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Franklin BA, Thompson PD, Al-Zaiti SS, Albert CM, Hivert MF, Levine BD, Lobelo F, Madan K, Sharrief AZ, Eijsvogels TMH. Exercise-Related Acute Cardiovascular Events and Potential Deleterious Adaptations Following Long-Term Exercise Training: Placing the Risks Into Perspective-An Update: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e705-e736. [PMID: 32100573 DOI: 10.1161/cir.0000000000000749] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Epidemiological and biological plausibility studies support a cause-and-effect relationship between increased levels of physical activity or cardiorespiratory fitness and reduced coronary heart disease events. These data, plus the well-documented anti-aging effects of exercise, have likely contributed to the escalating numbers of adults who have embraced the notion that "more exercise is better." As a result, worldwide participation in endurance training, competitive long distance endurance events, and high-intensity interval training has increased markedly since the previous American Heart Association statement on exercise risk. On the other hand, vigorous physical activity, particularly when performed by unfit individuals, can acutely increase the risk of sudden cardiac death and acute myocardial infarction in susceptible people. Recent studies have also shown that large exercise volumes and vigorous intensities are both associated with potential cardiac maladaptations, including accelerated coronary artery calcification, exercise-induced cardiac biomarker release, myocardial fibrosis, and atrial fibrillation. The relationship between these maladaptive responses and physical activity often forms a U- or reverse J-shaped dose-response curve. This scientific statement discusses the cardiovascular and health implications for moderate to vigorous physical activity, as well as high-volume, high-intensity exercise regimens, based on current understanding of the associated risks and benefits. The goal is to provide healthcare professionals with updated information to advise patients on appropriate preparticipation screening and the benefits and risks of physical activity or physical exertion in varied environments and during competitive events.
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202
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A microRNA Expression Profile as Non-Invasive Biomarker in a Large Arrhythmogenic Cardiomyopathy Cohort. Int J Mol Sci 2020; 21:ijms21041536. [PMID: 32102357 PMCID: PMC7073183 DOI: 10.3390/ijms21041536] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/14/2020] [Accepted: 02/19/2020] [Indexed: 01/01/2023] Open
Abstract
Arrhythmogenic Cardiomyopathy (AC) is a clinically and genetically heterogeneous myocardial disease. Half of AC patients harbour private desmosomal gene variants. Although microRNAs (miRNAs) have emerged as key regulator molecules in cardiovascular diseases and their involvement, correlated to phenotypic variability or to non-invasive biomarkers, has been advanced also in AC, no data are available in larger disease cohorts. Here, we propose the largest AC cohort unbiased by technical and biological factors. MiRNA profiling on nine right ventricular tissue, nine blood samples of AC patients, and four controls highlighted 10 differentially expressed miRNAs in common. Six of these were validated in a 90-AC patient cohort independent from genetic status: miR-122-5p, miR-133a-3p, miR-133b, miR-142-3p, miR-182-5p, and miR-183-5p. This six-miRNA set showed high discriminatory diagnostic power in AC patients when compared to controls (AUC-0.995), non-affected family members of AC probands carrying a desmosomal pathogenic variant (AUC-0.825), and other cardiomyopathy groups (Hypertrophic Cardiomyopathy: AUC-0.804, Dilated Cardiomyopathy: AUC-0.917, Brugada Syndrome: AUC-0.981, myocarditis: AUC-0.978). AC-related signalling pathways were targeted by this set of miRNAs. A unique set of six-miRNAs was found both in heart-tissue and blood samples of AC probands, supporting its involvement in disease pathogenesis and its possible role as a non-invasive AC diagnostic biomarker.
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203
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Lin X, Ma Y, Cai Z, Wang Q, Wang L, Huo Z, Hu D, Wang J, Xiang M. Next-generation sequencing identified novel Desmoplakin frame-shift variant in patients with Arrhythmogenic cardiomyopathy. BMC Cardiovasc Disord 2020; 20:74. [PMID: 32046637 PMCID: PMC7011609 DOI: 10.1186/s12872-020-01369-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/30/2020] [Indexed: 12/29/2022] Open
Abstract
Background Arrhythmogenic cardiomyopathy (AC) is one of the leading causes for sudden cardiac death (SCD). Recent studies have identified mutations in cardiac desmosomes as key players in the pathogenesis of AC. However, the specific etiology in individual families remains largely unknown. Methods A 4-generation family presenting with syncope, lethal ventricular arrhythmia and SCD was recruited. Targeted next generation sequencing (NGS) was performed and validated by Sanger sequencing. Plasmids containing the mutation and wild type (WT) were constructed. Real-time PCR, western-blot and immunofluorescence were performed to detect the functional change due to the mutation. Results The proband, a 56-year-old female, presented with recurrent palpitations and syncope. An ICD was implanted due to her family history of SCD/ aborted SCD. NGS revealed a novel heterozygous frame-shift variant (c.832delG) in Desmoplakin (DSP) among 5 family members. The variant led to frame-shift and premature termination, producing a truncated protein. Cardiac magnetic resonance (CMR) of the family members carrying the same variant shown myocardium thinning and fatty infiltration in the right ventricular, positive bi-ventricular late gadolinium enhancement and severe RV dysfunction, fulfilling the diagnostic criteria of AC. HEK293T cells transfected with mutant plasmids expressed truncated DSP mRNA and protein, upregulation of nuclear junction plakoglobin (JUP) and downregulation of β-catenin, when compared with WT. Conclusion We infer that the novel c.832delG variant in DSP was associated with AC in this family, likely through Wnt/β-catenin signaling pathway.
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Affiliation(s)
- Xiaoping Lin
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Yuankun Ma
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Zhejun Cai
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Qiyuan Wang
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Hangzhou, 310009, Zhejiang, China
| | - Lihua Wang
- Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Hangzhou, 310009, Zhejiang, China
| | - Zhaoxia Huo
- Experimental Teaching Center, School of Basic Medical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058, Zhejiang, China
| | - Dan Hu
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, 238 Jiefang Road, Wuhan, 430060, China
| | - Jian'an Wang
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.,Provincial Key Lab of Cardiovascular Research, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Meixiang Xiang
- Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China. .,Provincial Key Lab of Cardiovascular Research, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
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204
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Abstract
Although the specific content has been recommended, debated, and extensively reviewed over the past several decades, the preparticipation evaluation (PPE) has become standard of care for athletes as they prepare for organized athletic participation. The PPE seeks to detect conditions that predispose the athlete to injury or limit full participation in certain activities. Of particular interest, underlying cardiovascular and musculoskeletal conditions are sought because they are frequently associated with mortality and morbidity in athletes.
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205
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Wilhelm M. Pre-participation cardiovascular evaluation of young athletes: Should they sweat or not? Eur J Prev Cardiol 2020; 27:308-310. [DOI: 10.1177/2047487319897445] [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: 11/16/2022]
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206
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Waldmann V, Karam N, Rischard J, Bougouin W, Sharifzadehgan A, Dumas F, Narayanan K, Sideris G, Voicu S, Gandjbakhch E, Jost D, Lamhaut L, Ludes B, Plu I, Beganton F, Wahbi K, Varenne O, Megarbane B, Algalarrondo V, Extramiana F, Lellouche N, Celermajer DS, Spaulding C, Lafont A, Cariou A, Jouven X, Marijon E. Low rates of immediate coronary angiography among young adults resuscitated from sudden cardiac arrest. Resuscitation 2020; 147:34-42. [PMID: 31857140 DOI: 10.1016/j.resuscitation.2019.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/29/2019] [Accepted: 12/04/2019] [Indexed: 11/27/2022]
Abstract
AIM Coronary artery disease (CAD) has recently been emphasized as a major cause of sudden cardiac arrest (SCA) in young adults. We aim to assess the rate of immediate coronary angiography performance in young patients resuscitated from SCA. METHODS From May 2011 to May 2017, all cases of out-of-hospital SCA aged 18-40 years alive at hospital admission were prospectively included in 48 hospitals of the Great Paris area. Cardiovascular causes of SCA were centrally adjudicated, and management including immediate coronary angiography performance was assessed. RESULTS Out of 3579 SCA admitted alive, 409 (11.4%) patients were under 40 years of age (32.3 ± 6.2 years, 69.7% males), with 244 patients having a definite cause identified. Among those, CAD accounted for 72 (29.5%) cases, of which 64 (88.9%) were acute coronary syndromes. The rate of immediate coronary angiography was only 41.7% compared to 65.1% among those ≥40-years (P < 0.001). During the study period, while the rate of immediate coronary angiography increased from 60.5% to 70.3% (P < 0.001) in patients aged ≥40 years, the rate in patients aged less than 40 years remained stable (43.5% to 45.3%, P = 0.795). Patients younger than 40 years were significantly less likely to undergo immediate coronary angiography (OR = 0.34, 95% CI: 0.25-0.47), although early angiography was associated with survival at hospital discharge (OR = 2.68, 95% CI: 1.21-6.00). CONCLUSION CAD is the first cause of SCA in young adults aged less than 40 years. The observed low rates of immediate coronary angiography suggest a missed opportunity for early intervention.
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Affiliation(s)
- Victor Waldmann
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France
| | - Nicole Karam
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France
| | - Julien Rischard
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
| | - Wulfran Bougouin
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France; Ramsay Générale de Santé, Hôpital privé Jacques Cartier, Intensive Care Unit, Massy, France
| | - Ardalan Sharifzadehgan
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France
| | - Florence Dumas
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France; AP-HP, Cochin-Hotel Hospital, Emergency Department, Paris, France
| | - Kumar Narayanan
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Medicover Hospitals, Hyderabad, India
| | - Georgios Sideris
- AP-HP, Lariboisière Hospital, Cardiology Department, Paris, France
| | - Sebastian Voicu
- AP-HP, Lariboisière Hospital, Intensive Care Unit, Paris, France
| | - Estelle Gandjbakhch
- AP-HP, La Pitié Salpêtrière University Hospital, Cardiology Department, Paris, France; Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), France
| | | | | | | | - Isabelle Plu
- AP-HP, La Pitié Salpêtrière University Hospital, Anatomopathology Department, Paris, France
| | - Frankie Beganton
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
| | - Karim Wahbi
- Paris University, Paris, France; AP-HP, Cochin Hospital, Cardiology Department, Paris, France
| | - Olivier Varenne
- Paris University, Paris, France; AP-HP, Cochin Hospital, Cardiology Department, Paris, France
| | - Bruno Megarbane
- AP-HP, Lariboisière Hospital, Intensive Care Unit, Paris, France
| | - Vincent Algalarrondo
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), France; AP-HP, Bichat-Claude-Bernard Hospital, Cardiology Department, Paris, France
| | - Fabrice Extramiana
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), France; AP-HP, Bichat-Claude-Bernard Hospital, Cardiology Department, Paris, France
| | - Nicolas Lellouche
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), France; AP-HP, Henri Mondor Hospital, Cardiology Department, Créteil, France
| | | | - Christian Spaulding
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris University, Paris, France
| | - Antoine Lafont
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris University, Paris, France
| | - Alain Cariou
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France; AP-HP, Cochin Hospital, Intensive Care Unit, Paris, France
| | - Xavier Jouven
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France
| | - Eloi Marijon
- AP-HP, European Georges Pompidou Hospital, Cardiology Department, Paris, France; Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris University, Paris, France; Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), France.
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Abstract
Arrhythmogenic cardiomyopathy is a genetic disorder characterized by the risk of life-threatening arrhythmias, myocardial dysfunction and fibrofatty replacement of myocardial tissue. Mutations in genes that encode components of desmosomes, the adhesive junctions that connect cardiomyocytes, are the predominant cause of arrhythmogenic cardiomyopathy and can be identified in about half of patients with the condition. However, the molecular mechanisms leading to myocardial destruction, remodelling and arrhythmic predisposition remain poorly understood. Through the development of animal, induced pluripotent stem cell and other models of disease, advances in our understanding of the pathogenic mechanisms of arrhythmogenic cardiomyopathy over the past decade have brought several signalling pathways into focus. These pathways include canonical and non-canonical WNT signalling, the Hippo-Yes-associated protein (YAP) pathway and transforming growth factor-β signalling. These studies have begun to identify potential therapeutic targets whose modulation has shown promise in preclinical models. In this Review, we summarize and discuss the reported molecular mechanisms underlying the pathogenesis of arrhythmogenic cardiomyopathy.
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208
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Turkoglu E, Güngör H, Ergene O, Pelliccia A. Preparticipation screening of athletic participant: A proposal for the cardiologist. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2020. [DOI: 10.4103/ijca.ijca_11_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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209
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Timokhina V, Mekhdieva K, Zinovieva Y, Chestukhin V, Blyakhman F. Impact of connective tissue dysplasia on heart adaptation to exercise stress in young athletes. BIO WEB OF CONFERENCES 2020. [DOI: 10.1051/bioconf/20202202019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This study addresses the contribution of connective tissue dysplasia (CTD) to the cardiac function in young athletes. Thirty-three cross-country skiers aged 15 underwent maximum stress-ECG and TTE before and immediately after stress-test. Global and regional function of LV was evaluated with the use of further image processing. We found that 87.9 % of athletes had phenotypic markers of CTD ranged from 12 to 26 score points. Parameters of LV global function at rest in all studied athletes corresponded to normal age-gender values but markers of regional function showed high degree of mechanical asynchrony that depended on extent of CTD. All athletes passed stress-test successfully and demonstrated a high level of exercise performance. Meanwhile, the variables of LV pump-function and mechanical asynchrony close correlated with CTD extent. Obtained results imply that the increase of CTD extent was accompanied by the decrease of scale of heart adaptation to physical loads.
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210
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Bickel T, Gunasekaran P, Murtaza G, Gopinathannair R, Gunda S, Lakkireddy D. Sudden Cardiac Death in Famous Athletes, Lessons Learned, Heterogeneity in Expert Recommendations and Pitfalls of Contemporary Screening Strategies. J Atr Fibrillation 2019; 12:2193. [PMID: 32435342 DOI: 10.4022/jafib.2193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/11/2019] [Accepted: 10/12/2019] [Indexed: 01/02/2023]
Abstract
Sudden cardiac death (SCD) in competitive athletes, though relatively uncommon, invariably leads to controversy. Specific limitations of an extensive screening process include lack of robust evidence to support prevention of SCD, poor cost-effectiveness and uncertain downstream implications of a positive screening test. An emerging body of evidence points to enhanced neurologically intact survival to hospital discharge when automated external defibrillators (AEDs) are used in a timely manner following sudden cardiac arrest (SCA). A viable alternative to an expansive screening process could be a robust secondary prevention system comprising of improvements in AED availability, stringent enforcement of CPR training in athletes and trainers to provide timely and effective resuscitation to reduce death following SCA. This strategy could widen the window to diagnose and treat the underlying etiology and prevent recurrence of SCA while also offering financial feasibility. Restricting athletes from competitive sports is a difficult decision for physicians owing to a lack of well-defined cutoffs for acceptable and prohibitive risk from pathology predisposing to SCD, especially in the absence of a protective medico-legal framework. In this review, we highlight a few cases that generated intense scrutiny by the public, media and medical professionals about the efficacy, feasibility and pitfalls of the existing screening process to diagnose cardiovascular pathology predisposing to SCD. Furthermore, contrasting approaches to screening, diagnosis and downstream workup protocols between the European Society of Cardiology and the American Heart Association are analyzed.
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Affiliation(s)
- Trenton Bickel
- Division of Cardiovascular Disease, University of Kansas Hospital and Medical Center, Kansas City, Kansas
| | - Prasad Gunasekaran
- Division of Cardiovascular Disease, University of Kansas Hospital and Medical Center, Kansas City, Kansas
| | - Ghulam Murtaza
- The Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas
| | - Rakesh Gopinathannair
- The Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas
| | - Sampath Gunda
- Division of Cardiology, University of Michigan, Ann Arbor, Michigan
| | - Dhanunjaya Lakkireddy
- The Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas
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211
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Prior D, La Gerche A. Exercise and Arrhythmogenic Right Ventricular Cardiomyopathy. Heart Lung Circ 2019; 29:547-555. [PMID: 31964580 DOI: 10.1016/j.hlc.2019.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/08/2019] [Accepted: 12/10/2019] [Indexed: 01/30/2023]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a group of cardiomyopathies associated with ventricular arrhythmias predominantly arising from the right ventricle, sudden cardiac death and right ventricular failure, caused largely due to inherited mutations in proteins of the desmosomal complex. Whilst long recognised as a cause of sudden cardiac death (SCD) during exercise, it has recently been recognised that intense and prolonged exercise can worsen the disease resulting in earlier and more severe phenotypic expression. Changes in cardiac structure and function as a result of exercise training also pose challenges with diagnosis as enlargement of the right ventricle is commonly seen in endurance athletes. Advice regarding restriction of exercise is an important part of patient management, not only of those with established disease, but also in individuals known to carry gene mutations associated with development of ARVC.
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Affiliation(s)
- David Prior
- National Centre for Sports Cardiology, St Vincent's Hospital, Melbourne, Vic, Australia; Department of Medicine, University of Melbourne at St Vincent's Hospital (Melbourne), Melbourne, Vic, Australia.
| | - Andre La Gerche
- National Centre for Sports Cardiology, St Vincent's Hospital, Melbourne, Vic, Australia; Baker Heart & Diabetes Institute, Melbourne, Vic, Australia
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212
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Abela M, Sharma S. Abnormal ECG Findings in Athletes: Clinical Evaluation and Considerations. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:95. [PMID: 31865466 DOI: 10.1007/s11936-019-0794-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Pre-participation cardiovascular evaluation with electrocardiography is normal practice for most sporting bodies. Awareness about sudden cardiac death in athletes and recognizing how screening can help identify vulnerable athletes have empowered different sporting disciplines to invest in the wellbeing of their athletes. RECENT FINDINGS Discerning physiological electrical alterations due to athletic training from those representing cardiac pathology may be challenging. The mode of investigation of affected athletes is dependent on the electrical anomaly and the disease(s) in question. This review will highlight specific pathological ECG patterns that warrant assessment and surveillance, together with an in-depth review of the recommended algorithm for evaluation.
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Affiliation(s)
- Mark Abela
- Cardiology Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK.
- University of Malta, Msida, Malta.
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St. George's, University of London, St. George's University Hospitals NHS Foundation Trust, London, UK
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Zorzi A, Vessella T, De Lazzari M, Cipriani A, Menegon V, Sarto G, Spagnol R, Merlo L, Pegoraro C, Marra MP, Corrado D, Sarto P. Screening young athletes for diseases at risk of sudden cardiac death: role of stress testing for ventricular arrhythmias. Eur J Prev Cardiol 2019; 27:311-320. [PMID: 31791144 PMCID: PMC7008549 DOI: 10.1177/2047487319890973] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Aims The athletic preparticipation evaluation (PPE) protocol proposed by the European Society of Cardiology includes history, physical examination and resting electrocardiogram (ECG). The aim of this study was to assess the results of adding constant-load ECG stress testing (EST) to the protocol for the evaluation of ventricular arrhythmias (VA) inducibility. Methods We evaluated a consecutive cohort of young athletes with history, physical examination, resting ECG and EST. Athletes with VA induced by EST underwent 24-hour 12-lead Holter monitoring and echocardiography. Cardiac magnetic resonance (CMR) was reserved for those with frequent, repetitive or exercise-worsened VA, and for athletes with echocardiographic abnormalities. Results Of 10,985 athletes (median age 15 years, 66% males), 451 (4.1%) had an abnormal history, physical examination or resting ECG and 31 (0.28%) were diagnosed with a cardiac disease and were at risk of sudden cardiac death. Among the remaining 10,534 athletes, VA at EST occurred in 524 (5.0%) and a previously missed at-risk condition was identified in 23 (0.22%); the most common (N = 10) was an echocardiographically silent non-ischaemic left-ventricular fibrosis evidenced by CMR. The addition of EST increased the diagnostic yield of PPE by 75% (from 0.28% to 0.49%) and decreased the positive predictive value by 20% (from 6.9% to 5.5%). During a 32 ± 21 months follow-up, no cardiac arrests occurred among either eligible athletes or non-eligible athletes with cardiovascular disease. Conclusions The addition of exercise testing for the evaluation of VA inducibility to history, physical examination and ECG resulted in an increase of the diagnostic yield of PPE at the expense of an increase in false-positive findings.
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Affiliation(s)
- Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | | | - Manuel De Lazzari
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Vittoria Menegon
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Gianmarco Sarto
- Center for Sports Medicine, ULSS2 Marca Trevigiana, Treviso, Italy
| | - Rachele Spagnol
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Laura Merlo
- Center for Sports Medicine, ULSS2 Marca Trevigiana, Treviso, Italy
| | - Cinzia Pegoraro
- Center for Sports Medicine, ULSS2 Marca Trevigiana, Treviso, Italy
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Patrizio Sarto
- Center for Sports Medicine, ULSS2 Marca Trevigiana, Treviso, Italy
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Das 12-Kanal-Ruhe-EKG in der sportmedizinischen Untersuchung von Kindern und Jugendlichen. Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-019-00796-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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215
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Emery MS, Kovacs RJ. Sudden Cardiac Death in Athletes. JACC-HEART FAILURE 2019; 6:30-40. [PMID: 29284578 DOI: 10.1016/j.jchf.2017.07.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 12/24/2022]
Abstract
Sudden cardiac death is a tragedy at any age and under any circumstances but is perhaps most tragic when it claims the life of the athlete, the individual who epitomizes health and a healthy lifestyle. Sports cardiologists from around the world have worked to quantitate the incidence of sudden cardiac death (SCD) in the athlete, to identify risk factors, to develop pre-participation screening tools, and to formulate plans to deal with on-field SCD. Progress has been made, but much remains to be done in order to make both competitive and recreational sports safer for both patients with known cardiac disease and athletes without known or suspected cardiac abnormalities.
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Affiliation(s)
- Michael S Emery
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana; Center for Cardiovascular Care in Athletics, Indiana University Health, Indianapolis, Indiana
| | - Richard J Kovacs
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana; Center for Cardiovascular Care in Athletics, Indiana University Health, Indianapolis, Indiana.
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D'Ascenzi F, Solari M, Corrado D, Zorzi A, Mondillo S. Diagnostic Differentiation Between Arrhythmogenic Cardiomyopathy and Athlete's Heart by Using Imaging. JACC Cardiovasc Imaging 2019; 11:1327-1339. [PMID: 30190032 DOI: 10.1016/j.jcmg.2018.04.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/17/2018] [Accepted: 04/19/2018] [Indexed: 12/17/2022]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an important cause of sudden cardiac death (SCD) in youth and athletes. In the last decade, several studies focused on right ventricular (RV) remodeling in athletes and revealed that features of the physiological adaptation of the right heart to training, such as RV dilation, may overlap with those of ARVC. Therefore, a careful multiparametric evaluation is required for differential diagnosis in order to avoid false diagnosis of ARVC or, in contrast, fail to identify the risk of causing SCD. This review summarizes physiological adaptation of the RV to exercise and describes features that could help distinguishing between athlete's heart and ARVC.
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Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
| | - Marco Solari
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic, and Vascular Sciences, Division of Cardiology, University of Padova, Padova, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, and Vascular Sciences, Division of Cardiology, University of Padova, Padova, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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217
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Faganello G, Porcari A, Biondi F, Merlo M, Luca AD, Vitrella G, Belgrano M, Pagnan L, Di Lenarda A, Sinagra G. Cardiac Magnetic Resonance in Primary Prevention of Sudden Cardiac Death. J Cardiovasc Echogr 2019; 29:89-94. [PMID: 31728298 PMCID: PMC6829757 DOI: 10.4103/jcecho.jcecho_25_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sudden death accounts for 400,000 deaths annually in the United States. Most sudden deaths are cardiac and are related to arrhythmias secondary to structural heart disease or primary electrical abnormalities of the heart. Implantable cardioverter defibrillator significantly improves survival in patients at increased risk of life-threatening arrhythmias, but better selection of eligible patients is required to avoid unnecessary implantation and identify those patients who may benefit most from this therapy. Left ventricular (LV) ejection fraction (EF) measured by echocardiography has been considered the most reliable parameter for long-term outcome in many cardiac diseases. However, LVEF is an inaccurate parameter for arrhythmic risk assessment as patients with normal or mildly reduced LV systolic function could experience sudden cardiac death (SCD). Among other tools for arrhythmic stratification, magnetic resonance (CMR) provides the most comprehensive cardiac evaluation including in vivo tissue characterization and significantly aids in the identification of patients at higher SCD risk. Most of the evidence are related to late gadolinium enhancement (LGE), which was proven to detect cardiac fibrosis. LGE has been reported to add incremental value for prognostic stratification and SCD prediction across a wide range of cardiac diseases, including both ischemic and nonischemic cardiomyopathies. In addition, T1, T2 mapping and extracellular volume assessment were reported to add incremental value for arrhythmic assessment despite suffering from several technical limitations. CMR should be part of a multiparametric approach for patients' evaluation, and it will play a pivotal role in prognostic stratification according to the current evidence.
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Affiliation(s)
- Giorgio Faganello
- Department of Cardiovascular, Azienda Sanitaria Universitaria Integrata of Trieste, University of Trieste, Trieste, Italy
| | - Aldostefano Porcari
- Department of Cardiovascular, Azienda Sanitaria Universitaria Integrata of Trieste, University of Trieste, Trieste, Italy
| | - Federico Biondi
- Department of Cardiovascular, Azienda Sanitaria Universitaria Integrata of Trieste, University of Trieste, Trieste, Italy
| | - Marco Merlo
- Department of Cardiovascular, Azienda Sanitaria Universitaria Integrata of Trieste, University of Trieste, Trieste, Italy
| | - Antonio De Luca
- Department of Cardiovascular, Azienda Sanitaria Universitaria Integrata of Trieste, University of Trieste, Trieste, Italy
| | - Giancarlo Vitrella
- Department of Cardiovascular, Azienda Sanitaria Universitaria Integrata of Trieste, University of Trieste, Trieste, Italy
| | - Manuel Belgrano
- Department of Radiology, Azienda Sanitaria Universitaria Integrata of Trieste, University of Trieste, Trieste, Italy
| | - Lorenzo Pagnan
- Department of Radiology, Azienda Sanitaria Universitaria Integrata of Trieste, University of Trieste, Trieste, Italy
| | - Andrea Di Lenarda
- Department of Cardiovascular, Azienda Sanitaria Universitaria Integrata of Trieste, University of Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Department of Cardiovascular, Azienda Sanitaria Universitaria Integrata of Trieste, University of Trieste, Trieste, Italy
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218
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Sport Participation in Patients with Implantable Cardioverter-Defibrillators. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:66. [PMID: 31728782 DOI: 10.1007/s11936-019-0772-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Athletes diagnosed with cardiovascular disease may receive implantable cardioverter defibrillators (ICDs). Until recently, there were no data describing the safety of return to play for athletes receiving an ICD, and consensus recommendations restricted ICD patients to competitive sports no more vigorous than bowling or golf. RECENT FINDINGS The ICD Sports Registry prospectively followed 440 athletes who continued sports participation after receiving an ICD, for up to 4 years. While many received shocks, both appropriate and inappropriate, during competition or practice, as well as during other physical activity or rest, there were no failures to defibrillate and no injuries related to arrhythmia or shock during sports. Recent subanalyses as described below have focused on how best to program the ICD, and on the younger subgroup including interscholastic athletes. Based on these data, the most recent consensus statement from the AHA/ACC on athletic eligibility now describes sports participation with an ICD as a IIB recommendation, "may be considered".
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219
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Abstract
Primary care clinicians fulfill critical roles of screening for, diagnosing, and managing cardiovascular disease. In young athletes, primary structural and electrical diseases are the focus. Coronary artery disease is the chief concern in older athletes. Sudden cardiac arrest may be the initial presentation of disease and is more common in young athletes than historically appreciated. The traditional preparticipation evaluation, or sports physical, is limited in its ability to accurately raise suspicion of underlying disease. The 12-lead electrocardiogram is a more accurate screening tool. Contemporary risk stratification and treatment protocols may allow for safe return to sport on a case-by-case basis.
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Affiliation(s)
- David M Siebert
- Department of Family Medicine, UW Medicine Center for Sports Cardiology, University of Washington, 3800 Montlake Boulevard NE, Seattle, WA 98195, USA.
| | - Jonathan A Drezner
- Department of Family Medicine, UW Medicine Center for Sports Cardiology, University of Washington, 3800 Montlake Boulevard NE, Seattle, WA 98195, USA
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220
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Speers C, Seth AN, Patel KC, Rakhit DJ, Gillett MJ. Defining the Process of a Cardiovascular Risk Assessment Program: Lessons Learned From Cardiac Assessment of Elite Soccer Players in the United Kingdom. Clin J Sport Med 2019; 29:500-505. [PMID: 31688182 DOI: 10.1097/jsm.0000000000000534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Retrospectively analyze the cardiac assessment process for elite soccer players, and provide team physicians with a systematic guide to managing longitudinal cardiac risk. DESIGN Descriptive Epidemiology Study. SETTING Cardiac assessments incorporating clinical examination, 12-lead ECG, echocardiography, and health questionnaire. PARTICIPANTS Soccer players at 5 professional clubs in England, the United Kingdom. INTERVENTION Data was retrospectively collected, inspected, and analyzed to determine their clinical management and subsequent follow-up. RESULTS Over 2 years, 265 soccer players, aged 13 to 37 years with 66% of white European ethnicity, were included in the cohort. Eleven percent had "not-normal" assessments, of these assessments, 83% were considered gray screens, falling into three broad categories: structural cardiac features (including valvular abnormalities), functional cardiac features, and electrocardiogram changes. After cardiology consultation, all assessments were grouped into low, enhanced and high-risk categories for ongoing longitudinal risk management. Overall clear-cut pathology was identified in 2%. CONCLUSIONS Cardiovascular assessment is a vital tool in identifying athletes at risk of sudden cardiac death to mitigate their risk through surveillance, intervention, or participation restriction. The decision whether a player is fit to play or not requires a robust risk assessment followed by input from a multidisciplinary team that includes both the team physician and cardiologist. This educational article proposes a clinical management pathway to aid clinicians with this process. CLINICAL RELEVANCE Sudden cardiac death is the important medical cause of death during exercise. The team physician should assume responsibility for the management of the longitudinal risk of their players' cardiac assessments in conjunction with sports cardiologist.
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Affiliation(s)
| | | | | | - Dhrubo Jyoti Rakhit
- Southampton University Hospitals, NHS Trust, Cardiology Department, Southampton, England
| | - Mark James Gillett
- West Bromwich Albion F.C. Sports Medicine and Sports Science Department, West Bromwich, England
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221
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Carruth ED, Young W, Beer D, James CA, Calkins H, Jing L, Raghunath S, Hartzel DN, Leader JB, Kirchner HL, Smelser DT, Carey DJ, Kelly MA, Sturm AC, Alsaid A, Fornwalt BK, Haggerty CM. Prevalence and Electronic Health Record-Based Phenotype of Loss-of-Function Genetic Variants in Arrhythmogenic Right Ventricular Cardiomyopathy-Associated Genes. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2019; 12:e002579. [PMID: 31638835 DOI: 10.1161/circgen.119.002579] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with variants in desmosome genes. Secondary findings of pathogenic/likely pathogenic variants, primarily loss-of-function (LOF) variants, are recommended for clinical reporting; however, their prevalence and associated phenotype in a general clinical population are not fully characterized. METHODS From whole-exome sequencing of 61 019 individuals in the DiscovEHR cohort, we screened for putative loss-of-function variants in PKP2, DSC2, DSG2, and DSP. We evaluated measures from prior clinical ECG and echocardiograms, manually over-read to evaluate ARVC diagnostic criteria, and performed a PheWAS (phenome-wide association study). Finally, we estimated expected penetrance using Bayesian inference. RESULTS One hundred forty individuals (0.23%; 59±18 years old at last encounter; 33% male) had an ARVC variant (G+). None had an existing diagnosis of ARVC in the electronic health record, nor significant differences in prior ECG or echocardiogram findings compared with matched controls without variants. Several G+ individuals satisfied major repolarization (n=4) and ventricular function (n=5) criteria, but this prevalence matched controls. PheWAS showed no significant associations of other heart disease diagnoses. Combining our best genetic and disease prevalence estimates yields an estimated penetrance of 6.0%. CONCLUSIONS The prevalence of ARVC loss-of-function variants is ≈1:435 in a general clinical population of predominantly European descent, but with limited electronic health record-based evidence of phenotypic association in our population, consistent with a low penetrance estimate. Prospective deep phenotyping and longitudinal follow-up of a large sequenced cohort is needed to determine the true clinical relevance of an incidentally identified ARVC loss-of-function variant.
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Affiliation(s)
- Eric D Carruth
- Department of Imaging Science and Innovation (E.D.C., L.J., S.R., B.K.F., C.M.H.), Geisinger, Danville, PA.,Biomedical and Translational Informatics Institute (E.D.C., L.J., S.R., D.N.H., J.B.L., H.L.K., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Wilson Young
- The Heart Institute (W.Y., D.B., A.A., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Dominik Beer
- The Heart Institute (W.Y., D.B., A.A., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Cynthia A James
- Department of Medicine, Division of Cardiology, Johns Hopkins Medical Center, Baltimore, MD (C.A.J., H.C.)
| | - Hugh Calkins
- Department of Medicine, Division of Cardiology, Johns Hopkins Medical Center, Baltimore, MD (C.A.J., H.C.)
| | - Linyuan Jing
- Department of Imaging Science and Innovation (E.D.C., L.J., S.R., B.K.F., C.M.H.), Geisinger, Danville, PA.,Biomedical and Translational Informatics Institute (E.D.C., L.J., S.R., D.N.H., J.B.L., H.L.K., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Sushravya Raghunath
- Department of Imaging Science and Innovation (E.D.C., L.J., S.R., B.K.F., C.M.H.), Geisinger, Danville, PA.,Biomedical and Translational Informatics Institute (E.D.C., L.J., S.R., D.N.H., J.B.L., H.L.K., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Dustin N Hartzel
- Biomedical and Translational Informatics Institute (E.D.C., L.J., S.R., D.N.H., J.B.L., H.L.K., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Joseph B Leader
- Biomedical and Translational Informatics Institute (E.D.C., L.J., S.R., D.N.H., J.B.L., H.L.K., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - H Lester Kirchner
- Biomedical and Translational Informatics Institute (E.D.C., L.J., S.R., D.N.H., J.B.L., H.L.K., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Diane T Smelser
- Department of Molecular and Functional Genomics (D.T.S., D.J.C.), Geisinger, Danville, PA
| | - David J Carey
- Department of Molecular and Functional Genomics (D.T.S., D.J.C.), Geisinger, Danville, PA
| | - Melissa A Kelly
- Genomic Medicine Institute (M.A.K., A.C.S.), Geisinger, Danville, PA
| | - Amy C Sturm
- Genomic Medicine Institute (M.A.K., A.C.S.), Geisinger, Danville, PA
| | - Amro Alsaid
- The Heart Institute (W.Y., D.B., A.A., B.K.F., C.M.H.), Geisinger, Danville, PA
| | - Brandon K Fornwalt
- Department of Imaging Science and Innovation (E.D.C., L.J., S.R., B.K.F., C.M.H.), Geisinger, Danville, PA.,Biomedical and Translational Informatics Institute (E.D.C., L.J., S.R., D.N.H., J.B.L., H.L.K., B.K.F., C.M.H.), Geisinger, Danville, PA.,The Heart Institute (W.Y., D.B., A.A., B.K.F., C.M.H.), Geisinger, Danville, PA.,Department of Radiology (B.K.F.), Geisinger, Danville, PA
| | - Christopher M Haggerty
- Department of Imaging Science and Innovation (E.D.C., L.J., S.R., B.K.F., C.M.H.), Geisinger, Danville, PA.,Biomedical and Translational Informatics Institute (E.D.C., L.J., S.R., D.N.H., J.B.L., H.L.K., B.K.F., C.M.H.), Geisinger, Danville, PA.,The Heart Institute (W.Y., D.B., A.A., B.K.F., C.M.H.), Geisinger, Danville, PA
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Abstract
PURPOSE OF REVIEW The optimal approach to screening young people to decrease the risk of sudden death remains unknown. It deserves the passionate attention that researchers, clinicians and families have given it. The new data from January 2018 to July 2019 are reviewed here. RECENT FINDINGS Cardiac findings associated with a risk of sudden death were reported in 0.4% of screened athletes. Well run programs continue report varying sensitivity for screening ECGs (between 86 and 100%). One major article reported a higher incidence of sudden death in young people than has been previously published (6.8/100 000 athletes). SUMMARY The rate of important findings in sophisticated screening programs is approximately 0.4%, suggesting that this is near the population rate of detectable disease in most athletic groups. ECGs are unquestionably capable of detecting disease that can be missed by history and physical, but the performance characteristics of ECGs continue to vary from study to study. In addition, the underlying cost and infrastructure of ECG and echocardiographic screening remains unaddressed by the recent literature. A few small studies have started to look at alternative technology approaches to ECG screening. VIDEO ABSTRACT.
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223
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Orchard JJ, Neubeck L, Orchard JW, Puranik R, Raju H, Freedman B, La Gerche A, Semsarian C. ECG-based cardiac screening programs: Legal, ethical, and logistical considerations. Heart Rhythm 2019; 16:1584-1591. [DOI: 10.1016/j.hrthm.2019.03.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Indexed: 01/02/2023]
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224
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Tirapu L, San Antonio R, Tolosana JM, Roca-Luque I, Mont L, Guasch E. Exercise and atrial fibrillation: how health turns harm, and how to turn it back. Minerva Cardioangiol 2019; 67:411-424. [DOI: 10.23736/s0026-4725.19.04998-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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225
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Exercise related sudden cardiac death (SCD) in the young - Pre-mortal characterization of a Swedish nationwide cohort, showing a decline in SCD among athletes. Resuscitation 2019; 144:99-105. [PMID: 31560990 DOI: 10.1016/j.resuscitation.2019.09.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/15/2019] [Accepted: 09/16/2019] [Indexed: 02/07/2023]
Abstract
AIMS To study the frequency, etiology, and premortal abnormalities in exercise-related sudden cardiac death (SCD) in the young in Sweden. METHODS All subjects with SCD in 10-35-year olds in Sweden during 2000-10, were included (n = 514). Information about each case was retrieved from death certifications, autopsy- and medical records. The number of SCD in athletes was compared to national figures from 1992-99. RESULTS Exercise-related SCD occurred in 12% (62/514) of the SCD-population, a majority being men (56/62; 90%). Cardiopulmonary resuscitation (CPR) was started in 87% (54/62). In total, 48% (30/62), had a cardiac diagnosis, symptoms, family history and/or ECG-changes, before the fatal event. The most prevalent autopsy diagnosis was sudden arrhythmic death syndrome (15/62; 24%). The frequency of hypertrophic cardiomyopathy (HCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC) was significantly higher in exercise-related SCD compared to non-exertional SCD. Exercise-related SCD was more common in athletes (21/29) than in non-athletes (41/485) (P < 0.0001). The total number of SCDs/year in athletes 15-35 years old, are approximately halved in 2000-10 compared to the years 1992-99. CONCLUSION The increased risk of exercise-related SCD in HCM and ARVC underlines the importance of early detection and eligibility recommendations. There is a major reduction in deaths among athletes in the 2000s, compared to the previous decade. These results may partly be explained by improved acute preparedness for sudden cardiac arrest (CPR, defibrillation), but as a substantial percentage have preceding risk factors, such as symptoms and ECG-abnormalities, increased cardiac screening and increased general awareness, may also play a role.
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226
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Kim Y, Mahmood M, Lee Y, Kim NK, Kwon S, Herbert R, Kim D, Cho HC, Yeo W. All-in-One, Wireless, Stretchable Hybrid Electronics for Smart, Connected, and Ambulatory Physiological Monitoring. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2019; 6:1900939. [PMID: 31508289 PMCID: PMC6724359 DOI: 10.1002/advs.201900939] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/11/2019] [Indexed: 05/21/2023]
Abstract
Commercially available health monitors rely on rigid electronic housing coupled with aggressive adhesives and conductive gels, causing discomfort and inducing skin damage. Also, research-level skin-wearable devices, while excelling in some aspects, fall short as concept-only presentations due to the fundamental challenges of active wireless communication and integration as a single device platform. Here, an all-in-one, wireless, stretchable hybrid electronics with key capabilities for real-time physiological monitoring, automatic detection of signal abnormality via deep-learning, and a long-range wireless connectivity (up to 15 m) is introduced. The strategic integration of thin-film electronic layers with hyperelastic elastomers allows the overall device to adhere and deform naturally with the human body while maintaining the functionalities of the on-board electronics. The stretchable electrodes with optimized structures for intimate skin contact are capable of generating clinical-grade electrocardiograms and accurate analysis of heart and respiratory rates while the motion sensor assesses physical activities. Implementation of convolutional neural networks for real-time physiological classifications demonstrates the feasibility of multifaceted analysis with a high clinical relevance. Finally, in vivo demonstrations with animals and human subjects in various scenarios reveal the versatility of the device as both a health monitor and a viable research tool.
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Affiliation(s)
- Yun‐Soung Kim
- George W. Woodruff School of Mechanical EngineeringInstitute for Electronics and NanotechnologyGeorgia Institute of TechnologyAtlantaGA30332USA
| | - Musa Mahmood
- George W. Woodruff School of Mechanical EngineeringInstitute for Electronics and NanotechnologyGeorgia Institute of TechnologyAtlantaGA30332USA
| | - Yongkuk Lee
- Department of Biomedical EngineeringWichita State UniversityWichitaKS67260USA
| | - Nam Kyun Kim
- Department of PediatricsSchool of MedicineEmory UniversityAtlantaGA30322USA
- Department of PediatricsYonsei University College of MedicineSeoul03722South Korea
| | - Shinjae Kwon
- George W. Woodruff School of Mechanical EngineeringInstitute for Electronics and NanotechnologyGeorgia Institute of TechnologyAtlantaGA30332USA
| | - Robert Herbert
- George W. Woodruff School of Mechanical EngineeringInstitute for Electronics and NanotechnologyGeorgia Institute of TechnologyAtlantaGA30332USA
| | - Donghyun Kim
- George W. Woodruff School of Mechanical EngineeringInstitute for Electronics and NanotechnologyGeorgia Institute of TechnologyAtlantaGA30332USA
- Department of SurgeryYonsei University Wonju College of MedicineWonjuGangwon‐do220701South Korea
| | - Hee Cheol Cho
- Department of PediatricsSchool of MedicineEmory UniversityAtlantaGA30322USA
- Wallace H. Coulter Department of Biomedical EngineeringParker H. Petit Institute for Bioengineering and BiosciencesGeorgia Institute of Technology and Emory UniversityAtlantaGA30332USA
| | - Woon‐Hong Yeo
- George W. Woodruff School of Mechanical EngineeringInstitute for Electronics and NanotechnologyGeorgia Institute of TechnologyAtlantaGA30332USA
- Wallace H. Coulter Department of Biomedical EngineeringParker H. Petit Institute for Bioengineering and BiosciencesGeorgia Institute of Technology and Emory UniversityAtlantaGA30332USA
- Center for Flexible and Wearable Electronics Advanced ResearchInstitute for MaterialsNeural Engineering CenterGeorgia Institute of TechnologyAtlantaGA30332USA
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Özel E, Koşar MF, Özcan EE, Hünük B, Ulus T, Aytekin V, Yıldırır A, Özin B, Erdinler İ, Akyürek Ö. Turkish Society of Cardiology consensus report on recommendations for athletes with high-risk genetic cardiovascular diseases or implanted cardiac devices. Anatol J Cardiol 2019; 22:140-151. [PMID: 31475950 PMCID: PMC6735428 DOI: 10.14744/anatoljcardiol.2019.09633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Erdem Özel
- Department of Cardiology, İzmir Tepecik Training and Research Hospital; İzmir-Turkey
| | - Mustafa Feridun Koşar
- Department of Cardiology, İstanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital; İstanbul-Turkey
| | - Emin Evren Özcan
- Department of Cardiology, Faculty of Medicine, İzmir Dokuz Eylül University; İzmir-Turkey
| | - Burak Hünük
- Department of Cardiology, Faculty of Medicine, İstanbul Yeditepe University; İstanbul-Turkey
| | - Taner Ulus
- Department of Cardiology, Faculty of Medicine, Eskişehir Osmangazi University; Eskişehir-Turkey
| | - Vedat Aytekin
- Department of Cardiology, İstanbul Koç University Hospital; İstanbul-Turkey
| | - Aylin Yıldırır
- Department of Cardiology, Faculty of Medicine, Başkent University; Ankara-Turkey
| | - Bülent Özin
- Department of Cardiology, Faculty of Medicine, Başkent University; Ankara-Turkey
| | - İzzet Erdinler
- Department of Cardiology, Memorial Ataşehir Hospital; İstanbul-Turkey
| | - Ömer Akyürek
- Department of Cardiology, Faculty of Medicine, Ankara University; Ankara-Turkey
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228
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Canadian Cardiovascular Society Cardiovascular Screening of Competitive Athletes: The Utility of the Screening Electrocardiogram to Predict Sudden Cardiac Death. Can J Cardiol 2019; 35:1557-1566. [PMID: 31679625 DOI: 10.1016/j.cjca.2019.08.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/01/2019] [Accepted: 08/01/2019] [Indexed: 01/12/2023] Open
Abstract
Prevention of sudden cardiac arrest/death (SCA/D) among athletes is a universal goal, although the optimal strategy for its achievement is controversial, with the inclusion of the 12-lead electrocardiogram (ECG) at the center of the debate. The ECG exhibits superior sensitivity over history and physical examination to detect conditions associated with SCA/D. However, the identification of disease does not necessarily lead to a significant reduction in SCA/D. The "Canadian Cardiovascular Society/Canadian Heart Rhythm Society Joint Position Statement on the Cardiovascular Screening of Competitive Athletes" recommended against the routine performance of an ECG for the initial cardiovascular screening of competitive athletes. The incidence of SCA/D among athletes (<35 years of age), the risk of SCA/D during sport participation among individuals with abnormalities found on screening ECG, the efficacy of the ECG to identify conditions associated with SCA/D, and the positive predictive value of an abnormal ECG to predict SCA/D are critically examined. This review presents the evidence informing the panel's recommendation.
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229
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Morentin B, Suárez-Mier MP, Monzó A, Molina P, Lucena JS. Sports-related sudden cardiac death due to myocardial diseases on a population from 1-35 years: a multicentre forensic study in Spain. Forensic Sci Res 2019; 4:257-266. [PMID: 31489391 PMCID: PMC6713174 DOI: 10.1080/20961790.2019.1633729] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 06/14/2019] [Accepted: 06/16/2019] [Indexed: 11/20/2022] Open
Abstract
This is a multicentre forensic study that identifies all sports-related sudden deaths (SRSDs) in young people, due to myocardial diseases (MDs) that occurred in a large area of Spain. The aim of the study is to assess the epidemiology, causes of death, and sport activities associated with these fatalities. This is a retrospective study based on forensic autopsies performed in the provinces of Biscay, Seville, Valencia and in the jurisdiction covered by the National Institute of Toxicology and Forensic Sciences in Madrid (Spain). The retrospective study encompasses from 2010 to 2017. All sudden cardiac deaths (SCDs) in persons 1-35 years old were selected. The total number of SCDs were divided into death occurred during exercise (SRSD) and death during rest, sleep or normal activities (non-SRSD). Each of these two groups was subdivided according to the cause of death into MD (primary cardiomyopathies and myocarditis) and non-MD. Clinic-pathological, toxicological and genetic characteristics of SRSD due to MD were analysed. Over the 8-year study period, we identified 645 cases of SCD in the young: 75 SRSD (11.6%) and 570 non-SRSD (88.4%). MD was diagnosed in 33 (44.0%) of the SRSD and in 112 (19.6%) of the non-SRSD cases. All cases of SRSD due to MD were males (mean age (24.0 ± 7.6) years) practicing recreational sports (85%). SRSDs were more frequent in arrhythmogenic cardiomyopathy (ACM) (37%) and hypertrophic cardiomyopathy (HCM) (24%), followed by myocarditis (15%) and idiopathic left ventricular hypertrophy (ILVH) (9%). Only in five cases of SRSD the MD responsible of death (HCM) had been diagnosed in life. Cardiovascular symptoms related to the disease were present in other seven patients (six of them with ACM). Postmortem genetic studies were performed in 15/28 (54%) primary cardiomyopathies with positive results in 12 (80%) cases. The most frequent sports disciplines were football (49%) followed by gymnastics (15%) and running (12%). In Spain, SRSD in young people due to MDs occurs in males who perform a recreational activity. Compared with control group we observed a strong association between MDs and exertion. One in three SRSDs are due to cardiomyopathy, especially ACM, which reinforces the need for preparticipation screening to detect these pathologies in recreational sport athletes. Further studies are warranted to understand the causes and circumstances of sudden death to facilitate the development of preventive strategies.
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Affiliation(s)
- Benito Morentin
- Section of Forensic Pathology, Basque Institute of Legal Medicine, Bilbao, Spain
| | - M. Paz Suárez-Mier
- Histopathology Service, Department of Madrid, National Institute of Toxicology and Forensic Sciences, Spain
| | - Ana Monzó
- Forensic Pathology Service, Institute of Legal Medicine and Forensic Sciences, Valencia, Spain
| | - Pilar Molina
- Forensic Pathology Service, Institute of Legal Medicine and Forensic Sciences, Valencia, Spain
| | - Joaquín S. Lucena
- Forensic Pathology Service, Institute of Legal Medicine and Forensic Sciences, Seville, Spain
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230
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Fischetti CE, Kamyszek RW, Shaheen S, Oshlag B, Banks A, Blood AJ, Bytomski JR, Boggess B, Lahham S. Evaluation of a Standardized Cardiac Athletic Screening for National Collegiate Athletic Association (NCAA) Athletes. West J Emerg Med 2019; 20:810-817. [PMID: 31539339 PMCID: PMC6754195 DOI: 10.5811/westjem.2019.7.43190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 07/10/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Sudden cardiac death is a rare cause of death in young athletes. Current screening techniques include history and physical exam (H and P), with or without an electrocardiogram (ECG). Adding point of care cardiac ultrasound has demonstrated benefits, but there is limited data about implementing this technology. We evaluated the feasibility of adding ultrasound to preparticipation screening for collegiate athletes. METHODS We prospectively enrolled 42 collegiate athletes randomly selected from several sports. All athletes were screened using a 14-point H and P based on 2014 American College of Cardiology (ACC) and American Heart Association (AHA) guidelines, ECG, and cardiac ultrasound. RESULTS We screened 11 female and 31 male athletes. On ultrasound, male athletes demonstrated significantly larger interventricular septal wall thickness (p = 0.002), posterior wall thickness (p <0.001) and aortic root breadth (p = 0.002) compared to females. Based on H and P and ECGs alone and a combination of H and P with ECG, no athletes demonstrated a positive screening for cardiac abnormalities. However, with combined H and P, ECG, and cardiac ultrasound, one athlete demonstrated positive findings. CONCLUSIONS We believe that adding point of care ultrasound to the preparticipation exam of college athletes is feasible. This workflow may provide a model for athletic departments' screening.
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Affiliation(s)
- Chanel E Fischetti
- University of California, Irvine Medical Center, Department of Emergency Medicine, Orange, California
| | | | - Stephen Shaheen
- Duke University Medical Center, Department of Surgery, Durham, North Carolina
| | - Benjamin Oshlag
- New York Presbyterian Hospital/Columbia University Medical Center, Department of Emergency Medicine, New York, New York
| | - Adam Banks
- Duke University Medical Center, Department of Medicine, Durham, North Carolina
| | - A J Blood
- Brigham and Women's Hospital, Department of Medicine, Boston, Massachusetts
| | - Jeffrey R Bytomski
- Duke University Medical Center, Department of Community and Family Medicine, Durham, North Carolina
| | - Blake Boggess
- Duke University Medical Center, Department of Community and Family Medicine, Durham, North Carolina
| | - Shadi Lahham
- University of California, Irvine Medical Center, Department of Emergency Medicine, Orange, California
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231
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Aleixo H, Gomes da Silva M, Back Sternick E. An asymptomatic teenager clears preparticipation evaluation. When enough is enough? BRITISH HEART JOURNAL 2019; 105:1251-1259. [DOI: 10.1136/heartjnl-2019-314871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/14/2019] [Accepted: 03/27/2019] [Indexed: 11/03/2022]
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232
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Miragoli M, Goldoni M, Demola P, Paterlini A, Li Calzi M, Gioia MI, Visioli F, Rossi S, Pelà G. Left ventricular geometry correlates with early repolarization pattern in adolescent athletes. Scand J Med Sci Sports 2019; 29:1727-1735. [DOI: 10.1111/sms.13518] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Michele Miragoli
- Department of Medicine and Surgery University of Parma Parma Italy
- CERT, Center of Excellence for Toxicological Research, Department of Medicine and Surgery University of Parma Parma Italy
| | - Matteo Goldoni
- Department of Medicine and Surgery University of Parma Parma Italy
- CERT, Center of Excellence for Toxicological Research, Department of Medicine and Surgery University of Parma Parma Italy
| | - Pierluigi Demola
- Department of Medicine and Surgery University of Parma Parma Italy
- University Hospital of Parma Parma Italy
| | | | - Mauro Li Calzi
- Department of Medicine and Surgery University of Parma Parma Italy
| | | | - Francesco Visioli
- Department of Molecular Medicine University of Padova Parma Italy
- IMDEA‐Food Madrid Spain
| | - Stefano Rossi
- Department of Medicine and Surgery University of Parma Parma Italy
- CERT, Center of Excellence for Toxicological Research, Department of Medicine and Surgery University of Parma Parma Italy
| | - Giovanna Pelà
- Department of Medicine and Surgery University of Parma Parma Italy
- University Hospital of Parma Parma Italy
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233
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Roeh A, Bunse T, Lembeck M, Handrack M, Pross B, Schoenfeld J, Keeser D, Ertl-Wagner B, Pogarell O, Halle M, Falkai P, Hasan A, Scherr J. Running effects on cognition and plasticity (ReCaP): study protocol of a longitudinal examination of multimodal adaptations of marathon running. Res Sports Med 2019; 28:241-255. [PMID: 31345073 DOI: 10.1080/15438627.2019.1647205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Regular moderate physical activity (PA) has been linked to beneficial adaptations in various somatic diseases (e.g. cancer, endocrinological disorders) and a reduction in all-cause mortality from several cardiovascular and neuropsychiatric diseases. This study was designed to investigate acute and prolonged exercise-induced cardio- and neurophysiological responses in endurance runners competing in the Munich Marathon. ReCaP (Running effects on Cognition and Plasticity) is a multimodal and longitudinal experimental study. This study included 100 participants (20-60 years). Six laboratory visits were included during the 3-month period before and the 3-month period after the Munich marathon. The multimodal assessment included laboratory measurements, cardiac and cranial imaging (MRI scans, ultrasound/echocardiography) and neurophysiological methods (EEG and TMS/tDCS), and vessel-analysis (e.g. retinal vessels and wave-reflection analyses) and neurocognitive measurements. The ReCaP study was designed to examine novel exercise-induced cardio- and neurophysiological responses to marathon running at the behavioral, functional and morphological levels. This study will expand our understanding of exercise-induced adaptations and will lead to more individually tailored therapeutic options.
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Affiliation(s)
- A Roeh
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - T Bunse
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - M Lembeck
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - M Handrack
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - B Pross
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - J Schoenfeld
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - D Keeser
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - B Ertl-Wagner
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - O Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - M Halle
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, Munich, Germany
| | - P Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - A Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - J Scherr
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
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234
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Vessella T, Zorzi A, Merlo L, Pegoraro C, Giorgiano F, Trevisanato M, Viel M, Formentini P, Corrado D, Sarto P. The Italian preparticipation evaluation programme: diagnostic yield, rate of disqualification and cost analysis. Br J Sports Med 2019; 54:231-237. [PMID: 31315826 PMCID: PMC7029244 DOI: 10.1136/bjsports-2018-100293] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Italian law mandates that every competitive athlete must undergo annual preparticipation evaluation (PPE) to identify cardiovascular (CV) diseases that pose a risk of sudden death (SD) during sport and other conditions that may threaten the athlete's health. We investigated the diagnostic yield, rate of disqualification and costs of our PPE. METHODS We included 5910 consecutive apparently healthy athletes (61% males, mean age 15±4 years) who underwent annual PPE performed by a sports medicine specialist. The PPE included history, physical examination, weight, height and blood pressure measurement, test of visual acuity, spirometry, urine chemistry, resting 12-lead ECG and exercise testing with ECG monitoring. In cases of abnormal findings, we carried out second-line investigations. RESULTS During a 12-month study period, 5.326 (90.2%) athletes were cleared for competition after a normal first-line evaluation and 584 (9.8%) underwent one or more further examinations. Of those, 88 (1.5%) were diagnosed to have a CV disease (including 18 (0.3%) at-risk of SD) and 31 (0.5%) had a non-CV diagnosis. A total of 32 (0.5%) athletes were temporarily (n=15) or permanently (n=17) disqualified from competitive sports. The average cost per athlete was €79, which consisted of €64 (80%) for first-line evaluations and €15 (20%) for additional investigations. CONCLUSION PPE according to the Italian model identified a range of diseases in 2.0% of apparently healthy athletes at an average cost of €79.
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Affiliation(s)
- Teresina Vessella
- Center for Sports Medicine and Exercise Prescription, Treviso, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Laura Merlo
- Center for Sports Medicine and Exercise Prescription, Treviso, Italy
| | - Cinzia Pegoraro
- Center for Sports Medicine and Exercise Prescription, Treviso, Italy
| | | | | | - Mirella Viel
- Center for Sports Medicine and Exercise Prescription, Treviso, Italy
| | - Pietro Formentini
- Center for Sports Medicine and Exercise Prescription, Treviso, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Patrizio Sarto
- Center for Sports Medicine and Exercise Prescription, Treviso, Italy
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235
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Williams EA, Pelto HF, Toresdahl BG, Prutkin JM, Owens DS, Salerno JC, Harmon KG, Drezner JA. Performance of the American Heart Association ( AHA ) 14-Point Evaluation Versus Electrocardiography for the Cardiovascular Screening of High School Athletes: A Prospective Study. J Am Heart Assoc 2019; 8:e012235. [PMID: 31286819 PMCID: PMC6662133 DOI: 10.1161/jaha.119.012235] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Preparticipation cardiovascular screening in athletes is fully endorsed by major medical societies, yet the most effective screening protocol remains debated. We prospectively compared the performance of the American Heart Association (AHA) 14‐point screening evaluation and a resting ECG for cardiovascular screening of high school athletes. Methods and Results Competitive athletes participating in organized high school or premier/select level sports underwent cardiovascular screening using the AHA 14‐point history and physical examination, and an ECG interpreted with the Seattle Criteria. A limited echocardiogram was performed for all screening abnormalities. The primary outcome measure was identification of a cardiovascular disorder associated with sudden cardiac death. From October 2014 to June 2017, 3620 high school athletes (median age, 16 years; range 13–19; 46.2% female; 78.6% white, 8.0% black) were screened. One or more positive responses to the AHA 14‐point questionnaire were present in 814 (22.5%) athletes. The most common history responses included chest pain (8.1%), family history of inheritable conditions (7.3%), and shortness of breath (6.4%). Abnormal physical examination was present in 356 (9.8%) athletes, and 103 (2.8%) athletes had an abnormal ECG. Sixteen (0.4%) athletes had conditions associated with sudden cardiac death. The sensitivity (18.8%), specificity (68.0%), and positive predictive value (0.3%) of the AHA 14‐point evaluation was substantially lower than the sensitivity (87.5%), specificity (97.5%), and positive predictive value (13.6%) of ECG. Conclusions The AHA 14‐point evaluation performs poorly compared with ECG for cardiovascular screening of high school athletes. The use of consensus‐derived history questionnaires as the primary tool for cardiovascular screening in athletes should be reevaluated. See Editorial Maron et al
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Affiliation(s)
- Elizabeth A Williams
- 1 Sports Medicine Section Department of Family Medicine University of Washington Seattle WA
| | - Hank F Pelto
- 1 Sports Medicine Section Department of Family Medicine University of Washington Seattle WA
| | - Brett G Toresdahl
- 2 Department of Sports Medicine Hospital of Special Surgery New York NY
| | - Jordan M Prutkin
- 3 Division of Cardiology Department of Medicine University of Washington Seattle WA
| | - David S Owens
- 3 Division of Cardiology Department of Medicine University of Washington Seattle WA
| | - Jack C Salerno
- 4 Division of Cardiology Department of Pediatrics University of Washington Seattle WA
| | - Kimberly G Harmon
- 1 Sports Medicine Section Department of Family Medicine University of Washington Seattle WA
| | - Jonathan A Drezner
- 1 Sports Medicine Section Department of Family Medicine University of Washington Seattle WA
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Maron BJ, Thompson PD, Maron MS. There is No Reason to Adopt ECG s and Abandon American Heart Association/American College of Cardiology History and Physical Screening for Detection of Cardiovascular Disease in the Young. J Am Heart Assoc 2019; 8:e013007. [PMID: 31286811 PMCID: PMC6662134 DOI: 10.1161/jaha.119.013007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
See Article Williams et al.
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237
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Malhotra A, Dhutia H, Yeo TJ, Finocchiaro G, Gati S, Bulleros P, Fanton Z, Papatheodorou E, Miles C, Keteepe-Arachi T, Basu J, Parry-Williams G, Prakash K, Gray B, D'Silva A, Ensam B, Behr E, Tome M, Papadakis M, Sharma S. Accuracy of the 2017 international recommendations for clinicians who interpret adolescent athletes’ ECGs: a cohort study of 11 168 British white and black soccer players. Br J Sports Med 2019; 54:739-745. [DOI: 10.1136/bjsports-2017-098528] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 01/01/2023]
Abstract
AimTo investigate the accuracy of the recently published international recommendations for ECG interpretation in young athletes in a large cohort of white and black adolescent soccer players.Methods11 168 soccer players (mean age 16.4±1.2 years) were evaluated with a health questionnaire, ECG and echocardiogram; 10 581 (95%) of the players were male and 10 163 (91%) were white. ECGs were retrospectively analysed according to (1) the 2010 European Society of Cardiology (ESC) recommendations, (2) Seattle criteria, (3) refined criteria and (4) the international recommendations for ECG interpretation in young athletes.ResultsThe ESC recommendations resulted in a higher number of abnormal ECGs compared with the Seattle, refined and international criteria (13.2%, 4.3%, 2.9% and 1.8%, respectively). All four criteria were associated with a higher prevalence of abnormal ECGs in black athletes compared with white athletes (ESC: 16.2% vs 12.9%; Seattle: 5.9% vs 4.2%; refined: 3.8% vs 2.8%; international 3.6% vs 1.6%; p<0.001 each). Compared with ESC recommendations, the Seattle, refined and international criteria identified a lower number of abnormal ECGs—by 67%, 78% and 86%, respectively. All four criteria identified 36 (86%) of 42 athletes with serious cardiac pathology. Compared with ESC recommendations, the Seattle criteria improved specificity from 87% to 96% in white athletes and 84% to 94% in black athletes. The international recommendations demonstrated the highest specificity for white (99%) and black (97%) athletes and a sensitivity of 86%.ConclusionsThe 2017 international recommendations for ECG interpretation in young athletes can be applied to adolescent athletes to detect serious cardiac disease. These recommendations perform more effectively than previous ECG criteria in both white and black adolescent soccer players.
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238
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Johri AM, Grubic N, Kuljic N, O’Connor M, Graham K, Bennett R, Moulson N. Translation of the Canadian Cardiovascular Society/Canadian Heart Rhythm Society Cardiovascular Screening and Care of Athletes Program Into Practice. Can J Cardiol 2019; 35:935-939. [DOI: 10.1016/j.cjca.2019.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/23/2019] [Accepted: 03/31/2019] [Indexed: 11/16/2022] Open
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Eichhorn C, Bière L, Schnell F, Schmied C, Wilhelm M, Kwong RY, Gräni C. Myocarditis in Athletes Is a Challenge: Diagnosis, Risk Stratification, and Uncertainties. JACC Cardiovasc Imaging 2019; 13:494-507. [PMID: 31202742 DOI: 10.1016/j.jcmg.2019.01.039] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/10/2018] [Accepted: 01/05/2019] [Indexed: 12/12/2022]
Abstract
Presentation of myocarditis in athletes is heterogeneous and establishing the diagnosis is challenging with no current uniform clinical gold standard. The combined information from symptoms, electrocardiography, laboratory testing, echocardiography, cardiac magnetic resonance imaging, and in certain cases endomyocardial biopsy helps to establish the diagnosis. Most patients with myocarditis recover spontaneously; however, athletes may be at higher risk of adverse cardiac events. Based on scarce evidence and mainly autopsy studies and expert's opinions, current recommendations generally advise abstinence from competitive sports ranging from a minimum of 3 to 6 months. However, the dilemma poses that (un)necessary prolonged disqualification of athletes to avoid adverse cardiac events can cause considerable disruption to training schedules and tournament preparation and lead to a decline in performance and ability to compete. Therefore, better risk stratification tools are imperatively needed. Using latest available data, this review contrasts existing recommendations and presents a new proposed diagnostic flowchart putting a greater focus on the use of cardiac magnetic resonance imaging in athletes with suspected myocarditis. This may enable cardiac caregivers to counsel athletes with suspected myocarditis more systematically and furthermore allow for pooling of more unified data. To modify recommendations regarding sports behavior in athletes with myocarditis, evidence, based on large multicenter registries including cardiac magnetic resonance imaging and endomyocardial biopsy, is needed. In the future, physicians might rely on combined novel risk stratification methods, by implementing both noninvasive and invasive tissue characterization methods.
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Affiliation(s)
- Christian Eichhorn
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Womens Hospital, Harvard Medical School, Boston, Massachusetts
| | - Loïc Bière
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Womens Hospital, Harvard Medical School, Boston, Massachusetts; Institut MitoVasc, Laboratoire Cardioprotection, Remodelage et Thrombose, University of Angers, Angers, France; Department of Cardiology, University Hospital of Angers, Angers, France
| | - Frédéric Schnell
- Rennes University Health Centre, Sports Medicine Division, Physiology Laboratories, Rennes-1 University, Rennes, France
| | - Christian Schmied
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Swiss Cardiovascular Center, University Hospital Berne, Berne, Switzerland
| | - Raymond Y Kwong
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Womens Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christoph Gräni
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Womens Hospital, Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Swiss Cardiovascular Center, University Hospital Berne, Berne, Switzerland; Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.
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240
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Panhuyzen-Goedkoop NM. Prevention of cardiovascular events in amateur athletes begins with a healthy lifestyle at school age. Eur J Prev Cardiol 2019; 26:1519-1521. [PMID: 31161937 DOI: 10.1177/2047487319853907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nicole M Panhuyzen-Goedkoop
- 1 Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Meibergdreef, Amsterdam, the Netherlands.,2 Department of Sports Cardiology, Sports Medical Centre Papendal, Papendallaan, the Netherlands
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241
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Sawada H, Mitani Y, Nakayama T, Fukushima H, Kogaki S, Igarashi T, Ichida F, Ono Y, Nakanishi T, Doi S, Ishikawa S, Matsushima M, Yamada O, Saji T. Detection of Pediatric Pulmonary Arterial Hypertension by School Electrocardiography Mass Screening. Am J Respir Crit Care Med 2019; 199:1397-1406. [DOI: 10.1164/rccm.201802-0375oc] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Hirofumi Sawada
- Department of Pediatrics, Mie University School of Medicine, Mie, Japan
| | - Yoshihide Mitani
- Department of Pediatrics, Mie University School of Medicine, Mie, Japan
| | - Tomotaka Nakayama
- Department of Pediatrics, Toho University Omori Medical Center, Tokyo, Japan
| | - Hiroyuki Fukushima
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Shigetoyo Kogaki
- Department of Pediatrics, Osaka University School of Medicine, Osaka, Japan
| | - Takehiro Igarashi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Fukiko Ichida
- Department of Pediatrics, Toyama University School of Medicine, Toyama, Japan
| | - Yasuo Ono
- Department of Cardiology, Shizuoka Children’s Hospital, Shizuoka, Japan
| | - Toshio Nakanishi
- Department of Pediatric Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Shozaburo Doi
- Department of Pediatrics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shiro Ishikawa
- Department of Pediatric Cardiology, Fukuoka Children’s Hospital, Fukuoka, Japan; and
| | - Masaki Matsushima
- Department of Pediatric Cardiology, Social Insurance Chukyo Hospital, Aichi, Japan
| | - Osamu Yamada
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tsutomu Saji
- Department of Pediatrics, Toho University Omori Medical Center, Tokyo, Japan
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242
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Santos-Lozano A, Martín-Hernández J, Baladrón C, Turrado-Sevilla MÁ, Arrarás-Flores Á, Villacastín JP, Boraita A, Bueno H, Lucia A. Sudden Cardiac Death in Professional Soccer Players. J Am Coll Cardiol 2019; 70:1420-1421. [PMID: 28882241 DOI: 10.1016/j.jacc.2017.07.738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/03/2017] [Accepted: 07/12/2017] [Indexed: 11/18/2022]
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243
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Towbin JA, McKenna WJ, Abrams DJ, Ackerman MJ, Calkins H, Darrieux FCC, Daubert JP, de Chillou C, DePasquale EC, Desai MY, Estes NAM, Hua W, Indik JH, Ingles J, James CA, John RM, Judge DP, Keegan R, Krahn AD, Link MS, Marcus FI, McLeod CJ, Mestroni L, Priori SG, Saffitz JE, Sanatani S, Shimizu W, van Tintelen JP, Wilde AAM, Zareba W. 2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy. Heart Rhythm 2019; 16:e301-e372. [PMID: 31078652 DOI: 10.1016/j.hrthm.2019.05.007] [Citation(s) in RCA: 436] [Impact Index Per Article: 87.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Indexed: 02/08/2023]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is an arrhythmogenic disorder of the myocardium not secondary to ischemic, hypertensive, or valvular heart disease. ACM incorporates a broad spectrum of genetic, systemic, infectious, and inflammatory disorders. This designation includes, but is not limited to, arrhythmogenic right/left ventricular cardiomyopathy, cardiac amyloidosis, sarcoidosis, Chagas disease, and left ventricular noncompaction. The ACM phenotype overlaps with other cardiomyopathies, particularly dilated cardiomyopathy with arrhythmia presentation that may be associated with ventricular dilatation and/or impaired systolic function. This expert consensus statement provides the clinician with guidance on evaluation and management of ACM and includes clinically relevant information on genetics and disease mechanisms. PICO questions were utilized to evaluate contemporary evidence and provide clinical guidance related to exercise in arrhythmogenic right ventricular cardiomyopathy. Recommendations were developed and approved by an expert writing group, after a systematic literature search with evidence tables, and discussion of their own clinical experience, to present the current knowledge in the field. Each recommendation is presented using the Class of Recommendation and Level of Evidence system formulated by the American College of Cardiology and the American Heart Association and is accompanied by references and explanatory text to provide essential context. The ongoing recognition of the genetic basis of ACM provides the opportunity to examine the diverse triggers and potential common pathway for the development of disease and arrhythmia.
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Affiliation(s)
- Jeffrey A Towbin
- Le Bonheur Children's Hospital, Memphis, Tennessee; University of Tennessee Health Science Center, Memphis, Tennessee
| | - William J McKenna
- University College London, Institute of Cardiovascular Science, London, United Kingdom
| | | | | | | | | | | | | | | | | | - N A Mark Estes
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Wei Hua
- Fu Wai Hospital, Beijing, China
| | - Julia H Indik
- University of Arizona, Sarver Heart Center, Tucson, Arizona
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | | | - Roy M John
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel P Judge
- Medical University of South Carolina, Charleston, South Carolina
| | - Roberto Keegan
- Hospital Privado Del Sur, Buenos Aires, Argentina; Hospital Español, Bahia Blanca, Argentina
| | | | - Mark S Link
- UT Southwestern Medical Center, Dallas, Texas
| | - Frank I Marcus
- University of Arizona, Sarver Heart Center, Tucson, Arizona
| | | | - Luisa Mestroni
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Silvia G Priori
- University of Pavia, Pavia, Italy; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart); ICS Maugeri, IRCCS, Pavia, Italy
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - J Peter van Tintelen
- University of Amsterdam, Academic Medical Center, Amsterdam, the Netherlands; Utrecht University Medical Center Utrecht, University of Utrecht, Department of Genetics, Utrecht, the Netherlands
| | - Arthur A M Wilde
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart); University of Amsterdam, Academic Medical Center, Amsterdam, the Netherlands; Department of Medicine, Columbia University Irving Medical Center, New York, New York
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244
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Matsui S, Kitamura T, Sado J, Kiyohara K, Kobayashi D, Kiguchi T, Nishiyama C, Okabayashi S, Shimamoto T, Matsuyama T, Kawamura T, Iwami T, Tanaka R, Kurosawa H, Nitta M, Sobue T. Location of arrest and survival from out-of-hospital cardiac arrest among children in the public-access defibrillation era in Japan. Resuscitation 2019; 140:150-158. [PMID: 31075289 DOI: 10.1016/j.resuscitation.2019.04.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 04/22/2019] [Accepted: 04/27/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Our objective was to assess the characteristics such as public-access defibrillation (PAD) by laypersons and the outcomes after pediatric out-of-hospital cardiac arrest by location in the PAD era. METHODS From a nationwide, prospective, population-based registry of out-of-hospital cardiac arrest patients in Japan, we enrolled consecutive pediatric patients aged ≤17 years before emergency medical service (EMS) arrival between 2013 and 2015. The primary outcome measure was 1-month survival, with favorable neurologic outcome defined as cerebral performance category 1 or 2. Factors associated with favorable neurologic outcome were assessed using multivariable logistic regression analysis. RESULTS Among 3991 eligible pediatric out-of-hospital cardiac arrests, the proportion of PAD was 0.2% (5/2888) at residence, 1.6% (2/125) in public areas, 0.9% (3/321) on streets/highways, 21.6% (11/51) at recreation/sports event areas, 46.1% (82/178) at education institutions, and 1.2% (5/428) in others. In the multivariable analysis, arrest witnessed by family members (adjusted odds ratio [AOR], 5.25; 95% confidence interval [CI], 3.22-8.58) and nonfamily members (AOR, 2.45; 95% CI, 1.26-4.77), first documented ventricular fibrillation (AOR, 12.29; 95% CI, 7.08-21.35), PAD (AOR, 2.63; 95% CI, 1.23-5.62), and earlier EMS response time (AOR for 1-min increment, 0.88; 95% CI, 0.81-0.94) were associated with improving outcome. As for locations, recreation/sports event areas (AOR, 3.43; 95% CI, 1.17-10.07) and education institutions (AOR, 3.03; 95% CI, 1.39-6.63) were also associated with favorable neurologic outcome. CONCLUSIONS In Japan, where public-access automated external defibrillators are well disseminated, characteristics such as PAD and outcomes for pediatric out-of-hospital cardiac arrest before EMS arrival differed substantially by location.
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Affiliation(s)
- Satoshi Matsui
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Emergency and General Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Junya Sado
- Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Otsuma Women's University, Tokyo, Japan
| | | | | | - Chika Nishiyama
- Department of Critical Care Nursing, Kyoto University Graduate School of Human Health Science, Kyoto, Japan
| | | | | | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
| | - Ryojiro Tanaka
- Department of Emergency and General Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Hiroshi Kurosawa
- Division of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Masahiko Nitta
- Department of Emergency Medicine, Department of Pediatrics, Osaka Medical College, Takatsuki, Japan
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
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245
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Affiliation(s)
- Chris Miles
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Institute, St George's University of London, London, UK
| | - Zephryn Fanton
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Institute, St George's University of London, London, UK
| | - Maite Tome
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Institute, St George's University of London, London, UK
| | - Elijah R Behr
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Institute, St George's University of London, London, UK
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246
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Sado J, Kiyohara K, Kitamura T, Matsui S, Ayusawa M, Nitta M, Iwami T, Nakata K, Sobue T, Kitamura Y. Sports activity and paediatric out-of-hospital cardiac arrest at schools in Japan. Resuscitation 2019; 139:33-40. [PMID: 30953710 DOI: 10.1016/j.resuscitation.2019.03.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 03/12/2019] [Accepted: 03/26/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sudden cardiac death during exercise or sports is an important problem among young athletes and non-athletes. An understanding of the epidemiological features of sports-related out-of-hospital cardiac arrest (OHCA) among children is crucial for planning approaches for prevention and better outcomes of paediatric OHCAs. We assessed the characteristics and outcomes of sports-related OHCA among children at schools in Japan to prevent sports-related paediatric OHCA at schools. METHODS The Stop and Prevent cardIac aRrest, Injury, and Trauma in Schools (SPIRITS) is a nationwide, prospective, observational study linking databases of two nationally representative registries. Data on the characteristics and outcomes of sports-related paediatric OHCA at schools in Japan were obtained from these databases. RESULTS Between 2008 and 2015, 188 sports-related paediatric OHCAs due to presumed cardiac origin occurred. The greatest proportion of OHCA during or after sports was due to long-distance running (21.8%), followed by soccer/futsal (13.3%), basketball (12.2%), and baseball/rubber-ball baseball (11.2%). We also assessed the association between prehospital factors and one-month survival with favourable neurological outcome after sports-related OHCA. The proportions of ventricular fibrillation as the first documented rhythm, bystander cardiopulmonary resuscitation (CPR), and public-access defibrillation (PAD) were 87.8%, 87.2%, and 63.3%, respectively. Compared with the non-PAD group, the adjusted odds ratio (95% confidence interval) of the PAD group was 3.64 (1.78-7.45). CONCLUSIONS In Japan, 188 schoolchildren experienced OHCAs of cardiac origin occurring during or after sports activity at schools during the 8-year period. Increasing PAD is essential to enhance better neurological outcome after sports-related OHCA among students.
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Affiliation(s)
- Junya Sado
- Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita 565-0871, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Otsuma Women's University, 12 Sanbancho Chiyoda-ku, Tokyo 102-8357, Japan.
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita 565-0871, Japan
| | - Satoshi Matsui
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita 565-0871, Japan; Department of Emergency Medicine, Hyogo Prefectural Kobe Children's Hospital, 1-6-7 Minatojima Chuo-ku, Kobe 650-0047, Japan
| | - Mamoru Ayusawa
- Department of Pediatrics, Nihon University School of Medicine, 30-1 Ooyaguchikamichou, Itabashi-ku, Tokyo 173-8610, Japan
| | - Masahiko Nitta
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan; Department of Pediatrics, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Taku Iwami
- Kyoto University Health Service, Yoshida Honmachi, Sakyo-ku, Kyoto 606-8501, Japan
| | - Ken Nakata
- Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita 565-0871, Japan
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita 565-0871, Japan
| | - Yuri Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita 565-0871, Japan
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247
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Abstract
Distinguishing between adaptive and maladaptive cardiovascular response to exercise is crucial to prevent the unnecessary termination of an athlete's career and to minimize the risk of sudden death. This is a challenging task essentially due to the substantial phenotypic overlap between electrical and structural changes seen in the physiological athletic heart remodeling and pathological changes seen in inherited or acquired cardiomyopathies. Stress testing is an ideal tool to discriminate normal from abnormal cardiovascular response by unmasking subtle pathologic responses otherwise undetectable at rest. Treadmill or bicycle electrocardiography, transthoracic echocardiography, and cardiopulmonary exercise testing are common clinical investigations used in sports cardiology, specifically among participants presenting with resting electrocardiographic abnormalities, frequent premature ventricular beats, or non-sustained ventricular arrhythmias. In this setting, as well as in cases of left ventricular hypertrophy or asymptomatic left ventricular dysfunction, stress imaging and myocardial tissue characterization by cardiovascular magnetic resonance show promise. In this review, we aimed to reappraise current diagnostic schemes, screening strategies and novel approaches that may be used to distinguish adaptive remodeling patterns to physical exercise from early phenotypes of inherited or acquired pathological conditions commanding prompt intervention.
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248
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Brandt A, O'Keefe C. Integration of 12-Lead Electrocardiograms Into Preparticipation Screenings to Prevent Sudden Cardiac Death in High School Athletes. J Pediatr Health Care 2019; 33:153-161. [PMID: 30361038 DOI: 10.1016/j.pedhc.2018.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 06/25/2018] [Accepted: 07/15/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Sudden cardiac arrest continues to be the leading cause of death in young athletes despite preparticipation sports screening (PPS). The devastating loss of children to sudden cardiac arrest has led communities to demand more comprehensive heart screenings. The purpose of this study was to evaluate a community youth heart screening program in Minnesota. METHOD A retrospective chart review of 840 participants aged 14 to 18 years from August 2015 through March 2017 was conducted. RESULTS Referrals were made for two abnormal electrocardiography results, 12 abnormal echocardiography results, and 59 elevated blood pressure readings. Cross-tabulations showed one participant with an abnormal electrocardiogram and six participants with abnormal echocardiograms who had no other abnormal findings at the screening. Findings were not statistically significant. DISCUSSION It was clinically significant that six participants were found to have potentially lethal electrical or structural heart abnormalities who would have otherwise have remained unidentified with the standard preparticipation sports screening guidelines.
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249
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Ghorayeb N, Stein R, Daher DJ, Silveira ADD, Ritt LEF, Santos DFPD, Sierra APR, Herdy AH, Araújo CGSD, Colombo CSSDS, Kopiler DA, Lacerda FFRD, Lazzoli JK, Matos LDNJD, Leitão MB, Francisco RC, Alô ROB, Timerman S, Carvalho TD, Garcia TG. The Brazilian Society of Cardiology and Brazilian Society of Exercise and Sports Medicine Updated Guidelines for Sports and Exercise Cardiology - 2019. Arq Bras Cardiol 2019; 112:326-368. [PMID: 30916199 PMCID: PMC6424031 DOI: 10.5935/abc.20190048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Nabil Ghorayeb
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
- Programa de Pós-Graduação em Medicina do Esporte da Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brazil
- Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), São Paulo, SP - Brazil
| | - Ricardo Stein
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre, RS - Brazil
- Vitta Centro de Bem Estar Físico, Porto Alegre, RS - Brazil
| | - Daniel Jogaib Daher
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
| | - Anderson Donelli da Silveira
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre, RS - Brazil
- Vitta Centro de Bem Estar Físico, Porto Alegre, RS - Brazil
| | - Luiz Eduardo Fonteles Ritt
- Hospital Cárdio Pulmonar, Salvador, BA - Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brazil
| | | | | | - Artur Haddad Herdy
- Instituto de Cardiologia de Santa Catarina, Florianópolis, SC - Brazil
- Clínica Cardiosport de Prevenção e Reabilitação, Florianópolis, SC - Brazil
| | | | - Cléa Simone Sabino de Souza Colombo
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
- Sports Cardiology, Cardiology Clinical Academic Group - St George's University of London,14 London - UK
| | - Daniel Arkader Kopiler
- Sociedade Brasileira de Medicina do Esporte e do Exercício (SBMEE), São Paulo, SP - Brazil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brazil
| | - Filipe Ferrari Ribeiro de Lacerda
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil
| | - José Kawazoe Lazzoli
- Sociedade Brasileira de Medicina do Esporte e do Exercício (SBMEE), São Paulo, SP - Brazil
- Federação Internacional de Medicina do Esporte (FIMS), Lausanne - Switzerland
| | | | - Marcelo Bichels Leitão
- Sociedade Brasileira de Medicina do Esporte e do Exercício (SBMEE), São Paulo, SP - Brazil
| | - Ricardo Contesini Francisco
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
| | - Rodrigo Otávio Bougleux Alô
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil
- Hospital Geral de São Mateus, São Paulo, SP - Brazil
| | - Sérgio Timerman
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (InCor-FMUSP), São Paulo, SP - Brazil
- Universidade Anhembi Morumbi, Laureate International Universities, São Paulo, SP - Brazil
| | - Tales de Carvalho
- Clínica Cardiosport de Prevenção e Reabilitação, Florianópolis, SC - Brazil
- Departamento de Ergometria e Reabilitação Cardiovascular da Sociedade Brasileira de Cardiologia (DERC/SBC), Rio de Janeiro, RJ - Brazil
- Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC - Brazil
| | - Thiago Ghorayeb Garcia
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
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250
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Lynge TH, Nielsen JL, Blanche P, Gislason G, Torp-Pedersen C, Winkel BG, Risgaard B, Tfelt-Hansen J. Decline in incidence of sudden cardiac death in the young: a 10-year nationwide study of 8756 deaths in Denmark. Europace 2019; 21:909-917. [DOI: 10.1093/europace/euz022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/31/2019] [Indexed: 12/24/2022] Open
Affiliation(s)
- Thomas Hadberg Lynge
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, Copenhagen, Denmark
| | - Jakob Lund Nielsen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, Copenhagen, Denmark
| | - Paul Blanche
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark
- Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Bo Gregers Winkel
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, Copenhagen, Denmark
| | - Bjarke Risgaard
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, Copenhagen, Denmark
- Department of Medicine and Surgery, University of Copenhagen, Copenhagen, Denmark
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