was negative in 78 subjects, but 45 were nonetheless diagnosed as affected by LQTS based on unequivocal ECG abnormalities (QTc, 472±33 ms). The remaining 33, entirely asymptomatic and with a negative family history, showed an unexpected and practically complete normalization of the ECG abnormalities (their QTc shortened from 492±37 to 423±25 ms [P<0.001]; their Schwartz score went from 3.0 to 0.06) after detraining. They were considered not affected by congenital LQTS and are henceforth referred to as "cases." Furthermore, among them, those who resumed similarly heavy physical training showed reappearance of the repolarization abnormalities. CONCLUSION It is not uncommon to suspect LQTS among individuals actively practicing sports based on marked repolarization abnormalities. Among those who are genotype-negative, >40% normalize their ECG after detraining, but the abnormalities tend to recur with resumption of training. These individuals are not affected by congenital LQTS but could have a form of acquired LQTS. Care should be exercised to avoid diagnostic errors.
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Affiliation(s)
- Federica Dagradi
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin (F.D., C.S, S.C., L.C., P.J.S.)
| | - Carla Spazzolini
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin (F.D., C.S, S.C., L.C., P.J.S.)
| | - Silvia Castelletti
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin (F.D., C.S, S.C., L.C., P.J.S.)
| | - Matteo Pedrazzini
- Istituto Auxologico Italiano, IRCCS, Laboratory of Cardiovascular Genetics (M.P., M-C.K., L.C., P.J.S.)
| | - Maria-Christina Kotta
- Istituto Auxologico Italiano, IRCCS, Laboratory of Cardiovascular Genetics (M.P., M-C.K., L.C., P.J.S.)
| | - Lia Crotti
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin (F.D., C.S, S.C., L.C., P.J.S.).,Istituto Auxologico Italiano, IRCCS, Laboratory of Cardiovascular Genetics (M.P., M-C.K., L.C., P.J.S.).,Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital (L.C.), Milan, Italy.,University of Milano-Bicocca, Department of Medicine and Surgery, Milano, Italy (L.C.)
| | - Peter J Schwartz
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin (F.D., C.S, S.C., L.C., P.J.S.).,Istituto Auxologico Italiano, IRCCS, Laboratory of Cardiovascular Genetics (M.P., M-C.K., L.C., P.J.S.)
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165
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Abela M, Sharma S. Electrocardiographic interpretation in athletes. Minerva Cardiol Angiol 2020; 69:533-556. [PMID: 33059398 DOI: 10.23736/s2724-5683.20.05331-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Participation in regular exercise of moderate intensity is associated with a plethora of systemic benefits, including a reduction in risk factors for coronary atherosclerosis; however, intensive exercise may paradoxically culminate in sudden cardiac arrest among individuals harboring arrhythmogenic substrates. The precise mechanism for arrhythmogenesis is likely multifactorial, however, surges in catecholamines, electrolyte shifts, acid-base disturbances, increased core temperature and demand myocardial ischemia are potential contributors. Although most deaths occur in middle aged and older males with atherosclerotic coronary artery disease, a significant proportion also affect young athletes with inherited or congenital cardiac abnormalities. The impact of such catastrophes on society, particularly when a young high-profile athlete is affected could be considered a justified reason for identifying individuals who may be at risk. Given the rarity of deaths in young athletes, only the simplest screening test, such as the 12-lead electrocardiography (ECG) may be considered to be cost effective. The ECG is effective for detecting serious electrical diseases in young athletes such as congenital electrical accessory pathways and ion channel diseases but can also identify athletes with potential life-threatening structural diseases such as hypertrophic and arrhythmogenic cardiomyopathy. One of the concerns about ECG screening is that regular intensive exercise results in several physiological alterations in cardiac structure and function that are reflected on the athlete's ECG. Sinus bradycardia, first-degree atrioventricular block, incomplete right bundle branch block, minor J-point elevation and large QRS voltages are common. Conversely, some repolarization anomalies affecting the ST segment, T waves and QT interval may overlap with patterns observed in patients with serious cardiac diseases. The situation is complicated further because age, sex and ethnicity of the athletes also influence the ECG and there is a risk that erroneous interpretation could have serious consequences. This review will describe the normal electrical patterns of the "athlete's heart" and provide insights into differentiation physiological electrical patterns from those observed in serious cardiac disease.
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Affiliation(s)
- Mark Abela
- Department of Cardiology, Mater Dei Hospital, Msida, Malta - .,Malta Medical School, University of Malta, Msida, Malta - .,St. George's University Hospitals, NHS Foundation Trust, St George's University, London, UK -
| | - Sanjay Sharma
- St. George's University Hospitals, NHS Foundation Trust, St George's University, London, UK
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166
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Scacciavillani R, Galli M. Potential use of frontal QRS-T angle for sudden death risk stratification in athletes. Minerva Cardiol Angiol 2020; 69:241-243. [PMID: 33059408 DOI: 10.23736/s2724-5683.20.05402-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Roberto Scacciavillani
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Mattia Galli
- Department of Cardiovascular and Thoracic Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
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167
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Ha FJ, Han HC, Sanders P, Fendel K, Teh AW, Kalman JM, O'Donnell D, Leong T, Farouque O, Lim HS. Sudden Cardiac Death in the Young: Incidence, Trends, and Risk Factors in a Nationwide Study. Circ Cardiovasc Qual Outcomes 2020; 13:e006470. [PMID: 33079584 DOI: 10.1161/circoutcomes.119.006470] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Sudden cardiac death (SCD) in the young is devastating. Contemporary incidence remains unclear with few recent nationwide studies and limited data addressing risk factors for causes. We aimed to determine incidence, trends, causes, and risk factors for SCD in the young. METHODS AND RESULTS The National Coronial Information System registry was reviewed for SCD in people aged 1 to 35 years from 2000 to 2016 in Australia. Subjects were identified by the International Classification of Diseases, Tenth Revision code relating to circulatory system diseases (I00-I99) from coronial reports. Baseline demographics, circumstances, and cause of SCD were obtained from coronial and police reports, alongside autopsy and toxicology analyses where available. During the study period, 2006 cases were identified (median age, 28±7 years; men, 75%; mean body mass index, 29±8 kg/m2). Annual incidence ranged from 0.91 to 1.48 per 100 000 age-specific person-years, which was the lowest in 2013 to 2015 compared with previous 3-year intervals on Poisson regression model (P=0.001). SCD incidence was higher in nonmetropolitan versus metropolitan areas (0.99 versus 0.53 per 100 000 person-years; P<0.001). The most common cause of SCD was coronary artery disease (40%), followed by sudden arrhythmic death syndrome (14%). Incidence of coronary artery disease-related SCD decreased from 2001-2003 to 2013-2015 (P<0.001). Proportion of SCD related to sudden arrhythmic death syndrome increased during the study period (P=0.02) although overall incidence was stable (P=0.22). Residential remoteness was associated with coronary artery disease-related SCD (odds ratio, 1.44 [95% CI, 1.24-1.67]; P<0.001). For every 1-unit increase, body mass index was associated with increased likelihood of SCD from cardiomegaly (odds ratio, 1.08 [95% CI, 1.05-1.11]; P<0.001) and dilated cardiomyopathy (odds ratio, 1.04 [95% CI, 1.01-1.06]; P=0.005). CONCLUSIONS Incidence of SCD in the young and specifically coronary artery disease-related SCD has declined in recent years. Proportion of SCD related to sudden arrhythmic death syndrome increased over the study period. Geographic remoteness and obesity are risk factors for specific causes of SCD in the young.
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Affiliation(s)
- Francis J Ha
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., H.-C.H., K.F., A.W.T., D.O., O.F., H.S.L.).,St. Vincent's Hospital Melbourne, Victoria, Australia (F.J.H.)
| | - Hui-Chen Han
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., H.-C.H., K.F., A.W.T., D.O., O.F., H.S.L.).,University of Melbourne, Victoria, Australia (H.-C.H., A.W.T., J.M.K., O.F., H.S.L.)
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australia Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital Adelaide, South Australia, Australia (P.S.)
| | - Kim Fendel
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., H.-C.H., K.F., A.W.T., D.O., O.F., H.S.L.)
| | - Andrew W Teh
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., H.-C.H., K.F., A.W.T., D.O., O.F., H.S.L.).,University of Melbourne, Victoria, Australia (H.-C.H., A.W.T., J.M.K., O.F., H.S.L.)
| | - Jonathan M Kalman
- University of Melbourne, Victoria, Australia (H.-C.H., A.W.T., J.M.K., O.F., H.S.L.).,Melbourne Heart Centre, Royal Melbourne Hospital, Victoria, Australia (J.M.K.)
| | - David O'Donnell
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., H.-C.H., K.F., A.W.T., D.O., O.F., H.S.L.)
| | - Trishe Leong
- Department of Anatomical Pathology, St. Vincent's Hospital, Melbourne, Victoria, Australia (T.L.)
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., H.-C.H., K.F., A.W.T., D.O., O.F., H.S.L.).,University of Melbourne, Victoria, Australia (H.-C.H., A.W.T., J.M.K., O.F., H.S.L.)
| | - Han S Lim
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia (F.J.H., H.-C.H., K.F., A.W.T., D.O., O.F., H.S.L.).,University of Melbourne, Victoria, Australia (H.-C.H., A.W.T., J.M.K., O.F., H.S.L.).,Department of Cardiology, Northern Health, Melbourne, Victoria, Australia (H.S.L.)
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168
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Couper K, Putt O, Field R, Poole K, Bradlow W, Clarke A, Perkins GD, Royle P, Yeung J, Taylor-Phillips S. Incidence of sudden cardiac death in the young: a systematic review. BMJ Open 2020; 10:e040815. [PMID: 33033034 PMCID: PMC7542928 DOI: 10.1136/bmjopen-2020-040815] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/28/2020] [Accepted: 09/04/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To summarise studies describing incidence of sudden cardiac death in a general population of young individuals to inform screening policy. DESIGN Systematic review. DATA SOURCES Database searches of MEDLINE, EMBASE and the Cochrane library (all inception to current) on 29 April 2019 (updated 16 November 2019), and forward/backward citation tracking of eligible studies. STUDY ELIGIBILITY CRITERIA All studies that reported incidence of sudden cardiac death in young individuals (12-39 years) in a general population, with no restriction on language or date. Planned subgroups were incidence by age, sex, race and athletic status (including military personnel). DATA EXTRACTION Two reviewers independently assessed study eligibility, extracted study data and assessed risk of bias using the Joanna Briggs Institute critical appraisal checklist for prevalence studies. ANALYSIS Reported incidence of sudden cardiac death in the young per 100 000 person-years. RESULTS 38 studies that reported incidence across five continents. We identified substantial heterogeneity in population, sudden cardiac death definition, and case ascertainment methods, precluding meta-analysis. Median reported follow-up years was 6.97 million (IQR 2.34 million-23.70 million) and number of sudden cardiac death cases was 64 (IQR 40-251). In the general population, the median of reported incidence was 1.7 sudden cardiac death per 100 000 person-years (IQR 1.3-2.6, range 0.75-11.9). Most studies (n=14, 54%) reported an incidence between one and two cases per 100 000 person-years. Incidence was higher in males and older individuals. CONCLUSIONS This systematic review identified variability in the reported incidence of sudden cardiac death in the young across studies. Most studies reported an incidence between one and two cases per 100 000 person-years. PROSPERO REGISTRATION NUMBER CRD42019120563.
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Affiliation(s)
- Keith Couper
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Oliver Putt
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | - Richard Field
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kurtis Poole
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | - William Bradlow
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Aileen Clarke
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Pamela Royle
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
| | - Joyce Yeung
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sian Taylor-Phillips
- Warwick Medical School, University of Warwick Warwick Medical School, Coventry, UK
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169
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Palumbo P, Cannizzaro E, Di Cesare A, Bruno F, Schicchi N, Giovagnoni A, Splendiani A, Barile A, Masciocchi C, Di Cesare E. Cardiac magnetic resonance in arrhythmogenic cardiomyopathies. Radiol Med 2020; 125:1087-1101. [PMID: 32978708 DOI: 10.1007/s11547-020-01289-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/08/2020] [Indexed: 12/13/2022]
Abstract
Over the past few years, the approach to the 'arrhythmic patient' has profoundly changed. An early clinical presentation of arrhythmia is often accompanied by non-specific symptoms and followed by inconclusive electrocardiographic findings. In this scenario, cardiac magnetic resonance (CMR) has been established as a clinical tool of fundamental importance for a correct prognostic stratification of the arrhythmic patient. This technique provides a high-spatial-resolution tomographic evaluation of the heart, which allows studying accurately the ventricular volumes, identifying even segmental kinetic anomalies and properly detecting diffuse or focal tissue alterations through an excellent tissue characterization, while depicting different patterns of fibrosis distribution, myocardial edema or fatty substitution. Through these capabilities, CMR has a pivotal role for the adequate management of the arrhythmic patient, allowing the identification of those phenotypic manifestations characteristic of structural heart diseases. Therefore, CMR provides valuable information to reclassify the patient within the wide spectrum of potentially arrhythmogenic heart diseases, the definition of which remains the major determinants for both an adequate treatment and a poor prognosis. The purpose of this review study was to focus on the role of CMR in the evaluation of the main cardiac clinical entities associated with arrhythmogenic phenomena and to present a brief debate on the main pathophysiological mechanisms involved in the arrhythmogenesis process.
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Affiliation(s)
- Pierpaolo Palumbo
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, AQ, Italy.
| | | | - Annamaria Di Cesare
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, AQ, Italy
| | - Nicolò Schicchi
- Department of Radiology, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Andrea Giovagnoni
- Department of Radiology, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, AQ, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, AQ, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio 1, 67100, L'Aquila, AQ, Italy
| | - Ernesto Di Cesare
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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170
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(Organization of preparticipation screening of athletes in the Czech Republic). COR ET VASA 2020. [DOI: 10.33678/cor.2020.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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171
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(Hypertrophic cardiomyopathy and sports - is it time for a change in strategy?). COR ET VASA 2020. [DOI: 10.33678/cor.2020.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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172
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Tchanana GMK, Ngantcha M, Yuyun MF, Ajijola OA, Mbouh S, Tchameni SCT, Suliman A, Bonny A. Incidence of recreational sports-related sudden cardiac arrest in participants over age 12 in a general African population. BMJ Open Sport Exerc Med 2020; 6:e000706. [PMID: 32879735 PMCID: PMC7445330 DOI: 10.1136/bmjsem-2019-000706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2020] [Indexed: 11/21/2022] Open
Abstract
Background The incidence of sports-related sudden cardiac arrest (SrSCA) in sub-Saharan Africa is unknown. Objective To determine the incidence of sudden cardiac arrest (SCA) in non-competitive athletes in an urban population of Cameroon, a country in sub-Saharan Africa. Methods Two study populations in Cameroon were used. A 12-month, multisource surveillance system of 86 189 inhabitants over 12 years old recorded all deaths in two administrative districts of Douala City. All fields of sports, emergency medical service, local medical examiners and district hospital mortuaries were surveyed. Two blinded cardiologists used a verbal autopsy protocol to determine the cause of death. SCA was identified for all deaths occurring within 1 hour of onset of symptoms. A cross-sectional study was conducted among 793 persons in Yaoundé City, which is the second study population aimed at determining the proportion of people who are physically active. Results The mean age in the cross-sectional study was 27.3±10.7, with more men (56.2%). The cross-sectional study showed that 69.0% (95% CI 65.8 to 72.2) of the population could be considered to have at least 3 hours of physical activity per week. The surveillance found that among 288 all-cause deaths, 27 (9.4%) were due to SCA. One SrSCA was registered in a 35-year-old woman while running. Merging both sources revealed an SrSCA incidence of 1.7 (95% CI 0.2 to 12.0) cases per 100 000 athletes per year. Conclusion This pioneer study reports the incidence estimates of SrSCA in a sub-Saharan African general population and should be regarded as a first step to a big problem.
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Affiliation(s)
| | | | - Matthew F Yuyun
- Harvard Medical School and VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Olujimi A Ajijola
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, Los Angeles, California, USA
| | - Samuel Mbouh
- Youth and Sport Institute, University of Yaoundé 1, Yaoundé, Cameroon
| | | | | | - Aimé Bonny
- Medicine, Centre Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, Île-de-France, France.,Cardiology Department, University of Douala, Douala, Cameroon
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173
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Ding Y, Yang J, Chen P, Lu T, Jiao K, Tester DJ, Giudicessi JR, Jiang K, Ackerman MJ, Li Y, Wang DW, Lee H, Wang DW, Xu X. Knockout of SORBS2 Protein Disrupts the Structural Integrity of Intercalated Disc and Manifests Features of Arrhythmogenic Cardiomyopathy. J Am Heart Assoc 2020; 9:e017055. [PMID: 32808564 PMCID: PMC7660791 DOI: 10.1161/jaha.119.017055] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/13/2020] [Indexed: 12/21/2022]
Abstract
Background Sorbs2b (sorbin and SH3 domain-containing 2b) was recently identified as a cardiomyopathy gene from a zebrafish mutagenesis screen. However, cardiac functions of its mammalian ortholog remain elusive. Methods and Results We conducted a detailed expression and subcellular localization analysis of Sorbs2 ortholog in mice and a phenotypic characterization in Sorbs2 knockout mice. Sorbs2 is highly expressed in the mouse heart and encodes an adhesion junction/desmosome protein that is mainly localized to the intercalated disc. A mutation with near complete depletion of the Sorbs2 protein in mice results in phenotypes characteristic of human arrhythmogenic cardiomyopathy (ACM), including right ventricular dilation, right ventricular dysfunction, spontaneous ventricular tachycardia, and premature death. Sorbs2 is required to maintain the structural integrity of intercalated disc. Its absence resulted in profound cardiac electrical remodeling with impaired impulse conduction and action potential derangements. Targeted sequencing of human patients with ACM identified 2 rare splicing variants classified as likely pathogenic were in 2 unrelated individuals with ACM from a cohort of 59 patients with ACM. Conclusions The Sorbs2 knockout mouse manifests several key features reminiscent of human ACM. Although the candidacy of SORBS2 as a new ACM-susceptibility gene is supported by preliminary human genetics study, future validation in larger cohorts with ACM is needed.
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Affiliation(s)
- Yonghe Ding
- Department of Biochemistry and Molecular BiologyMayo ClinicRochesterMN
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
| | - Jingchun Yang
- Department of Biochemistry and Molecular BiologyMayo ClinicRochesterMN
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
| | - Peng Chen
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic DisordersDivision of CardiologyDepartments of Internal Medicine and Genetic Diagnosis CenterTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Tong Lu
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
| | - Kunli Jiao
- Department of Biochemistry and Molecular BiologyMayo ClinicRochesterMN
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
- Division of CardiologyXinhua HospitalShanghai Jiaotong UniversityShanghaiChina
| | | | | | - Kai Jiang
- Division of Nephrology and HypertensionMayo ClinicRochesterMN
| | - Michael J. Ackerman
- Department of Cardiovascular Medicine (Division of Heart Rhythm Services)Mayo ClinicRochesterMN
- Pediatric and Adolescent Medicine (Division of Pediatric Cardiology)Mayo ClinicRochesterMN
- Molecular Pharmacology and Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory)Mayo ClinicRochesterMN
| | - Yigang Li
- Division of CardiologyXinhua HospitalShanghai Jiaotong UniversityShanghaiChina
| | - Dao Wu Wang
- State Key Laboratory of Reproductive MedicineClinical Center of Reproductive Medicine and Department of CardiologyFirst Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - HoN‐chi Lee
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
| | - Dao Wen Wang
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic DisordersDivision of CardiologyDepartments of Internal Medicine and Genetic Diagnosis CenterTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Xiaolei Xu
- Department of Biochemistry and Molecular BiologyMayo ClinicRochesterMN
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
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174
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Affiliation(s)
- Aaron L. Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Harvard Medical School, Boston (A.L.B.)
| | - Benjamin D. Levine
- Institute for Exercise and Environmental Medicine, The University of Texas Southwestern Medical Center, Dallas (B.D.L.)
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175
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French preparticipation physical evaluation for children in 2020: What has changed? Arch Pediatr 2020; 27:338-341. [PMID: 32736913 DOI: 10.1016/j.arcped.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/30/2020] [Accepted: 06/23/2020] [Indexed: 11/21/2022]
Abstract
At the end of 2019, there was discussion in France about whether to abolish the obligatory medical certificate of no contraindication for a minor to obtain a sports license. It was finally decided not to abolish the certificate, but it raises the question of which steps should be taken to assess the physical capacities of children. General practitioners or pediatricians are responsible for the preparticipation physical evaluation of children wishing to obtain a sports license, in particular involving over 20 mandatory consultations between the ages of 0 and 18. The purpose of the article is to propose a course of action to be taken considering the French legislation and general pediatric resources concerning the medical examination and warning signs that should lead to vigilance.
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176
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Basu J, Malhotra A, Papadakis M. Exercise and hypertrophic cardiomyopathy: Two incompatible entities? Clin Cardiol 2020; 43:889-896. [PMID: 32048747 PMCID: PMC7403677 DOI: 10.1002/clc.23343] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 01/02/2023] Open
Abstract
A greater understanding of the pathogenic mechanisms underpinning hypertrophic cardiomyopathy (HCM) has translated to improved medical care and better survival of affected individuals. Historically these patients were considered to be at high risk of sudden cardiac death (SCD) during exercise; therefore, exercise recommendations were highly conservative and promoted a sedentary life style. There is emerging evidence that suggests that exercise in HCM has a favorable effect on cardiovascular remodeling and moderate exercise programs have not raised any safety concerns. Furthermore, individuals with HCM have a similar burden of atherosclerotic risk factors as the general population in whom exercise has been associated with a reduction in myocardial infarction, stroke, and heart failure, especially among those with a high-risk burden. Small studies revealed that athletes who choose to continue with regular competition do not demonstrate adverse outcomes when compared to those who discontinue sport, and active individuals implanted with an implantable cardioverter defibrillator do not have an increased risk of appropriate shocks or other adverse events. The recently published exercise recommendations from the European Association for Preventative Cardiology account for more contemporary evidence and adopt a more liberal stance regarding competitive and high intensity sport in individuals with low-risk HCM. This review addresses the issue of exercise in individuals with HCM, and explores current evidence supporting safety of exercise in HCM, potential caveats, and areas of further research.
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Affiliation(s)
- Joyee Basu
- Cardiac Risk in the Young Clinical Research Fellow, Cardiology Clinical Academic GroupSt George's University of LondonLondonUK
| | - Aneil Malhotra
- Cardiac Risk in the Young Clinical Research Fellow, Cardiology Clinical Academic GroupSt George's University of LondonLondonUK
- Division of Cardiovascular SciencesThe University of ManchesterManchesterUK
| | - Michael Papadakis
- Cardiac Risk in the Young Clinical Research Fellow, Cardiology Clinical Academic GroupSt George's University of LondonLondonUK
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177
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Tanisawa K, Wang G, Seto J, Verdouka I, Twycross-Lewis R, Karanikolou A, Tanaka M, Borjesson M, Di Luigi L, Dohi M, Wolfarth B, Swart J, Bilzon JLJ, Badtieva V, Papadopoulou T, Casasco M, Geistlinger M, Bachl N, Pigozzi F, Pitsiladis Y. Sport and exercise genomics: the FIMS 2019 consensus statement update. Br J Sports Med 2020; 54:969-975. [PMID: 32201388 PMCID: PMC7418627 DOI: 10.1136/bjsports-2019-101532] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2019] [Indexed: 12/26/2022]
Abstract
Rapid advances in technologies in the field of genomics such as high throughput DNA sequencing, big data processing by machine learning algorithms and gene-editing techniques are expected to make precision medicine and gene-therapy a greater reality. However, this development will raise many important new issues, including ethical, moral, social and privacy issues. The field of exercise genomics has also advanced by incorporating these innovative technologies. There is therefore an urgent need for guiding references for sport and exercise genomics to allow the necessary advancements in this field of sport and exercise medicine, while protecting athletes from any invasion of privacy and misuse of their genomic information. Here, we update a previous consensus and develop a guiding reference for sport and exercise genomics based on a SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis. This SWOT analysis and the developed guiding reference highlight the need for scientists/clinicians to be well-versed in ethics and data protection policy to advance sport and exercise genomics without compromising the privacy of athletes and the efforts of international sports federations. Conducting research based on the present guiding reference will mitigate to a great extent the risks brought about by inappropriate use of genomic information and allow further development of sport and exercise genomics in accordance with best ethical standards and international data protection principles and policies. This guiding reference should regularly be updated on the basis of new information emerging from the area of sport and exercise medicine as well as from the developments and challenges in genomics of health and disease in general in order to best protect the athletes, patients and all other relevant stakeholders.
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Affiliation(s)
- Kumpei Tanisawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Guan Wang
- Collaborating Centre of Sports Medicine, University of Brighton, Eastbourne, UK
| | - Jane Seto
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Ioanna Verdouka
- Collaborating Centre of Sports Medicine, University of Brighton, Eastbourne, UK
| | - Richard Twycross-Lewis
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Antonia Karanikolou
- Collaborating Centre of Sports Medicine, University of Brighton, Eastbourne, UK
| | - Masashi Tanaka
- Department for Health and Longevity Research, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Mats Borjesson
- Department of Neuroscience and Physiology, Center for Health and Performance, Goteborg University, Göteborg, Sweden
- Sahlgrenska University Hospital/Ostra, Göteborg, Sweden
| | - Luigi Di Luigi
- Unit of Endocrinology, Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Michiko Dohi
- Sport Medical Center, Japan Institute of Sports Sciences, Tokyo, Japan
| | - Bernd Wolfarth
- Department of Sport Medicine, Humboldt University and Charité University School of Medicine, Berlin, Germany
| | - Jeroen Swart
- UCT Research Unit for Exercise Science and Sports Medicine, Cape Town, South Africa
| | | | - Victoriya Badtieva
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia, Moscow, Russian Federation
- Moscow Research and Practical Center for Medical Rehabilitation, Restorative and Sports Medicine, Moscow Healthcare Department, Moscow, Russian Federation
| | - Theodora Papadopoulou
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK
- British Association of Sport and Exercise Medicine, Doncaster, UK
| | | | - Michael Geistlinger
- Unit of International Law, Department of Constitutional, International and European Law, University of Salzburg, Salzburg, Salzburg, Austria
| | - Norbert Bachl
- Institute of Sports Science, University of Vienna, Vienna, Austria
- Austrian Institute of Sports Medicine, Vienna, Austria
| | - Fabio Pigozzi
- Sport Medicine Unit, Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Yannis Pitsiladis
- Collaborating Centre of Sports Medicine, University of Brighton, Eastbourne, UK
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178
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Pieles GE, Stuart AG. The adolescent athlete's heart; A miniature adult or grown-up child? Clin Cardiol 2020; 43:852-862. [PMID: 32643161 PMCID: PMC7403711 DOI: 10.1002/clc.23417] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/16/2020] [Accepted: 06/26/2020] [Indexed: 12/18/2022] Open
Abstract
The systematic development of early age talent in sports academies has led to the professionalization of pediatric sport and the sports physician need to be aware of pediatric cardiological problems. Research into the medical cardiac care and assessment of the pediatric athlete are accumulating, but specific pediatric international guidelines are not available yet and reference data for ECG and echocardiography are incomplete, in particular for the age group <12 years of age. This article is an introduction to the physiological and diagnostics specifics of the pediatric athlete. The focus lies in the differences in presentation and diagnosis between pediatric and adult athletes for the most common pathologies. Reference data for electrical and structural adaptations to intensive exercise are sparse particularly in athletes aged below 12 years old. Training related changes include decrease of resting heart rate, increase of cardiac output, ventricular cavity size, and wall thickness. Cardiac hypertrophy is less pronounced in pediatric athletes, as HR mediated cardiac output increase to endurance exercise is the dominant mechanism in peripubertal children. As in adults, the most pronounced cardiovascular adaptations appear in classical endurance sports like rowing, triathlon, and swimming, but the specifics of pediatric ECG and echocardiographic changes need to be considered.
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Affiliation(s)
- Guido E Pieles
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Heart Institute, Bristol, UK.,Institute of Sport, Exercise and Health, University College London, London, UK
| | - A Graham Stuart
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre, Congenital Heart Unit, Bristol Heart Institute, Bristol, UK
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179
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Petek BJ, Baggish AL. Current controversies in pre-participation cardiovascular screening for young competitive athletes. Expert Rev Cardiovasc Ther 2020; 18:435-442. [PMID: 32594825 DOI: 10.1080/14779072.2020.1787154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Pre-participation cardiovascular screening (PPCS) in athletes is recommended by numerous medical and sporting societies. While there is consensus that young athletes should be screened prior to participation in competitive sports, there are on-going debates regarding the true incidence of sudden cardiac death (SCD), the most frequent causes of SCD, and the optimal methods for PPCS. AREAS COVERED This review focuses on the current evidence for the incidence of SCD, causes of SCD, and the pros and cons of a history and physical exam (H&P) and electrocardiogram (ECG) in PPCS of young competitive athletes. EXPERT OPINION With significant controversy surrounding PPCS in athletes, a large-randomized trial powered for mortality is needed to assess the utility of PPCS and to define the optimal screening methods to detect cardiovascular diseases that may lead to SCD in competitive athletes. Until a trial of this caliber is created, controversy will remain and heterogeneity in care will exist. Future research should also define the optimal timing and frequency of PPCS given age-related penetrance of certain diseases, create evidence-based history questionnaires, continue to optimize ECG screening criteria, and create more learning modules for ECG interpretation in athletes.
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Affiliation(s)
- Bradley J Petek
- Department of Medicine, Massachusetts General Hospital , Boston, MA, USA
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital , Boston, MA, USA
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180
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Anomalous Left Coronary Artery Originating from the Right Coronary Sinus with an Interarterial Course: a Case Report and Literature Review. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2020. [DOI: 10.2478/jce-2020-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction: The diagnosis of coronary artery anomalies (CAAs) can be challenging due to the highly variable manifestations and symptoms. CAAs occur in less than 1% of the population. Multidetector cardiac computed tomography angiography (CTA) provides excellent spatial and temporal resolution for the imaging of CAAs. This case report describes an anomalous origin of the left main coronary artery.
Case presentation: A 64-year-old woman with atypical chest pain underwent coronary CTA. The CT demonstrated that the left coronary artery was originating from the right coronary sinus and had an interarterial course with an approximately 50% stenosis at the segment between the great arteries. Invasive coronary angiography confirmed hemodynamically significant stenosis of the interarterial segment. The patient underwent off-pump coronary artery bypass graft surgery.
Conclusion: Left coronary artery originating from the right coronary sinus with an interarterial course increases the risk of sudden cardiac death. In these patients, surgical revascularization is recommended. However, timely diagnosis, especially in those with mild symptoms, remains challenging. Coronary CTA is a robust tool to diagnose CAA and provides valuable information to support the clinical decision making in this patient population.
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181
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Limongelli G, Nunziato M, D'Argenio V, Esposito MV, Monda E, Mazzaccara C, Caiazza M, D'Aponte A, D'Andrea A, Bossone E, Maggio FD, Buono P, Pica PW, Capua LD, Penco M, Romano S, Paolo FD, Pelliccia A, Frisso G, Salvatore F. Yield and clinical significance of genetic screening in elite and amateur athletes. Eur J Prev Cardiol 2020; 28:1081-1090. [PMID: 32615795 DOI: 10.1177/2047487320934265] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/25/2020] [Indexed: 11/17/2022]
Abstract
AIMS The purpose of this study was to assess the value of genetic testing in addition to a comprehensive clinical evaluation, as part of the diagnostic work-up of elite and/or amateur Italian athletes referred for suspicion of inherited cardiac disease, following a pre-participation screening programme. METHODS Between January 2009-December 2018, of 5892 consecutive participants, 61 athletes were investigated: 30 elite and 31 amateur athletes. Elite and amateur athletes were selected, on the basis of clinical suspicion for inherited cardiac disease, from two experienced centres for a comprehensive cardiovascular evaluation. Furthermore, the elite and amateur athletes were investigated for variants at DNA level up to 138 genes suspected to bear predisposition for possible cardiac arrest or even sudden cardiac death. RESULTS Of these 61 selected subjects, six (10%) had diagnosis made possible by a deeper clinical evaluation, while genetic testing allowed a definite diagnosis in eight (13%). The presence of >3 clinical markers (i.e. family history, electrocardiogram and/or echocardiographic abnormalities, exercise-induced ventricular arrhythmias) was associated with a higher probability of positive genetic diagnosis (75%), compared with the presence of two or one clinical markers (14.2%, 8.1%, respectively, p-value = 0.004). CONCLUSION A combined clinical and genetic evaluation, based on the subtle evidence of clinical markers for inherited disease, was able to identify an inherited cardiac disease in about one-quarter of the examined athletes.
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Affiliation(s)
- Giuseppe Limongelli
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Italy.,Monaldi Hospital, AO Colli, Italy
| | - Marcella Nunziato
- CEINGE - Biotecnologie Avanzate, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Italy
| | - Valeria D'Argenio
- CEINGE - Biotecnologie Avanzate, Italy.,San Raffaele Open University, Italy
| | - Maria V Esposito
- CEINGE - Biotecnologie Avanzate, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Italy
| | - Emanuele Monda
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Italy.,Monaldi Hospital, AO Colli, Italy
| | - Cristina Mazzaccara
- CEINGE - Biotecnologie Avanzate, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Italy
| | - Martina Caiazza
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Italy.,Monaldi Hospital, AO Colli, Italy
| | - Antonello D'Aponte
- Department of Experimental Medicine, University of Campania 'Luigi Vanvitelli', Italy
| | - Antonello D'Andrea
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Italy.,Monaldi Hospital, AO Colli, Italy
| | | | - Federica Di Maggio
- CEINGE - Biotecnologie Avanzate, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Italy
| | - Pasqualina Buono
- CEINGE - Biotecnologie Avanzate, Italy.,Department of Movement Sciences and Wellness (DiSMEB), University of Naples Parthenope, Italy
| | - Paolo W Pica
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Italy.,Monaldi Hospital, AO Colli, Italy
| | - Luca De Capua
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Italy.,Monaldi Hospital, AO Colli, Italy
| | - Maria Penco
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
| | - Silvio Romano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
| | | | | | - Giulia Frisso
- CEINGE - Biotecnologie Avanzate, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Italy
| | - Francesco Salvatore
- CEINGE - Biotecnologie Avanzate, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Italy
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182
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Mascia G, Arbelo E, Porto I, Brugada R, Brugada J. The arrhythmogenic right ventricular cardiomyopathy in comparison to the athletic heart. J Cardiovasc Electrophysiol 2020; 31:1836-1843. [PMID: 32367567 DOI: 10.1111/jce.14526] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/25/2020] [Accepted: 04/24/2020] [Indexed: 01/02/2023]
Abstract
Intense exercise-induced right ventricular remodeling is a potential adaptation of cardiac function and structure. The features of the remodeling may overlap with those of a very early form of arrhythmogenic right ventricular cardiomyopathy (ARVC): at this early stage, it could be difficult to discriminate ARVC, from exercise-induced cardiac adaptation that may develop in normal individuals. The purpose of this paper is to discuss which exercise-induced remodeling may be a pathological or a physiological finding. A complete evaluation may be required to identify the pathological features of ARVC that would include potential risk of sudden cardiac death during sport or, to avoid the false diagnosis of ARVC. The most recent expert assessment of arrhythmogenic cardiomyopathy focuses on endurance athletes presenting with clinical features indistinguishable from ARVC.
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Affiliation(s)
- Giuseppe Mascia
- Department of Internal Medicine (DIMI) Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Italian IRCCS Cardiovascular Network, Genoa, Italy.,Cardiology and Electrophysiology Unit, Department of Internal Medicine, Azienda USL Toscana Centro, Florence, Italy
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Institut d'Investigaciò August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Italo Porto
- Department of Internal Medicine (DIMI) Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Italian IRCCS Cardiovascular Network, Genoa, Italy
| | - Ramon Brugada
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica Girona (IDIBGI), University of Girona, Girona, Spain
| | - Josep Brugada
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Institut d'Investigaciò August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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183
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Arrhythmic risk stratification by cardiac magnetic resonance tissue characterization: disclosing the arrhythmic substrate within the heart muscle. Heart Fail Rev 2020; 27:49-69. [PMID: 32564329 DOI: 10.1007/s10741-020-09986-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Sudden cardiac death (SCD) is a pivotal health problem worldwide. The identification of subjects at increased risk of SCD is crucial for the accurate selection of candidates for implantable cardioverter defibrillator (ICD) therapy. Current strategies for arrhythmic stratification largely rely on left ventricular (LV) ejection fraction (EF), mostly measured by echocardiography, and New York Heart Association functional status for heart failure with reduced EF. For specific diseases, such as hypertrophic and arrhythmogenic cardiomyopathy, some risk scores have been proposed; however, these scores take into account some parameters that are a partial reflection of the global arrhythmic risk and show a suboptimal accuracy. Thanks to a more comprehensive evaluation, cardiac magnetic resonance (CMR) provides insights into the heart muscle (the so-called tissue characterization) identifying cardiac fibrosis as an arrhythmic substrate. Combining sequences before and after administration of contrast media and mapping techniques, CMR is able to characterize the myocardial tissue composition, shedding light on both intracellular and extracellular alterations. Over time, late gadolinium enhancement (LGE) emerged as solid prognostic marker, strongly associated with major arrhythmic events regardless of LVEF, adding incremental value over current strategy in ischemic heart disease and non-ischemic cardiomyopathies. The evidence on a potential prognostic role of mapping imaging is promising. However, mapping techniques require further investigation and standardization. Disclosing the arrhythmic substrate within the myocardium, CMR should be considered as part of a multiparametric approach to personalized arrhythmic stratification.
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184
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Zorzi A, Cardaioli F, Cipriani A, D'Ascenzi F, Corrado D, Solmi M. Impact of exercise addiction on attitude to preparticipation evaluation and adherence to medical prescription. J Cardiovasc Med (Hagerstown) 2020; 21:772-778. [PMID: 32520862 DOI: 10.2459/jcm.0000000000000997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Identification of silent cardiovascular diseases by preparticipation evaluation (PPE) and disqualification from competitive sports have the potential to prevent sudden death but may induce adverse psychological consequences, particularly for exercise addicted athletes. We investigated the relationship between exercise addiction, attitude towards PPE and reaction to cardiovascular disease diagnosis. METHODS We invited Italian competitive athletes to participate in an online questionnaire investigating exercise addiction, opinion about mandatory PPE and potential reaction to both sports disqualification and hypothetical diagnosis of different cardiovascular diseases. RESULTS The survey was completed by 1011 athletes (75% men, median age 30 years) encompassing a wide range of sports disciplines and competition levels. According to the 'Exercise Dependence Scale-21', 6% were classified as exercise addicted. The vast majority of both exercise addicted and nonexercise addicted athletes agreed that PPE should be mandatory (92 and 96%, P = 0.17) and that the eligibility decision should be left to the sports medicine physician (82 and 89%, P = 0.08). In case a cardiovascular disease is identified, a higher proportion of exercise addicted athletes would undergo 'open-heart' surgery if this would allow resuming high-intensity sport (54 versus 31%, P < 0.001) and would continue exercising in case of diagnosis of a disease at risk of sudden death (57 versus 32%, P < 0.001). CONCLUSION Exercise addiction does not interfere with a general positive opinion about PPE, but is likely to impact on the adherence to medical prescription should a cardiovascular diagnosis be made. Exercise addiction should be taken into account when counselling athletes with newly diagnosed heart diseases.
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Affiliation(s)
- Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padova, Padova
| | - Francesco Cardaioli
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padova, Padova
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padova, Padova
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padova, Padova
| | - Marco Solmi
- Department of Neuroscience.,Padua Neuroscience Centre, University of Padova, Padova, Italy
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185
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Affiliation(s)
- Silvia Castelletti
- Istituto Auxologico Italiano, IRCCS, Centre for Cardiac Arrhythmias of Genetic Origin, Italy
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186
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Maestrini V, Torlasco C, Hughes R, Moon JC. Cardiovascular Magnetic Resonance and Sport Cardiology: a Growing Role in Clinical Dilemmas. J Cardiovasc Transl Res 2020; 13:296-305. [PMID: 32436168 PMCID: PMC7360536 DOI: 10.1007/s12265-020-10022-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/05/2020] [Indexed: 12/14/2022]
Abstract
Exercise training induces morphological and functional cardiovascular adaptation known as the "athlete's heart" with changes including dilatation, hypertrophy, and increased stroke volume. These changes may overlap with pathological appearances. Distinguishing athletic cardiac remodelling from cardiomyopathy is important and is a frequent medical dilemma. Cardiac magnetic resonance (CMR) has a role in clinical care as it can refine discrimination of health from a disease where ECG and echocardiography alone have left or generated uncertainty. CMR can more precisely assess cardiac structure and function as well as characterise the myocardium detecting key changes including myocardial scar and diffuse fibrosis. In this review, we will review the role of CMR in sports cardiology.
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Affiliation(s)
- Viviana Maestrini
- Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology and Geriatric Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Camilla Torlasco
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department of Cardiovascular, Neural and Metabolic Sciences, S.Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Rebecca Hughes
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK
- Barts Heart Centre, Advanced Cardiac Imaging and The Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, Gower Street, London, UK.
- Barts Heart Centre, Advanced Cardiac Imaging and The Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
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187
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Limongelli G, Nunziato M, Mazzaccara C, Intrieri M, D’Argenio V, Esposito MV, Monda E, Di Maggio F, Frisso G, Salvatore F. Genotype-Phenotype Correlation: A Triple DNA Mutational Event in a Boy Entering Sport Conveys an Additional Pathogenicity Risk. Genes (Basel) 2020; 11:genes11050524. [PMID: 32397162 PMCID: PMC7288460 DOI: 10.3390/genes11050524] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/28/2020] [Accepted: 05/06/2020] [Indexed: 12/17/2022] Open
Abstract
The purpose of this paper is to present a clinical and laboratory study of a family, in which a 12-year-old boy was examined to assess his health status before starting competitive sports. A variety of clinical and instrumental tests were used to evaluate the status of the heart and its functions. Using Sanger sequencing (SS), we sequenced six related genes to verify suspected arrhythmogenic right ventricular cardiomyopathy (ARVC) hypothesized at the cardiac assessment and, subsequently, by a next-generation sequencing (NGS)-based multi-gene panel for more paramount genetic risk of sudden cardiac death (SCD) assessment. SS revealed two variants in the PKP2 gene, one was inherited from the father and the other from the mother. The analysis on a large panel of genes (n = 138), putatively associated with sudden cardiac death, revealed, in the proband, a third variant in a different gene (DES) that encodes the protein desmin. Our results indicate that: i) NGS revealed a mutational event in a gene not conventionally screened as a first-line test in the presence of clinical suspicion of the arrhythmic disease; ii) a plurality of variants in different genes in the same subject (the proband) may increase the risk of heart disease; iii) in silico analysis with various methodological software and bioinformatic prediction tools indicates that the cumulative effects of the three variants in the same subject constitute an additional risk factor. This case report indicates that more pathogenic variants or likely pathogenic variants can contribute to the clinical phenotype of an individual, thereby contributing to the diagnosis and prognosis of inherited heart diseases.
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Affiliation(s)
- Giuseppe Limongelli
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AO Colli-Monaldi Hospital, Via Leonardo Bianchi, 80131 Naples, Italy;
- Correspondence: (G.L.); (F.S.); Tel.: +39-0817064050 (G.L.); +39-0813737826 (F.S.)
| | - Marcella Nunziato
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.N.); (C.M.); (M.V.E.); (F.D.M.); (G.F.)
- CEINGE-Advanced Biotechnologies, Via G. Salvatore 486, 80145 Naples, Italy;
| | - Cristina Mazzaccara
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.N.); (C.M.); (M.V.E.); (F.D.M.); (G.F.)
- CEINGE-Advanced Biotechnologies, Via G. Salvatore 486, 80145 Naples, Italy;
| | - Mariano Intrieri
- Department of Medicine and Health Sciences “Vincenzo Tiberio” and University of Molise, Campobasso, Via de Sanctis, 86100 Campobasso, Italy;
| | - Valeria D’Argenio
- CEINGE-Advanced Biotechnologies, Via G. Salvatore 486, 80145 Naples, Italy;
- San Raffaele Open University, Via di Val Cannuta, 247, 00166 Rome, Italy
| | - Maria Valeria Esposito
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.N.); (C.M.); (M.V.E.); (F.D.M.); (G.F.)
- CEINGE-Advanced Biotechnologies, Via G. Salvatore 486, 80145 Naples, Italy;
| | - Emanuele Monda
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, AO Colli-Monaldi Hospital, Via Leonardo Bianchi, 80131 Naples, Italy;
| | - Federica Di Maggio
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.N.); (C.M.); (M.V.E.); (F.D.M.); (G.F.)
- CEINGE-Advanced Biotechnologies, Via G. Salvatore 486, 80145 Naples, Italy;
| | - Giulia Frisso
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.N.); (C.M.); (M.V.E.); (F.D.M.); (G.F.)
- CEINGE-Advanced Biotechnologies, Via G. Salvatore 486, 80145 Naples, Italy;
| | - Francesco Salvatore
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Via Sergio Pansini, 5, 80131 Naples, Italy; (M.N.); (C.M.); (M.V.E.); (F.D.M.); (G.F.)
- CEINGE-Advanced Biotechnologies, Via G. Salvatore 486, 80145 Naples, Italy;
- Correspondence: (G.L.); (F.S.); Tel.: +39-0817064050 (G.L.); +39-0813737826 (F.S.)
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188
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Pieles GE, Oberhoffer R. The Assessment of the Paediatric Athlete. J Cardiovasc Transl Res 2020; 13:306-312. [PMID: 32367344 PMCID: PMC7360531 DOI: 10.1007/s12265-020-10005-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 04/15/2020] [Indexed: 12/27/2022]
Abstract
The success of systematic early age talent development has led to the professionalisation of youth sports academies used by clubs and governing bodies alike, and sports physicians are nowadays commonly confronted with paediatric cardiological problems. Medical cardiac care of the paediatric athlete is however in its infancy, and the international guidelines that are present for adult athletes, are not yet available. Similarly, reference data for ECG and echocardiography are incomplete. The aim of this article is to provide and introduction to the cardiac care of the paediatric athlete to facilitate healthy and above all, safe talent development, but also provide guidance on how to distinguish adaptive, beneficial cardiovascular remodelling from underlying pathology of congenital or inherited cardiovascular disease. Differences in presentation, diagnosis and treatment between childhood and adult athletes are highlighted and can educate the reader in the emerging field of paediatric sports cardiology.
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Affiliation(s)
- Guido E Pieles
- Congenital Heart Unit, Bristol Heart Institute, Upper Maudlin Street, Bristol, BS2 8BJ, UK.
| | - Renate Oberhoffer
- Department of Sports and Health Sciences, Technical University Munich, Georg Brauchle Ring, 80992, Munich, Germany
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189
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Baggish AL, Battle RW, Beaver TA, Border WL, Douglas PS, Kramer CM, Martinez MW, Mercandetti JH, Phelan D, Singh TK, Weiner RB, Williamson E. Recommendations on the Use of Multimodality Cardiovascular Imaging in Young Adult Competitive Athletes: A Report from the American Society of Echocardiography in Collaboration with the Society of Cardiovascular Computed Tomography and the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2020; 33:523-549. [PMID: 32362332 DOI: 10.1016/j.echo.2020.02.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Robert W Battle
- University of Virginia Health System, Charlottesville, Virginia
| | | | - William L Border
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | - Dermot Phelan
- Sanger Heart and Vascular Institute in Atrium Health, Charlotte, North Carolina
| | | | - Rory B Weiner
- Massachusetts General Hospital, Boston, Massachusetts
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190
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Hosatte‐Ducassy C, Correa JA, Lalonde F, Mohindra R, Marton G, Chetrit M, Marcotte A, Tournoux F, Bridges E. Electrocardiographic changes after completion of a triathlon. TRANSLATIONAL SPORTS MEDICINE 2020. [DOI: 10.1002/tsm2.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - José A. Correa
- Department of Mathematics and Statistics McGill University Montreal QC Canada
| | - François Lalonde
- Département de cardiologie Axe cardio‐métabolique Centre de Recherche du Centre Hospitalier de l'Université de Montréal Montréal QC Canada
- Département des sciences de l'activité physique Faculté des sciences Université du Québec à Montréal Montréal QC Canada
| | - Rohit Mohindra
- Department of Emergency Medicine McGill University Health Center Montreal QC Canada
| | - Gregory Marton
- Department of Emergency Medicine McGill University Health Center Montreal QC Canada
| | - Michael Chetrit
- Department of Cardiology McGilll University Health Center Montreal QC Canada
| | - Audrey Marcotte
- Department of Emergency Medicine McGill University Health Center Montreal QC Canada
| | - François Tournoux
- Département de cardiologie Axe cardio‐métabolique Centre de Recherche du Centre Hospitalier de l'Université de Montréal Montréal QC Canada
| | - Eileen Bridges
- Department of Emergency Medicine McGill University Health Center Montreal QC Canada
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191
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Dorian P, Goodman JM, Connelly KA. Policies to Prevent Sudden Cardiac Death in Young Athletes: Challenging, But More Testing Is Not the Answer. J Am Heart Assoc 2020; 9:e016332. [PMID: 32306795 PMCID: PMC7428526 DOI: 10.1161/jaha.120.016332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Paul Dorian
- Division of Cardiology Department of Medicine St. Michael's Hospital University of Toronto Ontario Canada
| | - Jack M Goodman
- Faculty of Kinesiology and Physical Education University of Toronto Canada
| | - Kim A Connelly
- Division of Cardiology Department of Medicine St. Michael's Hospital University of Toronto Ontario Canada
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192
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Weiss M, Rao P, Johnson D, Billups T, Taing C, LaNoue M, Koilor C, Miller S, Langstaff R, Shipon D. Physician adherence to 'Seattle' and 'International' ECG criteria in adolescent athletes: An analysis of compliance by specialty, experience, and practice environment. J Electrocardiol 2020; 60:98-101. [PMID: 32339816 DOI: 10.1016/j.jelectrocard.2020.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/06/2020] [Accepted: 04/11/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Screening electrocardiography (ECG) for athletes is both controversial and rapidly evolving. While identifying an abnormal ECG could detect a serious cardiovascular disease, falsely interpreting a benign ECG pattern as abnormal can lead to unnecessary testing, cost, and anxiety. Though recent refinements of athlete screening ECG criteria have significantly improved its accuracy, in clinical practice physician adherence to these criteria may vary. METHODS We analyzed physician adherence to contemporary athlete ECG criteria in a large, national athlete screening registry. 1577 consecutive screening ECGs were independently re- interpreted to assess for physician adherence to Seattle Criteria or International Criteria, respective to the criteria in place when the screening was performed. We further determined the most common ECG interpretations that deviated from these criteria, and analyzed physician characteristics for independent predictors of adherence to published ECG criteria. RESULTS Though overall adherence to contemporary criteria was high, 60.4% of ECGs interpreted as abnormal did not meet athlete ECG criteria for pathology when independently re- read. The most common ECG patterns misinterpreted as abnormal were isolated left ventricular hypertrophy (LVH) and non-pathologic T-wave inversions (TWI). Multivariate regression identified three independent predictors of adherence to athlete ECG criteria: participating in a screening overseen by the organization's medical leadership, electrophysiology specialists and adult cardiologists. CONCLUSION This study highlights the need for quality control measures and continued clinician education in a controversial and rapidly evolving field. Clinician education for athlete screening ECG criteria should emphasize the recent changes in how TWI and LVH voltage criteria should be interpreted in this patient population.
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Affiliation(s)
- Max Weiss
- Thomas Jefferson University Hospital, Philadelphia, PA, United States of America.
| | - Prashant Rao
- Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Drew Johnson
- Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Taiwanna Billups
- Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Chou Taing
- Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Marianna LaNoue
- Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Chris Koilor
- Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Stanton Miller
- Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Renee Langstaff
- Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - David Shipon
- Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
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193
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Myocarditis in the Athlete: Arrhythmogenic Substrates, Clinical Manifestations, Management, and Eligibility Decisions. J Cardiovasc Transl Res 2020; 13:284-295. [PMID: 32270467 DOI: 10.1007/s12265-020-09996-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/24/2020] [Indexed: 12/26/2022]
Abstract
Myocarditis is as an important cause of sudden cardiac death (SCD) among athletes. The incidence of SCD ascribed to myocarditis did not change after the introduction of pre-participation screening in Italy, due to the transient nature of the disease and problems in the differential diagnosis with the athlete's heart. The arrhythmic burden and the underlying mechanisms differ between the acute and chronic setting, depending on the relative impact of acute inflammation versus post-inflammatory myocardial fibrosis. In the acute phase, ventricular arrhythmias vary from isolated ventricular ectopic beats to complex tachycardias that can lead to SCD. Atrioventricular blocks are typical of specific forms of myocarditis, and supraventricular arrhythmias may be observed in case of atrial inflammation. Athletes with acute myocarditis should be temporarily restricted from physical exercise, until complete recovery. However, ventricular tachycardia may also occur in the chronic phase in the context of post-inflammatory myocardial scar.
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194
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MacLachlan H, Drezner JA. Cardiac evaluation of young athletes: Time for a risk-based approach? Clin Cardiol 2020; 43:906-914. [PMID: 32242971 PMCID: PMC7403680 DOI: 10.1002/clc.23364] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 12/13/2022] Open
Abstract
Pre‐participation cardiovascular screening (PPCS) is recommended by several scientific and sporting organizations on the premise that early detection of cardiac disease provides a platform for individualized risk assessment and management; which has been proven to lower mortality rates for certain conditions associated with sudden cardiac arrest (SCA) and sudden cardiac death (SCD). What constitutes the most effective strategy for PPCS of young athletes remains a topic of considerable debate. The addition of the electrocardiogram (ECG) to the medical history and physical examination undoubtedly enhances early detection of disease, which meets the primary objective of PPCS. The benefit of enhanced sensitivity must be carefully balanced against the risk of potential harm through increased false‐positive findings, costly downstream investigations, and unnecessary restriction/disqualification from competitive sports. To mitigate this risk, it is essential that ECG‐based PPCS programs are implemented by institutions with a strong infrastructure and by physicians appropriately trained in modern ECG standards with adequate cardiology resources to guide downstream investigations. While PPCS is compulsory for most competitive athletes, the current debate surrounding ECG‐based programs exists in a binary form; whereby ECG screening is mandated for all competitive athletes or none at all. This polarized approach fails to consider individualized patient risk and the available sports cardiology resources. The limitations of a uniform approach are highlighted by evolving data, which suggest that athletes display a differential risk profile for SCA/SCD, which is influenced by age, sex, ethnicity, sporting discipline, and standard of play. Evaluation of the etiology of SCA/SCD within high‐risk populations reveals a disproportionately higher prevalence of ECG‐detectable conditions. Selective ECG screening using a risk‐based approach may, therefore, offer a more cost‐effective and feasible approach to PPCS in the setting of limited sports cardiology resources, although this approach is not without important ethical considerations.
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Affiliation(s)
- Hamish MacLachlan
- Cardiovascular Sciences Research Centre, St Georges University of London, London, UK
| | - Jonathan A Drezner
- Department of Family Medicine and the Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
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195
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Fanous Y, Dorian P. The prevention and management of sudden cardiac arrest in athletes. CMAJ 2020; 191:E787-E791. [PMID: 31308007 DOI: 10.1503/cmaj.190166] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Yehia Fanous
- Faculty of Medicine (Fanous, Dorian), University of Toronto; Division of Cardiology (Dorian), Department of Medicine, St. Michael's Hospital, Toronto, Ont
| | - Paul Dorian
- Faculty of Medicine (Fanous, Dorian), University of Toronto; Division of Cardiology (Dorian), Department of Medicine, St. Michael's Hospital, Toronto, Ont.
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196
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D’Ascenzi F, Fiorentini C, Anselmi F, Mondillo S. Left ventricular hypertrophy in athletes: How to differentiate between hypertensive heart disease and athlete’s heart. Eur J Prev Cardiol 2020; 28:1125-1133. [PMID: 33611377 DOI: 10.1177/2047487320911850] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/18/2020] [Indexed: 12/15/2022]
Abstract
Abstract
Athlete’s heart is typically accompanied by a remodelling of the cardiac chambers induced by exercise. However, although competitive athletes are commonly considered healthy, they can be affected by cardiac disorders characterised by an increase in left ventricular mass and wall thickness, such as hypertension. Unfortunately, training-induced increase in left ventricular mass, wall thickness, and atrial and ventricular dilatation observed in competitive athletes may mimic the pathological remodelling of pathological hypertrophy. As a consequence, distinguishing between athlete’s heart and hypertension can sometimes be challenging. The present review aimed to focus on the differential diagnosis between hypertensive heart disease and athlete’s heart, providing clinical information useful to distinguish between physiological and pathological remodelling.
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Affiliation(s)
- Flavio D’Ascenzi
- Department of Medical Biotechnologies, University of Siena, Italy
| | | | | | - Sergio Mondillo
- Department of Medical Biotechnologies, University of Siena, Italy
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197
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Kato T. A Diversified Approach for the Prevention of Pediatric Sudden Cardiovascular Death in Japan. Circ J 2020; 84:544-545. [DOI: 10.1253/circj.cj-20-0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Taichi Kato
- Department of Pediatrics/Developmental Pediatrics, Nagoya University Graduate School of Medicine
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198
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Basso C, Rizzo S, Carturan E, Pilichou K, Thiene G. Cardiac arrest at rest and during sport activity: causes and prevention. Eur Heart J Suppl 2020; 22:E20-E24. [PMID: 32523432 PMCID: PMC7270916 DOI: 10.1093/eurheartj/suaa052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
In the Western Countries, cardiovascular diseases are still the most frequent cause of death, which is often sudden. Sudden death (SD) in the young population occurs at a rate of 1/100 000/year and carries a profound social impact both for the young age of the victims and the unanticipated occurrence. Physical effort is a triggering risk factor, in fact SD occurs three times more frequently in athletes than in non-athletes. The screening for sport activity fitness can identify apparently healthy subjects carrying a silent abnormality able to trigger sudden cardiac death during sport activity, thus the fitness screening could be lifesaving. The spectrum of cardiovascular conditions identified at post-mortem examination is quite extensive, and include: coronary, myocardial, valvular diseases, as well as conduction system abnormalities. In 20% of the cases, the heart is normal, and sudden cardiac death is ascribed to ionic channel disease. The diagnosis of cardiomyopathy is possible with the integration of electrocardiogram and echography, thus decreasing significantly the occurrence of SD of athletes in Italy, but early diagnosis of coronary artery disease still remains challenging. The best strategy to further decrease sudden cardiac death during sport activities consists in combining early diagnosis with widespread availability of defibrillators on site.
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Affiliation(s)
- Cristina Basso
- UOC Patologia Cardiovascolare, Azienda Ospedaliera-Università di Padova
| | - Stefania Rizzo
- UOC Patologia Cardiovascolare, Azienda Ospedaliera-Università di Padova
| | - Elisa Carturan
- UOC Patologia Cardiovascolare, Azienda Ospedaliera-Università di Padova
| | - Kalliopi Pilichou
- UOC Patologia Cardiovascolare, Azienda Ospedaliera-Università di Padova
| | - Gaetano Thiene
- UOC Patologia Cardiovascolare, Azienda Ospedaliera-Università di Padova
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199
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Mattesi G, Zorzi A, Corrado D, Cipriani A. Natural History of Arrhythmogenic Cardiomyopathy. J Clin Med 2020; 9:jcm9030878. [PMID: 32210158 PMCID: PMC7141540 DOI: 10.3390/jcm9030878] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/07/2020] [Accepted: 03/20/2020] [Indexed: 02/07/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (AC) is a heart muscle disease characterized by a scarred ventricular myocardium with a distinctive propensity to ventricular arrhythmias (VAs) and sudden cardiac death, especially in young athletes. Arrhythmogenic right ventricular cardiomyopathy (ARVC) represents the best characterized variant of AC, with a peculiar genetic background, established diagnostic criteria and management guidelines; however, the identification of nongenetic causes of the disease, combined with the common demonstration of biventricular and left-dominant forms, has led to coin the term of “arrhythmogenic cardiomyopathy”, to better define the broad spectrum of the disease phenotypic expressions. The genetic basis of AC are pathogenic mutations in genes encoding the cardiac desmosomes, but also non-desmosomal and nongenetic variants were reported in patients with AC, some of which showing overlapping phenotypes with other non-ischemic diseases. The natural history of AC is characterized by VAs and progressive deterioration of cardiac performance. Different phases of the disease are recognized, each characterized by pathological and clinical features. Arrhythmic manifestations are age-related: Ventricular fibrillation and SCD are more frequent in young people, while sustained ventricular tachycardia is more common in the elderly, depending on the different nature of the myocardial lesions. This review aims to address the genetic basis, the clinical course and the phenotypic variants of AC.
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200
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D'Ascenzi F, Zorzi A, Sciaccaluga C, Berrettini U, Mondillo S, Brignole M. Syncope in the Young Adult and in the Athlete: Causes and Clinical Work-up to Exclude a Life-Threatening Cardiac Disease. J Cardiovasc Transl Res 2020; 13:322-330. [PMID: 32198700 DOI: 10.1007/s12265-020-09989-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/11/2020] [Indexed: 12/28/2022]
Abstract
Syncope is defined as a transient loss of consciousness due to cerebral hypoperfusion, characterized by a rapid onset, short duration, and spontaneous complete recovery. It is usually a benign event, but sometimes it may represent the initial presentation of several cardiac disorders associated with sudden cardiac death during physical activity. A careful evaluation is essential particularly in young adults and in competitive athletes in order to exclude the presence of an underlying life-threatening cardiovascular disease. The present review analyzes the main non-cardiac and cardiac causes of syncope and the contribution of the available tools for differential diagnosis. Clinical work-up of the athlete with syncope occurring in extreme environments and management in terms of sports eligibility and disqualification are also discussed.
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Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale M. Bracci, 16 53100, Siena, Italy.
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Carlotta Sciaccaluga
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale M. Bracci, 16 53100, Siena, Italy
| | | | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale M. Bracci, 16 53100, Siena, Italy
| | - Michele Brignole
- Faint&Fall Programme, IRCCS Istituto Auxologico Italiano, Milan, Italy
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