251
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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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252
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Lin CY, Chung FP, Kuo L, Lin YJ, Chang SL, Lo LW, Hu YF, Tuan TC, Chao TF, Liao JN, Chang TY, Yamada S, Te ALD, Huang TC, Chen SA. Characteristics of recurrent ventricular tachyarrhythmia after catheter ablation in patients with arrhythmogenic right ventricular cardiomyopathy. J Cardiovasc Electrophysiol 2019; 30:582-592. [PMID: 30699244 DOI: 10.1111/jce.13853] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 12/21/2018] [Accepted: 01/04/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The reason for recurrence of ventricular arrhythmia (VA) after catheter ablation in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) is not clear. METHODS In this study, 91 ARVC patients (age, 47 ± 13 years; 47 men) who underwent catheter ablation for drug-refractory ventricular arrhythmia (VA) were enrolled. The patients were categorized into single or multiple procedures (n = 28). The baseline characteristics and electrophysiological features of the patients were examined to elucidate the reason of the VA recurrences. RESULTS A total of 186 VAs were induced during the index procedure and 176 (94.6%) were eliminated. Successful, partially successful, and failed ablations were achieved in 89.0%, 8.8%, and 2.2% of the patients, respectively. During a mean follow-up period of 32 ± 26 months, 35 patients had VA recurrences. Forty-two repeat procedures were performed for 81 induced VAs in 28 patients. Of the 42 repeat procedures, successful, partially successful, and failed ablations were achieved in 37, 4, and 1 of the procedures, respectively. Most of the recurrent VAs (70 [72.9%]) originated from the newly-developed circuits owing to the scar progression. The patients with repeat procedure had worsening right ventricular remodeling. The multivariate analysis revealed that history as endurance athlete significantly predicted the need of a repeat procedure in spite of the initially successful endocardial/epicardial ablation and negative inducibility (hazard ratio: 3.014, 95% confidence interval: 1.493-6.084, P = 0.002). CONCLUSIONS In spite of the initial complete VA elimination, history as an athlete was associated with scar progression, RV remodeling, and VA recurrences from the newly developed arrhythmogenic substrates/circuit in ARVC.
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Affiliation(s)
- Chin-Yu Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Department of Medicine, Taipei Veterans General Hospital, Yuan-Shan Branch, I-Lan, Taiwan
| | - Fa-Po Chung
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ling Kuo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yenn-Jiang Lin
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ta-Chuan Tuan
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Tze-Fan Chao
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Jo-Nan Liao
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ting-Yung Chang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shinya Yamada
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Abigail Louise D Te
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ting-Chun Huang
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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253
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Outcome of exercise-related out-of-hospital cardiac arrest is dependent on location: Sports arenas vs outside of arenas. PLoS One 2019; 14:e0211723. [PMID: 30707745 PMCID: PMC6358107 DOI: 10.1371/journal.pone.0211723] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/20/2019] [Indexed: 11/19/2022] Open
Abstract
Background The chance of surviving an out-of-hospital cardiac arrest (OHCA) seems to be increased if the cardiac arrests occurs in relation to exercise. Hypothetically, an exercise-related OHCA at a sports arena would have an even better prognosis, because of an increased likelihood of bystander cardiopulmonary resuscitation (CPR) and higher availability of automated external defibrillators (AEDs). The purpose of the study was to compare survival rates between exercise-related OHCA at sports arenas versus outside of sports arenas. Methods Data from all treated exercise-related OHCA outside home reported to the Swedish Register of Cardiopulmonary Resuscitation (SRCR) from 2011 to 2014 in 10 counties of Sweden was analyzed (population 6 million). The registry has in those counties a coverage of almost 100% of all OHCAs. Results 3714 cases of OHCA outside of home were found. Amongst them, 268(7%) were exercise-related and 164 (61.2%) of those occurred at sports arenas. The 30-day survival rate was higher for exercise-related OHCA at sports arenas compared to outside (55.7% vs 30.0%, p<0.0001). OHCA-victims at sports arenas were younger (mean age±SD 57.6±16.3 years compared to 60.9±17.0 years, p = 0.05), less likely female (4.3% vs 12.2%, p = 0.02) and had a higher frequency of shockable rhythm (73.0% vs 54.3%, p = 0.004). OHCAs at arenas were more often witnessed (83.9% vs 68.9%, p = 0.007), received bystander CPR to a higher extent (90.0% vs 56.8%, p<0.0001) and the AED-use before EMS-arrival was also higher in this group (29.8% vs 11.1%, p = 0.009). Conclusion The prognosis is markedly better for exercise-related OHCA occurring at sports arenas compared to outside. Victims of exercise-related OHCA at sports arenas are more likely to receive bystander CPR and to be connected to a public AED. These findings support an increased use of public AEDs and implementation of Medical Action Plans (MAP), to possibly increase survival of exercise-related OHCA even further.
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254
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Calò L, Martino A, Tranchita E, Sperandii F, Guerra E, Quaranta F, Parisi A, Nigro A, Sciarra L, Ruvo ED, Casasco M, Pigozzi F. Electrocardiographic and echocardiographic evaluation of a large cohort of peri-pubertal soccer players during pre-participation screening. Eur J Prev Cardiol 2019; 26:1444-1455. [PMID: 30696262 DOI: 10.1177/2047487319826312] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The early diagnosis of cardiac abnormalities in young athletes may be helpful not only to identify subjects potentially at risk of sudden cardiac death but also to prevent stress-related cardiac dysfunction and cardiovascular events during the life of these subjects. The aim of our study was to investigate the prevalence of cardiac abnormalities in a population of young male soccer players undergoing pre-participation screening through electrocardiogram and trans-thoracic echocardiography. METHODS All consecutive male football players undergoing pre-participation screening comprehensive of medical history, physical examination, 12-lead electrocardiogram and trans-thoracic echocardiography at the FMSI Sport Medicine Institute in Rome between January 2008-March 2009 were enrolled in the study. RESULTS Overall, 2261 consecutive young athletes aged 12.4 ± 2.6 years were evaluated. Training-unrelated electrocardiogram abnormalities were observed in 65 (2.9%) athletes. Abnormal trans-thoracic echocardiography was observed in 102 athletes (4.5%), including two cases of hypertrophic cardiomyopathy, eight of mild left ventricular hypertrophy, six of mild left ventricular dilation and 17 of bicuspid aortic valve. An abnormal electrocardiogram was associated with anomalous trans-thoracic echocardiography in 11/65 (16.9%) cases. All athletes requiring sport disqualification were identified by electrocardiogram. Notably, among 2216 athletes with a normal electrocardiogram, 91 had abnormal trans-thoracic echocardiography, including six cases of left ventricular dilation and six of ventricular hypertrophy. CONCLUSIONS In a wide population of peri-pubertal male athletes, evaluation of the electrocardiogram identified all cardiac diseases requiring sport disqualification. Trans-thoracic echocardiography alone allowed the identification of cardiac abnormalities potentially leading to cardiomyopathies or major cardiovascular events over time.
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Affiliation(s)
- Leonardo Calò
- 1 Division of Cardiology, Policlinico Casilino, Italy
- 2 Department of Health Sciences, University of Rome 'Foro Italico', Italy
- 3 Italian Federation of Sport Medicine (FMSI) Institute, Villa Stuart Sport Clinic-FIFA Medical Centre of Excellence, Italy
| | | | - Eliana Tranchita
- 2 Department of Health Sciences, University of Rome 'Foro Italico', Italy
| | - Fabio Sperandii
- 4 Operating Unit of Sport Medicine and Physical Activity Promotion, AUSL Piacenza, Italy
| | - Emanuele Guerra
- 5 Operating Unit of Sport Medicine, Azienda Unità Sanitaria Locale Modena, Italy
| | - Federico Quaranta
- 2 Department of Health Sciences, University of Rome 'Foro Italico', Italy
| | - Attilio Parisi
- 2 Department of Health Sciences, University of Rome 'Foro Italico', Italy
| | - Antonia Nigro
- 3 Italian Federation of Sport Medicine (FMSI) Institute, Villa Stuart Sport Clinic-FIFA Medical Centre of Excellence, Italy
| | - Luigi Sciarra
- 1 Division of Cardiology, Policlinico Casilino, Italy
| | | | | | - Fabio Pigozzi
- 1 Division of Cardiology, Policlinico Casilino, Italy
- 2 Department of Health Sciences, University of Rome 'Foro Italico', Italy
- 3 Italian Federation of Sport Medicine (FMSI) Institute, Villa Stuart Sport Clinic-FIFA Medical Centre of Excellence, Italy
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[High performance athlete's heart: Results of a cross-sectional survey conducted in Bobo-Dioulasso, Burkina Faso]. Ann Cardiol Angeiol (Paris) 2019; 68:17-21. [PMID: 30685082 DOI: 10.1016/j.ancard.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 06/12/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE OF THE STUDY To describe the clinical, electrocardiographic and echocardiographic features of the athlete's heart. PATIENTS AND METHODS This was a cross-sectional study conducted from August 2015 to February 2016 in the city of Bobo-Dioulasso in Burkina Faso. Athletes of high level of training (at least 8hours of weekly training, for more than six months regardless of the type of sport) have benefited from: a clinical examination, an electrocardiography and a cardiac ultrasound rest to look for electrical, morphological and functional cardiac changes. RESULTS The 192 athletes with an athlete heart included had a median age of 24 years (IQI: 21-27). The median seniority in high performance sport was 6 years (IQI: 4-8) and 10hours weekly training sessions (IQI: 10-10). The consumption of tobacco, alcohol, tea/coffee, medicines and/or energy drinks was reported respectively in 4.2%, 7.3%, 99.0%, 53.4%. A history of exertional discomfort was reported by 4.7 athletes. Electrical modifications were present in 92.1%. Sinus bradycardia was the most common abnormality (75.0% of cases). The prevalence of left atrium dilatation and left ventricular dilation was 72.4 and 22.4%, respectively. That of left ventricular hypertrophy was 9.0%. CONCLUSION In the high-performance athlete, the prevalence of electrical, morphological and functional changes was high. These need to be known by practitioners to differentiate them from cardiac pathology.
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256
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James CA, Calkins H. Arrhythmogenic Right Ventricular Cardiomyopathy: Progress Toward Personalized Management. Annu Rev Med 2019; 70:1-18. [DOI: 10.1146/annurev-med-041217-010932] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited heart disease characterized by fibrofatty replacement of the ventricular myocardium, a high risk of ventricular arrhythmias, and progressive ventricular dysfunction. The clinical course is highly variable, and optimal approaches to management remain undefined. ARVC is associated with pathogenic variants in genes encoding the cardiac desmosome. Genetic testing facilitates identification of at-risk family members, but penetrance of ARVC in pathogenic variant carriers is difficult to predict. Participation in endurance exercise is a known key risk factor. However, there remains significant uncertainty about which family member will develop disease and how best to approach longitudinal screening. Our clinically focused review describes how new insights gained from natural history studies, improved understanding of pathogenic mechanisms, and appreciation of genetic and environmental modifiers have set the stage for developing personalized approaches to managing both ARVC patients and their at-risk family members.
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Affiliation(s)
- Cynthia A. James
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA;,
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA;,
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257
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van de Sande DAJP, Hoogsteen J, Doevendans PA, Kemps HMC. The influence of LV geometry on the occurrence of abnormal exercise tests in athletes. BMC Cardiovasc Disord 2019; 19:6. [PMID: 30612547 PMCID: PMC6322237 DOI: 10.1186/s12872-018-0983-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 12/17/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Previous studies revealed a high rate of abnormal exercise test (ET) results in the absence of obstructive coronary artery disease (CAD) in asymptomatic athletes. The physiological background of this phenomenon is not well established. In particular, it is unclear whether sports-induced morphological cardiac adaptations are determinants of abnormal ET results. The main objective of this study was to investigate if healthy asymptomatic recreational and competitive athletes with abnormal ET results without obstructive CAD have a higher LV mass when compared with athletes with normal ET results. METHODS Seventy-three athletes with abnormal ET results without presence of obstructive CAD underwent echocardiographic assessment of LV mass, systolic and diastolic measurements. These data were compared with data from 73 athletes with normal ET results, matched for gender, age, body composition, sports characteristics and exercise capacity. RESULTS No significant increase in LV mass (161.9 ± 39 g vs. 166.9 ± 42.1 g, p = 0.461) was found between groups. Athletes with abnormal ET results had a significant thicker IVSd (9.7 ± 1.8 mm vs. 9.0 ± 1.7 mm, p = 0.014), higher IVSd/PWTd ratio (1.08 ± 0.20 vs. 1.00 ± 0.12, p = 0.011) and deceleration time (DT) was prolonged ((225.14 ± 55.08 vs. 199.96 ± 34.65, p = 0.003). CONCLUSION Athletes with abnormal ET result did not show a higher in LV mass when compared to athletes with a normal ET result. However, a pattern of asymmetric cardiac remodeling, together with altered diastolic function is present. Due to small differences, cardiac remodeling only plays a limited role in the occurrence of positive ET results in athletes.
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Affiliation(s)
| | - Jan Hoogsteen
- Department of Cardiology, Máxima Medical Center, De Run 4600, 5504 DB Veldhoven, The Netherlands
| | - Pieter A. Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hareld M. C. Kemps
- Department of Cardiology, Máxima Medical Center, De Run 4600, 5504 DB Veldhoven, The Netherlands
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Caparrós-Hernández ME, García-Fernández M, Miró-Vicedo C, Ponce-Abellán MDM, Ruso-Ruso A, Jover-Ríos MD, Méndez-Mora J, Caparrós-Hernández F, Seguí-Pérez C, Seguí-Pérez M, Esteve-Atiénzar P, Peris-García J, Bonet-Tur D, Roig-Rico P, Pérez-Fullana A, Seguí-Ripoll JM. Sudden Death in Sports: Case Report and Review of an Ongoing Problem. Health (London) 2019. [DOI: 10.4236/health.2019.111008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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259
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Johri AM, Poirier P, Dorian P, Fournier A, Goodman JM, McKinney J, Moulson N, Pipe A, Philippon F, Taylor T, Connelly K, Baggish AL, Krahn A, Sharma S. Canadian Cardiovascular Society/Canadian Heart Rhythm Society Joint Position Statement on the Cardiovascular Screening of Competitive Athletes. Can J Cardiol 2019; 35:1-11. [DOI: 10.1016/j.cjca.2018.10.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 12/15/2022] Open
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260
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Wang W, James CA, Calkins H. Diagnostic and therapeutic strategies for arrhythmogenic right ventricular dysplasia/cardiomyopathy patient. Europace 2019; 21:9-21. [PMID: 29688316 PMCID: PMC6321962 DOI: 10.1093/europace/euy063] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/16/2018] [Indexed: 12/21/2022] Open
Abstract
Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is a rare inherited heart muscle disease characterized by ventricular tachyarrhythmia, predominant right ventricular dysfunction, and sudden cardiac death. Its pathophysiology involves close interaction between genetic mutations and exposure to physical activity. Mutations in genes encoding desmosomal protein are the most common genetic basis. Genetic testing plays important roles in diagnosis and screening of family members. Syncope, palpitation, and lightheadedness are the most common symptoms. The 2010 Task Force Criteria is the standard for diagnosis today. Implantation of a defibrillator in high-risk patients is the only therapy that provides adequate protection against sudden death. Selection of patients who are best candidates for defibrillator implantation is challenging. Exercise restriction is critical in affected individuals and at-risk family members. Antiarrhythmic drugs and ventricular tachycardia ablation are valuable but palliative components of the management. This review focuses on the current diagnostic and therapeutic strategies in ARVD/C and outlines the future area of development in this field.
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Affiliation(s)
- Weijia Wang
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 600 N. Wolfe Street, Sheikh Zayed Tower 7125R, Baltimore, MD, USA
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 600 N. Wolfe Street, Sheikh Zayed Tower 7125R, Baltimore, MD, USA
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 600 N. Wolfe Street, Sheikh Zayed Tower 7125R, Baltimore, MD, USA
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261
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Helal L, Ferrari F, Stein R. Sudden Death in Young Brazilian Athletes: Isn't It Time We Created a Genuinely National Register? Arq Bras Cardiol 2018; 111:856-859. [PMID: 30517381 PMCID: PMC6263455 DOI: 10.5935/abc.20180207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/12/2018] [Indexed: 11/20/2022] Open
Abstract
Young competitive athletes (≤ 35 years old) with or without a previous
diagnosis of cardiovascular disease may suddenly die in competitive activities,
potentially leading to an impact in society through the media. Although the
relative risk for sudden death (SD) in athletes is twice as high as for their
counterparts, the absolute incidence is low. While there is consensus among
medical societies worldwide that early detection of causal factors is highly
desirable, there is debate among different screening schemes to that end. In
Brazil, the recommendations of the Brazilian Society of Cardiology mirror the
guidelines of the European Society of Cardiology (ESC), which indicate a
clinical examination combined with a 12-lead resting electrocardiogram,
regardless of the presence of risk factors. The possibility of genetic screening
is also plausible, since most clinical entities that cause SD in young
competitive athletes are related to genotype. Finally, considering the diversity
of practiced sports, and the population miscegenation, we emphasize the need to
a national registry of cases.
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Affiliation(s)
- Lucas Helal
- Programa de Pós-graduação em Cardiologia e Ciências Cardiovasculares da Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil.,Laboratório de Fisiopatologia do Exercício, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brazil
| | - Filipe Ferrari
- Programa de Pós-graduação em Cardiologia e Ciências Cardiovasculares da Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brasil.,Grupo de Pesquisa em Cardiologia do Exercício, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brazil
| | - Ricardo Stein
- Laboratório de Fisiopatologia do Exercício, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brazil.,Grupo de Pesquisa em Cardiologia do Exercício, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brazil.,Departamento de Medicina Interna da Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brazil
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262
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Longmuir PE, Jackson J, Ertel E, Bhatt M, Doja A, Duffy C, Gardin L, Jurencak R, Katz SL, Lai L, Lamontagne C, Lee S, Lougheed J, McCormick A, McMillan H, Pohl D, Roth J, Theoret-Douglas C, Watanabe Duffy K, Wong D, Zemek R. Sensitivity, specificity, and reliability of the Get Active Questionnaire for identifying children with medically necessary special considerations for physical activity. Appl Physiol Nutr Metab 2018; 44:736-743. [PMID: 30500268 DOI: 10.1139/apnm-2018-0314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Physical activity is promoted for optimal health but may carry risks for children who require medically necessary activity restrictions. The sensitivity, specificity, and reliability of the Get Active Questionnaire (GAQ) for identifying children needing special considerations during physical activity was evaluated among parents of 207 children aged 3 to 14 years (97 (47%) female, mean age of 8.4 ± 3.7 years). GAQ responses were compared with reports obtained directly from the treating physician (n = 192/207) and information in the medical chart (clinic notes/physician letter, n = 111/207). Parent GAQ responses (either "No to all questions" or "Yes to 1 or more questions") agreed with physician (κ = 0.16, p = 0.003) and medical record (κ = 0.15, p = 0.003) reports regarding the need for special consideration during physical activity (Yes/No). Sensitivity was 71% (20/28) and specificity was 59% (96/164), with few false-negative responses. The GAQ was most effective for rheumatology and cardiology patients. False positives were 29% to 46%, except among chronic pain (80%) and rehabilitation (75%) patients. Test-retest reliability was moderate (Cronbach's α = 0.70) among 57 parents who repeated the GAQ 1 week later. The GAQ effectively identified children not requiring physical activity restrictions and those with medical conditions similar to those of concern among adults. Additional questions from a qualified exercise professional, as recommended for a "Yes" response on the GAQ, should reduce the false-positive burden. Indicating the timeframe of reference for each question and including an option to describe other special considerations (e.g., medication, supervision) are recommended.
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Affiliation(s)
- Patricia E Longmuir
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Julia Jackson
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
| | - Emily Ertel
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
| | - Maala Bhatt
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Asif Doja
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Ciarán Duffy
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Letizia Gardin
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Roman Jurencak
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Sherri Lynne Katz
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Lillian Lai
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Christine Lamontagne
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Suzie Lee
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Jane Lougheed
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Anna McCormick
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Hugh McMillan
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Daniela Pohl
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Johannes Roth
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Carol Theoret-Douglas
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Karen Watanabe Duffy
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Derek Wong
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Roger Zemek
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
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263
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Aengevaeren VL, Aengevaeren WRM, Eijsvogels TMH. Outcomes of Cardiac Screening in Adolescent Soccer Players. N Engl J Med 2018; 379:2083. [PMID: 30474941 DOI: 10.1056/nejmc1813056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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264
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Coronary atherosclerosis in apparently healthy master athletes discovered during pre-PARTECIPATION screening. Role of coronary CT angiography (CCTA). Int J Cardiol 2018; 282:99-107. [PMID: 30482442 DOI: 10.1016/j.ijcard.2018.11.099] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/11/2018] [Accepted: 11/19/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pre-participation screening (PPS) of athletes aged over 35 years (master athletes, MA) is a major concern in Sports Cardiology. In this population, sports-related sudden cardiac death is rare but usually due to coronary atherosclerosis (CA). Coronary CT Angiography (CCTA) has changed the approach to diagnosis/management of CA, but its role in this context still needs to be assessed. METHODS AND RESULTS We retrospectively examined 167 MA who underwent CCTA in our hospital since 2006, analyzing symptoms, stress-test ECG, cardiovascular risk profiles (SCORE) and CCTA findings. Among the whole enrolled population, 153 (91.6%) MA underwent CCTA for equivocal/positive stress-test ECG with/without symptoms, 13 (7.8%) just for clinical symptoms, 1 (0.6%) for the family history. The CCTA showed the presence of CA in 69 MA (41.3%), congenital coronary anomalies (anomalous origin or deep myocardial bridge) in 8 (4.8%), both in 7 (4.2%). A negative CCTA was observed in 83 MA (49.7%). The risk-SCORE (age, hypertension, hypercholesterolemia, smoking) was a good indicator for the presence of moderate/severe CA on CCTA. However, mild/moderate CA was present in 17.8% of MA clinically stratified at a low risk-SCORE. CONCLUSION While coronary angiography is more indicated in athletes with positive stress-test ECG and high clinical risk, the CCTA may be useful in the evaluation of MA with an abnormal stress test ECG and/or clinical symptoms engaged in competitive sports with a high cardiovascular involvement. Age, gender, presence of symptoms and clinical risk-SCORE assessment may help sports physicians and cardiologists to decide whether to request a CCTA or not.
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265
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Abstract
Sudden cardiac death (SCD) is the leading cause of death in athletes. A large proportion of these deaths are associated with undiagnosed cardiovascular disease. Screening for high-risk individuals enables early detection of pathology, as well as permitting lifestyle modification or therapeutic intervention.ECG changes in athletes occur as a result of electrical and structural adaptations secondary to repeated bouts of exercise. Such changes are common and may overlap with patterns suggestive of underlying cardiovascular disease. Correct interpretation is therefore essential, in order to differentiate physiology from pathology. Erroneous interpretation may result in false reassurance or expensive investigations for further evaluation and unnecessary disqualification from competitive sports.Interpretation of the athlete's ECG has evolved over the past 12 years, beginning with the 2005 European Society of Cardiology (ESC) consensus, progressing to the ESC recommendations (2010), Seattle Criteria (2013) and the 'refined' criteria (2014). This evolution culminated in the recently published international recommendations for ECG interpretation in athletes (2017), which has led to a significant reduction in false positives and screening-associated costs. This review aims to describe the evolution of the current knowledge on ECG interpretation as well as future directions.
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Affiliation(s)
- Joyee Basu
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
| | - Aneil Malhotra
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
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266
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Berge HM, Andersen TE, Bahr R. Cardiovascular incidents in male professional football players with negative preparticipation cardiac screening results: an 8-year follow-up. Br J Sports Med 2018; 53:1279-1284. [PMID: 30442719 DOI: 10.1136/bjsports-2018-099845] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Preparticipation cardiac screening of athletes aims to detect cardiovascular disease at an early stage to prevent sudden cardiac arrests and deaths. Few studies have described the cardiovascular outcomes in athletes classified as negative on screening. OBJECTIVE To identify cardiovascular incidents in a cohort of male professional football players who were cleared to play after a negative screening result. METHODS This is a retrospective 8-year follow-up study of 595 professional male football players in Norway who underwent preparticipation cardiac screening by experienced cardiologists, including electrocardiography (ECG) and echocardiography, in 2008. We performed a media search to identify sudden cardiovascular incidents between January 2008 and February 2016. Incidents were cross-checked with medical records. RESULTS Six of the 595 players (1%), all classified as negative on cardiac screening, experienced severe cardiovascular incidents during follow-up. Retrospective review revealed abnormal ECG findings in one case, not recognised at the time of screening. Three players suffered a sudden cardiac arrest (all resuscitated successfully), one a myocardial infarction, one a transient ischaemic attack and one atrial flutter. Three of the players ignored chest pain, paresis, dyspnoea or near-syncope, two completed a match with symptoms before seeking medical assistance, one player's symptoms were misinterpreted and received inappropriate treatment initially, and two players were discharged from hospital without proper follow-up, despite having serious cardiovascular symptoms. CONCLUSIONS A comprehensive preparticipation cardiac screening did not identify a subset of 6 of 595 players who experienced subsequent cardiovascular incidents as being at risk. It is important to remind athletes that a normal cardiac screening exam does not protect against all cardiac diseases. Timely reporting of symptoms is essential.
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Affiliation(s)
- Hilde Moseby Berge
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Thor Einar Andersen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Roald Bahr
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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267
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Kirchhof P, Fabritz L. Anterior T-Wave Inversion Does Not Convey Short-Term Sudden Death Risk: Inverted Is the New Normal. J Am Coll Cardiol 2018; 69:10-12. [PMID: 28057232 DOI: 10.1016/j.jacc.2016.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 11/03/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Cardiology, University Hospital Birmingham Foundation National Health Service Trust, Birmingham, United Kingdom; Department of Cardiology, Division of Rhythmology, Hospital of the University of Münster, Münster, Germany; Department of Cardiology, Sandwell and West Birmingham Hospitals National Health Service Trust, Birmingham, United Kingdom.
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Cardiology, University Hospital Birmingham Foundation National Health Service Trust, Birmingham, United Kingdom; Department of Cardiology, Division of Rhythmology, Hospital of the University of Münster, Münster, Germany
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268
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Steinskog DM, Solberg EE. Sudden cardiac arrest in sports: a video analysis. Br J Sports Med 2018; 53:1293-1298. [DOI: 10.1136/bjsports-2018-099578] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2018] [Indexed: 11/04/2022]
Abstract
ObjectivesInformation about sudden cardiac arrest (SCA) in sports arises from registries, insurance claims and various reports. Analysing video footage of SCA during sports for scientific purposes has scarcely been done. The objective of this study was to examine videotaped SCA in athletes to better understand the mechanisms of SCA.MethodsPublicly available online video databases were searched for videos displaying SCA in athletes.ResultsThirty-five online videos (26 from professional and 9 from amateur sport; 34 male victims) were obtained. Twenty-one events resulted in survival and 14 in sudden cardiac death. Level of physical activity prior to SCA was assessable in 28 videos; 19 events occurred during low-intensity, 6 during moderate-intensity and 3 during high-intensity activity. SCA predominately occurred during low-intensity compared with both moderate-intensity and high-intensity activities (p<0.01). In 26/35 videos, it was possible to observe if resuscitation was provided. Resuscitation was carried out in 20 cases; cardiopulmonary resuscitation (CPR) alone (8 cases), CPR+defibrillation (10), cardiac thump (1) or shock from an implantable cardioverter defibrillator (1). Thirteen of the 20 cases with resuscitation received an intervention within 1 min after collapse. Survival was high when intervention occurred within 1 min (12/13) compared with those who received delayed (3/5) or no intervention (1/6). Associated signs of SCA such as agonal respirations and seizure-like movements were observed in 66% of the cases.ConclusionsSCA during sport most often occurred during low-intensity activity. Prompt intervention within 1 min demonstrated a high survival rate and should be the standard expectation for witnessed SCA in athletes.
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269
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Sotiriou P, Kouidi E, Karagiannis A, Koutlianos N, Geleris P, Vassilikos V, Deligiannis A. Arterial adaptations in athletes of dynamic and static sports disciplines - a pilot study. Clin Physiol Funct Imaging 2018; 39:183-191. [PMID: 30417605 DOI: 10.1111/cpf.12554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 10/19/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Structural and functional arterial adaptations with regard to the type and level of training in young athletes are understudied. Our research aimed at evaluating them in two types of exercise (dynamic and static) and two levels of engagement (high and recreational). METHODS A total of 76 volunteers formed five groups. Group A included 17 high-level dynamic sports athletes 30·9 ± 6·4 years old, group B 14 recreational ones aged 28·7 ± 6·2 years, group C 15 high-level static sports athletes 26·4 ± 3·9 years old and group D 16 recreational ones, aged 25·8 ± 4·8 years. Fourteen sedentary men 30 ± 3·8 years old formed control group E. Structural indices of left cardiac chambers and thoracic aorta were echographically obtained, as well as common carotid intima-media thickness (cIMT). Furthermore, applanation tonometry was conducted, at rest and during a handgrip strength test, for the acquisition of central arterial pressure parameters, carotid-femoral pulse wave velocity (cfPWV) and total arterial compliance (Cτ ). RESULTS No significant differences in structural arterial markers were observed. However, group A obtained the highest handgrip central systolic pressure values (13·1% compared to group D, P<0·05). Resting cfPWV was lower in group B by 13·8% (P<0·05) than C and by 16·7% (P<0·01) than E, whereas Cτ was higher in group Β by 33·3% than C (P<0·05) and by 40·9% than E (P<0·01). CONCLUSION Functional arterial exercise-induced adaptations become apparent at an early age, without being in conjunction with structural ones. Recreational dynamic exercise results in the most favourable arterial characteristics.
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Affiliation(s)
- Panagiota Sotiriou
- Laboratory of Sports Medicine, Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia Kouidi
- Laboratory of Sports Medicine, Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Asterios Karagiannis
- 2nd Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Koutlianos
- Laboratory of Sports Medicine, Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Parashos Geleris
- 3rd Cardiology Department, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Vassilikos
- 3rd Cardiology Department, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Asterios Deligiannis
- Laboratory of Sports Medicine, Department of Physical Education and Sports Science, Aristotle University of Thessaloniki, Thessaloniki, Greece
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270
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Pelliccia A, Drezner JA. Cardiovascular screening in Olympic athletes: time to achieve a uniform standard. Br J Sports Med 2018; 53:1-2. [PMID: 30377175 DOI: 10.1136/bjsports-2018-099795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Antonio Pelliccia
- Department of Medicine, Institute of Sports Medicine and Science, Rome, Italy
| | - Jonathan A Drezner
- Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
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271
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Cater C, MacDonald M, Lithwick D, Sidhu K, Isserow S, McKinney J. Perspectives on pre-participation cardiovascular screening in young competitive athletes: U SPORTS. PHYSICIAN SPORTSMED 2018; 46:509-514. [PMID: 30148661 DOI: 10.1080/00913847.2018.1516107] [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] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To investigate the pre-participation cardiovascular screening (PPS) protocols currently implemented at U SPORTS (the governing body of university sport in Canada) sanctioned schools as well as the attitudes toward PPS as reported by Canadian University medical and athletic personnel. METHODS A 15-question survey was sent to the U SPORTS athletic directors in both French and English. The survey focused on the current practices of PPS within the respondents' universities as well as attitudes regarding PPS. Athletic directors distributed the instructions to participate in the voluntary survey at their own discretion to coaches, athletic therapists, physicians, and associated personnel working within U SPORTS-sanctioned schools. RESULTS Twenty-three athletic therapists, 12 coaches, 6 physicians, and 5 associated personnel completed the survey (46 in total). Half of the respondents (52%) reported that some form of PPS was conducted at their institution. Eighty percent of respondents agreed with the implementation of mandatory PPS, and 60% reported that they believe their athletes have a neutral attitude toward PPS. Three respondents documented having witnessed an athlete's sudden cardiac arrest/death. CONCLUSION Members of the athletic care teams at U SPORTS-sanctioned schools display an overall positive attitude toward the implementation of mandatory PPS. Based on concerns raised by survey respondents, PPS procedures would need to be developed in a time- and cost-effective manner if PPS were to be expanded.
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Affiliation(s)
- Carlee Cater
- a SportsCardiologyBC, Division of Cardiology , University of British Columbia , Vancouver , Canada
| | - Mackenzie MacDonald
- a SportsCardiologyBC, Division of Cardiology , University of British Columbia , Vancouver , Canada
| | - Daniel Lithwick
- a SportsCardiologyBC, Division of Cardiology , University of British Columbia , Vancouver , Canada.,b Weill Cornell Graduate School of Medical Sciences , New York City , United States of America
| | - Kamal Sidhu
- c Faculty of Medicine , University of British Columbia , Vancouver , Canada
| | - Saul Isserow
- a SportsCardiologyBC, Division of Cardiology , University of British Columbia , Vancouver , Canada.,d Division of Cardiology , University of British Columbia , Vancouver , Canada
| | - James McKinney
- a SportsCardiologyBC, Division of Cardiology , University of British Columbia , Vancouver , Canada.,d Division of Cardiology , University of British Columbia , Vancouver , Canada
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272
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Strengths, Limitations, and Geographical Discrepancies in the Eligibility Criteria for Sport Participation in Young Patients With Congenital Heart Disease. Clin J Sport Med 2018; 28:540-560. [PMID: 28742603 DOI: 10.1097/jsm.0000000000000474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Benefits of physical activity has been shown in children with congenital heart disease (CHD). In several forms of CHD, the risk of sudden death remains a major concern both for parents and clinicians, who in turn will have to consider the risk-benefit ratio of sport participation versus restriction. DATA SOURCE A literature search was performed within the National Library of Medicine using the keywords: Sport, CHD, and Eligibility. The search was further refined by adding the keywords: Children, Adult, and Criteria. MAIN RESULTS Fifteen published studies evaluating sport eligibility criteria in CHD were included. Seven documents from various scientific societies have been published in the past decade but which of them should be adopted remains unclear. Our research highlighted accuracy and consistency of the latest documents; however, differences have emerged between the US and European recommendations. Eligibility criteria were consistent between countries for simple congenital heart defects, whereas there are discrepancies for borderline conditions including moderate valvular lesions and mild or moderate residual defects after CHD repair. Furthermore, some of the more severe defects were not evaluated. Multiple recommendations have been made for the same CHD, and cut-off values used to define disease severity have varied. Published eligibility criteria have mainly focused on competitive sports. Little attention was paid to recreational activities, and the psychosocial consequences of activity restriction were seldom evaluated. CONCLUSIONS Comprehensive consensus recommendations for sport eligibility evaluating all CHD types and stages of repair are needed. These should include competitive and recreational activities, use standardized classifications to grade disease severity, and address the consequences of restriction.
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273
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Martins D, Ovaert C, Khraiche D, Boddaert N, Bonnet D, Raimondi F. Myocardial inflammation detected by cardiac MRI in Arrhythmogenic right ventricular cardiomyopathy: A paediatric case series. Int J Cardiol 2018; 271:81-86. [DOI: 10.1016/j.ijcard.2018.05.116] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/10/2018] [Accepted: 05/28/2018] [Indexed: 12/24/2022]
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274
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Torlasco C, Castelletti S, Perego GB, Parati G. Advanced Arrhythmogenic Cardiomyopathy in Former Marathon Runner. Circ Cardiovasc Imaging 2018; 11:e008204. [PMID: 30354480 DOI: 10.1161/circimaging.118.008204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Camilla Torlasco
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy (C.T., G.B.P., G.P.).,Department of Medicine and Surgery, University of Milano-Bicocca, Italy (C.T., G.P.)
| | - Silvia Castelletti
- Instituto Auxologico Italiano, IRCCS, Department of Inherited Cardiac Diseases, San Carlo, Milan, Italy (S.C.)
| | - Giovanni B Perego
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy (C.T., G.B.P., G.P.)
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy (C.T., G.B.P., G.P.).,Department of Medicine and Surgery, University of Milano-Bicocca, Italy (C.T., G.P.)
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275
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Sudden Death and Ventricular Arrhythmias in Athletes: Screening, De-Training and the Role of Catheter Ablation. Heart Lung Circ 2018; 28:155-163. [PMID: 30554599 DOI: 10.1016/j.hlc.2018.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/05/2018] [Indexed: 01/29/2023]
Abstract
Athletes enjoy excellent health outcomes including greater longevity relative to non-athletic counterparts. Paradoxically, however, endurance athletic conditioning is associated with an increase in some arrhythmias. This review discusses the potential mechanisms for this paradox and strategies enabling early identification of potentially serious pathologies. Screening remains contentious due to the challenges of identifying relatively rare entities amongst a healthy cohort. The imperfect diagnostic accuracy of all current tests means that screening strategies have potential for harm through incorrect diagnoses as well as the potential for identification of important sub-clinical pathologies. Management of athletes at risk of ventricular arrhythmias and sudden cardiac death is similarly complex. There is much yet to learn about the specific patterns of ventricular arrhythmias in athletes, and the separation of benign from potentially life-threatening remains imperfect. There are some promising advances, however, such as specialised imaging modalities combined with improved electrophysiological diagnostics and therapeutics. Some unique clinical patterns are emerging to advance our understanding and management of athletes with ventricular arrhythmias, requiring specialised skillsets for evaluation and management.
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276
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Abu Bakar NA, Luqman N, Shaaban E, Abdul Rahman H. Prevalence and predictors of electrocardiogram abnormalities among athletes. Asian Cardiovasc Thorac Ann 2018; 26:603-607. [PMID: 30301359 DOI: 10.1177/0218492318807533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Existing evidence, predominantly from Western countries, has demonstrated that athletes' hearts undergo structural, physiological, and electrical changes, leading to abnormal electrocardiogram readings that are said to be training-related. Athletes with non-training-related electrocardiographic abnormalities risk developing sudden cardiac death. The lack of studies on this issue in the Asian population warrants further exploration. Therefore, the aim of this study was to estimate the prevalence and predictive factors contributing to electrocardiogram abnormalities among athletes in Brunei. Methods A descriptive cross-sectional study was conducted on 100 athletes (median age 25.2 years) in 10 sporting disciplines, whose electrocardiogram readings and essential information was obtained. Results The prevalence of an abnormal electrocardiogram was 52% (95% confidence interval: 42.0%-62.0%), comprising training-related changes in 49% (95% confidence interval: 39.0%-59.0%) and non-training-related changes in 3% (95% confidence interval: 0.4%-6.4%). Athletes with a higher body mass index were 3.3-times (95% confidence interval: 1.47-9.58) more likely to have abnormal electrocardiogram readings. Athletes <25-years old (odds ratio = 0.25, 95% confidence interval: 0.07-0.81) and those who trained with low dynamic intensity (odds ratio = 0.33, 95% confidence interval: 0.12-0.93) were significantly less likely to have electrocardiogram abnormalities. Conclusions This is the first study reporting abnormal electrocardiograms among athletes in Brunei, which provides important information to relevant agencies involved in the preparation of Asian athletes for domestic or international competitions, particularly those with a higher body mass index and low dynamic training intensity.
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Affiliation(s)
| | - Nazar Luqman
- 2 Department of Cardiology, Raja Isteri Pengiran Anak Saleha Hospital, Ministry of Health, Brunei
| | | | - Hanif Abdul Rahman
- 1 PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Brunei
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277
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De Bortoli M, Postma AV, Poloni G, Calore M, Minervini G, Mazzotti E, Rigato I, Ebert M, Lorenzon A, Vazza G, Cipriani A, Bariani R, Perazzolo Marra M, Husser D, Thiene G, Daliento L, Corrado D, Basso C, Tosatto SC, Bauce B, van Tintelen JP, Rampazzo A. Whole-Exome Sequencing Identifies Pathogenic Variants in
TJP1
Gene Associated With Arrhythmogenic Cardiomyopathy. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2018; 11:e002123. [DOI: 10.1161/circgen.118.002123] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Alex V. Postma
- Department of Medical Biology and Department of Clinical Genetics, Academic Medical Center, Amsterdam, The Netherlands (A.V.P.)
| | - Giulia Poloni
- Departments of Biology (M.D.B., G.P., M.C., A.L., G.V., A.R.)
| | - Martina Calore
- Departments of Biology (M.D.B., G.P., M.C., A.L., G.V., A.R.)
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherland (M.C.)
| | | | - Elisa Mazzotti
- Cardiac, Thoracic, and Vascular Sciences (E.M., I.R., A.C., R.B., M.P.M.,G.T., L.D., D.C., C.B., B.B.), University of Padua, Italy
| | - Ilaria Rigato
- Cardiac, Thoracic, and Vascular Sciences (E.M., I.R., A.C., R.B., M.P.M.,G.T., L.D., D.C., C.B., B.B.), University of Padua, Italy
| | - Micaela Ebert
- Department of Electrophysiology, Heart Center, University of Leipzig, Germany (M.E., D.H.)
- Department of Cardiology, Leiden University Medical Center, The Netherlands (M.E.)
| | | | - Giovanni Vazza
- Departments of Biology (M.D.B., G.P., M.C., A.L., G.V., A.R.)
| | - Alberto Cipriani
- Cardiac, Thoracic, and Vascular Sciences (E.M., I.R., A.C., R.B., M.P.M.,G.T., L.D., D.C., C.B., B.B.), University of Padua, Italy
| | - Riccardo Bariani
- Cardiac, Thoracic, and Vascular Sciences (E.M., I.R., A.C., R.B., M.P.M.,G.T., L.D., D.C., C.B., B.B.), University of Padua, Italy
| | - Martina Perazzolo Marra
- Cardiac, Thoracic, and Vascular Sciences (E.M., I.R., A.C., R.B., M.P.M.,G.T., L.D., D.C., C.B., B.B.), University of Padua, Italy
| | - Daniela Husser
- Department of Electrophysiology, Heart Center, University of Leipzig, Germany (M.E., D.H.)
| | - Gaetano Thiene
- Cardiac, Thoracic, and Vascular Sciences (E.M., I.R., A.C., R.B., M.P.M.,G.T., L.D., D.C., C.B., B.B.), University of Padua, Italy
| | - Luciano Daliento
- Cardiac, Thoracic, and Vascular Sciences (E.M., I.R., A.C., R.B., M.P.M.,G.T., L.D., D.C., C.B., B.B.), University of Padua, Italy
| | - Domenico Corrado
- Cardiac, Thoracic, and Vascular Sciences (E.M., I.R., A.C., R.B., M.P.M.,G.T., L.D., D.C., C.B., B.B.), University of Padua, Italy
| | - Cristina Basso
- Cardiac, Thoracic, and Vascular Sciences (E.M., I.R., A.C., R.B., M.P.M.,G.T., L.D., D.C., C.B., B.B.), University of Padua, Italy
| | - Silvio C.E. Tosatto
- Biomedical Sciences (G.M., S.C.E.T.)
- CNR Institute of Neuroscience, Padua, Italy (S.C.E.T.)
| | - Barbara Bauce
- Cardiac, Thoracic, and Vascular Sciences (E.M., I.R., A.C., R.B., M.P.M.,G.T., L.D., D.C., C.B., B.B.), University of Padua, Italy
| | - J. Peter van Tintelen
- Department of Clinical Genetics, Amsterdam University Medical Center, University of Amsterdam, The Netherlands (J.P.v.T.)
- Department of Genetics, University Medical Center Utrecht, The Netherlands (J.P.v.T.)
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278
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Differentiating Athlete’s Heart from Cardiomyopathies – The Right Side. Heart Lung Circ 2018; 27:1063-1071. [DOI: 10.1016/j.hlc.2018.04.300] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 04/19/2018] [Indexed: 11/21/2022]
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279
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Dhutia H, MacLachlan H. Cardiac Screening of Young Athletes: a Practical Approach to Sudden Cardiac Death Prevention. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:85. [PMID: 30155696 PMCID: PMC6132782 DOI: 10.1007/s11936-018-0681-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW We aim to report on the current status of cardiovascular screening of athletes worldwide and review the up-to-date evidence for its efficacy in reducing sudden cardiac death in young athletes. RECENT FINDINGS A large proportion of sudden cardiac death in young individuals and athletes occurs during rest with sudden arrhythmic death syndrome being recognised as the leading cause. The international recommendations for ECG interpretation have reduced the false-positive ECG rate to 3% and reduced the cost of screening by 25% without compromising the sensitivity to identify serious disease. There are some quality control issues that have been recently identified including the necessity for further training to guide physicians involved in screening young athletes. Improvements in our understanding of young sudden cardiac death and ECG interpretation guideline modification to further differentiate physiological ECG patterns from those that may represent underlying disease have significantly improved the efficacy of screening to levels that may make screening more attractive and feasible to sporting organisations as a complementary strategy to increased availability of automated external defibrillators to reduce the overall burden of young sudden cardiac death.
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Affiliation(s)
- Harshil Dhutia
- Cardiovascular Sciences Research Centre, St George's University of London, London, UK.
- Department of Cardiology, Glenfield Hospital, Leicester, UK.
| | - Hamish MacLachlan
- Cardiovascular Sciences Research Centre, St George's University of London, London, UK
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280
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Ahluwalia N, Raju H. Assessment of the QT Interval in Athletes: Red Flags and Pitfalls. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:82. [PMID: 30146672 DOI: 10.1007/s11936-018-0678-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Pre-participation athlete screening has led to the referral of asymptomatic athletes with a prolonged QT interval warranting their evaluation for long QT syndrome (LQTS). Establishing a diagnosis of LQTS can be difficult, particularly in asymptomatic athletes presenting with a prolonged QTc < 500 ms. This review examines the evaluatory pathway to ascertain the common pitfalls leading to mis- or overdiagnosis. We discuss the advanced ECG-based tools and consider their application in the diagnostic process. RECENT FINDINGS Critical analysis of the ECG, symptom, and pedigree analysis has established value but relies on experienced interpretation. Protocolisation of the former has effectively reduced error. Exercise recovery ECG testing has demonstrated diagnostic value and provocation testing, reliant on QT hysteresis in LQTS, have shown reasonable sensitivity. Although it is becoming more established in experienced centres, its diagnostic value relies on effective risk stratification and subject selection. LQTS is a rare condition and the precision of any available test is greatly diluted if pre-test probability is low. Clinical and familial evaluation and exercise ECG testing are the foundation of the evaluatory process following referral. Adjunctive tests may have high sensitivity for LQTS but rely on high pre-test probability. Several pitfalls have been identified that can lead to misdiagnosis and thus informed evaluation at an experienced specialist centre is appropriate.
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Affiliation(s)
| | - Hariharan Raju
- MQ Health Cardiology, Macquarie University, 2 Technology Place, Sydney, NSW, 2109, Australia.
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281
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Ruiz Salas A, Barrera Cordero A, Navarro‐Arce I, Jiménez Navarro M, García Pinilla JM, Cabrera Bueno F, Abdeselam‐Mohamed N, Morcillo‐Hidalgo L, Gómez Doblas JJ, Teresa E, Alzueta J. Impact of dynamic physical exercise on high‐risk definite arrhythmogenic right ventricular cardiomyopathy. J Cardiovasc Electrophysiol 2018; 29:1523-1529. [DOI: 10.1111/jce.13704] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 07/12/2018] [Accepted: 07/24/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Amalio Ruiz Salas
- Arrhythmia Unit, UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Ciber CV, Universidad de Málaga, Hospital Universitario Virgen de la VictoriaMálaga España
| | - Alberto Barrera Cordero
- Arrhythmia Unit, UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Ciber CV, Universidad de Málaga, Hospital Universitario Virgen de la VictoriaMálaga España
| | - Isabel Navarro‐Arce
- Arrhythmia Unit, UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Ciber CV, Universidad de Málaga, Hospital Universitario Virgen de la VictoriaMálaga España
| | - Manuel Jiménez Navarro
- Arrhythmia Unit, UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Ciber CV, Universidad de Málaga, Hospital Universitario Virgen de la VictoriaMálaga España
| | - José Manuel García Pinilla
- Arrhythmia Unit, UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Ciber CV, Universidad de Málaga, Hospital Universitario Virgen de la VictoriaMálaga España
| | - Fernando Cabrera Bueno
- Arrhythmia Unit, UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Ciber CV, Universidad de Málaga, Hospital Universitario Virgen de la VictoriaMálaga España
| | - Nasiba Abdeselam‐Mohamed
- Arrhythmia Unit, UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Ciber CV, Universidad de Málaga, Hospital Universitario Virgen de la VictoriaMálaga España
| | - Luis Morcillo‐Hidalgo
- Arrhythmia Unit, UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Ciber CV, Universidad de Málaga, Hospital Universitario Virgen de la VictoriaMálaga España
| | - Juan José Gómez Doblas
- Arrhythmia Unit, UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Ciber CV, Universidad de Málaga, Hospital Universitario Virgen de la VictoriaMálaga España
| | - Eduardo Teresa
- Arrhythmia Unit, UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Ciber CV, Universidad de Málaga, Hospital Universitario Virgen de la VictoriaMálaga España
| | - Javier Alzueta
- Arrhythmia Unit, UGC del Corazón, Instituto de Biomedicina de Málaga (IBIMA), Ciber CV, Universidad de Málaga, Hospital Universitario Virgen de la VictoriaMálaga España
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282
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Ripoll-Vera T, Alvarez-Rubio J. Hypertrophic cardiomyopathy with little hypertrophy and severe arrhythmia. Glob Cardiol Sci Pract 2018; 2018:26. [PMID: 30393638 PMCID: PMC6209437 DOI: 10.21542/gcsp.2018.26] [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] [Indexed: 11/05/2022] Open
Abstract
[first paragraph of article]Hypertrophic cardiomyopathy (HCM) is an inherited autosomal-dominant disease with a heterogeneous clinical presentation and natural history, and is a frequent cause of sudden cardiac death (SCD) in young people. It is associated with mutations in genes coding for sarcomere proteins. In the literature, debate surrounds the genotype-phenotype correlation of individual mutations concerning establishing a prognosis according to the mutation present, which could help stratify the disease and allow appropriate genetic counselling to families.
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Affiliation(s)
- Tomas Ripoll-Vera
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.,Balearic Islands Health Research Institute (iDisBA),Inherited Cardiovascular Disease Unit, Cardiology Department, Hospital Universitari Son Espases, Edifici S, Carretera de Valldemossa 79, 07120 Palma, Illes Balears Spain.,Son Llatzer University Hospital, Carretera de Manacor km.4, 07198 Palma, Illes Balears, Spain
| | - Jorge Alvarez-Rubio
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.,Balearic Islands Health Research Institute (iDisBA),Inherited Cardiovascular Disease Unit, Cardiology Department, Hospital Universitari Son Espases, Edifici S, Carretera de Valldemossa 79, 07120 Palma, Illes Balears Spain.,Son Llatzer University Hospital, Carretera de Manacor km.4, 07198 Palma, Illes Balears, Spain
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283
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Malhotra A, Dhutia H, Finocchiaro G, Gati S, Beasley I, Clift P, Cowie C, Kenny A, Mayet J, Oxborough D, Patel K, Pieles G, Rakhit D, Ramsdale D, Shapiro L, Somauroo J, Stuart G, Varnava A, Walsh J, Yousef Z, Tome M, Papadakis M, Sharma S. Outcomes of Cardiac Screening in Adolescent Soccer Players. N Engl J Med 2018; 379:524-534. [PMID: 30089062 DOI: 10.1056/nejmoa1714719] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Reports on the incidence and causes of sudden cardiac death among young athletes have relied largely on estimated rates of participation and varied methods of reporting. We sought to investigate the incidence and causes of sudden cardiac death among adolescent soccer players in the United Kingdom. METHODS From 1996 through 2016, we screened 11,168 adolescent athletes with a mean (±SD) age of 16.4±1.2 years (95% of whom were male) in the English Football Association (FA) cardiac screening program, which consisted of a health questionnaire, physical examination, electrocardiography, and echocardiography. The FA registry was interrogated to identify sudden cardiac deaths, which were confirmed with autopsy reports. RESULTS During screening, 42 athletes (0.38%) were found to have cardiac disorders that are associated with sudden cardiac death. A further 225 athletes (2%) with congenital or valvular abnormalities were identified. After screening, there were 23 deaths from any cause, of which 8 (35%) were sudden deaths attributed to cardiac disease. Cardiomyopathy accounted for 7 of 8 sudden cardiac deaths (88%). Six athletes (75%) with sudden cardiac death had had normal cardiac screening results. The mean time between screening and sudden cardiac death was 6.8 years. On the basis of a total of 118,351 person-years, the incidence of sudden cardiac death among previously screened adolescent soccer players was 1 per 14,794 person-years (6.8 per 100,000 athletes). CONCLUSIONS Diseases that are associated with sudden cardiac death were identified in 0.38% of adolescent soccer players in a cohort that underwent cardiovascular screening. The incidence of sudden cardiac death was 1 per 14,794 person-years, or 6.8 per 100,000 athletes; most of these deaths were due to cardiomyopathies that had not been detected on screening. (Funded by the English Football Association and others.).
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Affiliation(s)
- Aneil Malhotra
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Harshil Dhutia
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Gherardo Finocchiaro
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Sabiha Gati
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Ian Beasley
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Paul Clift
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Charlotte Cowie
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Antoinette Kenny
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Jamil Mayet
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - David Oxborough
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Kiran Patel
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Guido Pieles
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Dhrubo Rakhit
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - David Ramsdale
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Leonard Shapiro
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - John Somauroo
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Graham Stuart
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Amanda Varnava
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - John Walsh
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Zaheer Yousef
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Maite Tome
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Michael Papadakis
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Sanjay Sharma
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
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284
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Sydó N, Sydó T, Gonzalez Carta KA, Hussain N, Merkely B, Murphy JG, Squires RW, Lopez-Jimenez F, Allison TG. Significance of an Increase in Diastolic Blood Pressure During a Stress Test in Terms of Comorbidities and Long-Term Total and CV Mortality. Am J Hypertens 2018; 31:976-980. [PMID: 29767671 DOI: 10.1093/ajh/hpy080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/11/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND A decrease in diastolic blood pressure (DBP) with exercise is considered normal, but the significance of an increase in DBP has not been validated. Our aim was to determine the relationship of DBP increasing on a stress test regarding comorbidities and mortality. METHODS Our database was reviewed from 1993 to 2010 using the first stress test of a patient. Non-Minnesota residence, baseline cardiovascular (CV) disease, rest DBP <60 or >100 mm Hg, and age <30 or ≥80 were exclusion criteria. DBP response was classified: normal if peak DBP-rest DBP < 0, borderline 0-9, and abnormal ≥10 mm Hg. Mortality was determined from Mayo Clinic records and Minnesota Death Index. Logistic regression was used to determine the relationship of DBP response to the presence of comorbidities. Cox regression was used to determine total and CV mortality risk by DBP response. All analyses were adjusted for age, sex, and resting DBP. RESULTS Twenty thousand seven hundred sixty patients were included (51 ± 11 years, female n = 7,314). Rest/peak averaged DBP 82 ± 8/69 ± 15 mm Hg in normal vs. 79 ± 9/82 ± 9 mm Hg in borderline vs. 76 ± 9/92 ± 11 mm Hg in abnormal DBP response. There were 1,582 deaths (8%) with 557 (3%) CV deaths over 12 ± 5 years of follow-up. In patients with borderline and abnormal DBP response, odds ratios for obesity, hypertension, diabetes, and current smoking were significant, while hazard ratios for total and CV death were not significant compared with patients with normal DBP response. CONCLUSIONS DBP response to exercise is significantly associated with important comorbidities at the time of the stress test but does not add to the prognostic yield of stress test.
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Affiliation(s)
- Nóra Sydó
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Tibor Sydó
- Csolnoky Ferenc Hospital, Veszprém, Hungary
| | | | - Nasir Hussain
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Joseph G Murphy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ray W Squires
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Thomas G Allison
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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285
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Providencia R, Teixeira C, Segal OR, Ullstein A, Mueser K, Lambiase PD. Empowerment of athletes with cardiac disorders: a new paradigm. Europace 2018; 20:1243-1251. [PMID: 29016796 PMCID: PMC6075459 DOI: 10.1093/europace/eux268] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 07/14/2017] [Indexed: 12/11/2022] Open
Abstract
Athletes with cardiac disorders frequently pose an ethical and medical dilemma to physicians assessing their eligibility to participate in sport. In recent decades, patient empowerment has been gaining increasing recognition in clinical decision-making. Empowerment is a process through which people are involved over the decisions and actions that affect their own lives. In the context of a cardiac disorder, empowerment means giving an athlete the chance to participate in the decision about whether or not to remain active in competition. Three models of treatment decision-making are described in this article, with progressive levels of empowerment: the paternalistic model (the athlete has a passive role), the shared-decision making model (both athlete and physician participate in the decision), and the informed-decision making (the decision is made by the athlete while the role of the physician is solely to provide information). This article critically discusses the issues involved in disqualification of athletes with cardiovascular disorders and suggests possible ways of incorporating patient empowerment in potentially career-ending decisions. The authors propose a model of empowerment, which gives patients the opportunity to choose how much, and if, they would like to be involved in the decision-making process.
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Affiliation(s)
- Rui Providencia
- Farr Institute of Health Informatics, University College London, London, UK
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK
| | - Carina Teixeira
- Centre for Psychiatric Rehabilitation, Boston University, Boston, MA, USA
| | - Oliver R Segal
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK
| | | | - Kim Mueser
- Centre for Psychiatric Rehabilitation, Boston University, Boston, MA, USA
| | - Pier D Lambiase
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, UK
- Institute of Cardiovascular Science, University College of London, London, UK
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286
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Angelini P, Cheong BY, Lenge De Rosen VV, Lopez A, Uribe C, Masso AH, Ali SW, Davis BR, Muthupillai R, Willerson JT. High-Risk Cardiovascular Conditions in Sports-Related Sudden Death: Prevalence in 5,169 Schoolchildren Screened via Cardiac Magnetic Resonance. Tex Heart Inst J 2018; 45:205-213. [PMID: 30374227 DOI: 10.14503/thij-18-6645] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Improving preparticipation screening of candidates for sports necessitates establishing the prevalence of high-risk cardiovascular conditions (hr-CVC) that predispose young people to sudden cardiac death (SCD). Our accurate, novel protocol chiefly involved the use of cardiac magnetic resonance (CMR) to estimate this prevalence. Middle and high school students from a general United States population were screened by means of questionnaires, resting electrocardiograms, and CMR to determine the prevalence of 3 types of hr-CVC: electrocardiographic abnormalities, cardiomyopathies, and anomalous coronary artery origin from the opposite sinus with intramural coronary course (ACAOS-IM). We examined the range of normal left ventricular size and function in the main study cohort (schoolchildren 11-14 yr old). We defined diagnostic criteria for hr-CVC and compared the cardiac measurements of these younger participants with those of older children whom we examined (age, 15-18 yr). From 5,169 completed diagnostic studies (mean participant age, 13.06 ± 1.78 yr), CMR results revealed 76 previously undiagnosed cases of hr-CVC (1.47% of the total cohort): 11 of dilated cardiomyopathy (14.5%), 3 of nonobstructive hypertrophic cardiomyopathy (3.9%), 23 ACAOS-IM cases (30.3%; 6 left-ACAOS and 17 right-ACAOS), 4 Wolff-Parkinson-White patterns (5.3%), 34 prolonged QT intervals (44.7%), and 1 Brugada pattern (1.3%). Cardiomyopathies were significantly more prevalent in the older children. Of note, we identified 959 cases (18.5%) of left ventricular noncompaction. If our estimate is accurate, only 1.47% of school-age sports participants will need focused secondary evaluations; the rest can probably be reassured about their cardiac health after one 30-minute screening study.
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287
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Cho Y. Arrhythmogenic right ventricular cardiomyopathy. J Arrhythm 2018; 34:356-368. [PMID: 30167006 PMCID: PMC6111474 DOI: 10.1002/joa3.12012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 10/19/2017] [Indexed: 02/06/2023] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a progressive cardiomyopathy characterized by fibrofatty infiltration of the myocardium, ventricular arrhythmias, sudden death, and heart failure. ARVC may be an important cause of syncope, sudden death, ventricular arrhythmias, and/or wall motion abnormalities, especially in the young. As the first symptom is sudden death or cardiac arrest in many cases, an early diagnosis and risk stratification are important. Recent advances in diagnostic modalities will be helpful in the early diagnosis and proper management of patients at risk. Restriction of strenuous exercise and implantation of implantable cardioverter-defibrillators are important in addition to medical treatment and catheter ablation of ventricular tachycardia. Recently introduced genetic screening may help to identify asymptomatic carriers with a risk of a disease progression and sudden death.
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Affiliation(s)
- Yongkeun Cho
- Department of Internal MedicineKyungpook National University HospitalDaeguKorea
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288
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Mavrogeni SI, Bacopoulou F, Apostolaki D, Chrousos GP. Sudden cardiac death in athletes and the value of cardiovascular magnetic resonance. Eur J Clin Invest 2018; 48:e12955. [PMID: 29782639 DOI: 10.1111/eci.12955] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 05/16/2018] [Indexed: 01/21/2023]
Abstract
Sudden cardiac death (SCD) is the nontraumatic death, due to loss of heart function that occurs suddenly and unexpectedly within 6 hours of a previously normal state of health. It is related to intense competitive sports promoting ventricular tachycardia (VT)/ventricular fibrillation (VF) in the presence of underlying abnormal substrate. A serial evaluation of cardiac physiologic changes taking place during training will allow the better understanding of athlete's heart and will facilitate its discrimination from other grey-zone cardiomyopathies. According to the ESC recommendations, a pre-participation evaluation should include medical history, physical examination as well as a 12-lead electrocardiogram (ECG). Additional tests, such as echocardiography, 24-hours Holter monitoring, stress testing and cardiovascular magnetic resonance (CMR) should be requested upon positive findings at the initial evaluation. Cardiovascular magnetic resonance can be of great value in the differential diagnosis between various cardiomyopathies including hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), left ventricle noncompaction cardiomyopathy (LVNC) and athlete's heart. This is due to its great versatility that can provide reliable and reproducible anatomical, functional and tissue characterization information, which are operator and acoustic window independent.
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Affiliation(s)
| | - Flora Bacopoulou
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, Aghia Sophia Children's Hospital, Kapodistrian University of Athens, Athens, Greece
| | - Despoina Apostolaki
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, Aghia Sophia Children's Hospital, Kapodistrian University of Athens, Athens, Greece
| | - George P Chrousos
- Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, Aghia Sophia Children's Hospital, Kapodistrian University of Athens, Athens, Greece
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289
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Idris A, Shah SR, Park K. Right ventricular dysplasia: management and treatment in light of current evidence. J Community Hosp Intern Med Perspect 2018; 8:101-106. [PMID: 29915644 PMCID: PMC5998293 DOI: 10.1080/20009666.2018.1472513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/24/2018] [Indexed: 10/26/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare cardiovascular disease that predisposes to ventricular arrhythmias potentially leading to sudden cardiac death (SCD). ARVC varies considerably with multiple clinical presentations, ranging from no symptoms to cardiac arrhythmias to SCD. ARVC prevalence is not well known, but the estimated prevalence in the general population is 1:5000. Diagnosis of ARVC can be made by using the Revised European Society of Cardiology criteria for ARVC that includes ventricular structural and functional changes, ECG abnormalities, arrhythmias, family and genetic factors. The management of ARVC is focused on prevention of lethal events such as SCD. Implantable cardioverter defibrillator placement is the only proven mortality benefit in treatment of ARVC. Other treatment strategies include medications such as beta blockers and antiarrhythmics, radiofrequency ablation, surgery, cardiac transplantation, and lifestyle changes. All these interventions help in symptomatic treatment but none of them have proved to decrease mortality rates. ARVC is a progressive disease that leads to SCD if not treated appropriately. Management of these diseases has been a challenge for physicians. With the advent of technology and many new drugs/devices under clinical investigation, this might change in the future. However, while advances in technologies have helped elucidate many aspects of these diseases, many mysteries still remain of this unique disease. With continued research, we can expect more cost-effective and patient-friendly drug therapies and ablation techniques to be developed in the near future.
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Affiliation(s)
- Amr Idris
- Department of Internal Medicine, North Florida Regional Medical Center, University of Central Florida (Gainesville), Gainesville, FL, USA
| | - Syed Raza Shah
- Department of Internal Medicine, North Florida Regional Medical Center, University of Central Florida (Gainesville), Gainesville, FL, USA
| | - Ki Park
- Department of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
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290
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Abstract
The field of sports cardiology has advanced significantly over recent times. It has incorporated clinical and research advances in cardiac imaging, electrophysiology and exercise physiology to enable better diagnostic and therapeutic management of our patients. One important endeavour has been to try and better differentiate athletic cardiac remodelling from inherited cardiomyopathies and other pathologies. Whilst our diagnostic tools have improved, there have also been errors resulting from assumptions that the pathological traits observed in the general population would be generalisable to athletic populations. However, we have learnt that athletes with hypertrophic cardiomyopathy, for example, have many unique features when compared with non-athletic patients with hypertrophic cardiomyopathy. We are learning the limitations of cross-sectional observations and a greater number of prospective studies have been initiated which should enable us to more confidently interrogate the associations between exercise, cardiac remodelling and clinical outcomes. This review of the field enables some of the world's experts in sports cardiology to reflect on where there is a need for research focus to advance knowledge and clinical care in sports cardiology.
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291
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Affiliation(s)
- Marina Cerrone
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Medical Center, New York, NY
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292
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Link MS, Kulkarni N. Moderatio Rebus Omnibus. JACC Clin Electrophysiol 2018; 4:754-756. [DOI: 10.1016/j.jacep.2018.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 02/22/2018] [Indexed: 10/28/2022]
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293
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Friedberg MK, Barach P. A dynamic risk management approach to reduce harm in hypertrophic cardiomyopathy. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.04.004] [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: 12/20/2022]
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294
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Toresdahl BG, Asif IM, Rodeo SA, Ling DI, Chang CJ. Cardiovascular screening of Olympic athletes reported by chief medical officers of the Rio 2016 Olympic Games. Br J Sports Med 2018; 52:1097-1100. [DOI: 10.1136/bjsports-2018-099029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2018] [Indexed: 11/03/2022]
Abstract
ObjectiveThe IOC recommends periodic cardiovascular screening of athletes, but the adoption of these recommendations is unknown. The purpose of this investigation was to evaluate and compare cardiovascular screening practices of countries participating in the Rio 2016 Olympic Games.MethodsA list of chief medical officers (CMOs) was compiled by the IOC during the 2016 Olympic Games. CMOs were requested to complete an online survey about cardiovascular screening of their countries’ Olympic athletes. Comparisons of screening practices were made by categorising countries by continent, gross domestic product (GDP) per capita and size of athlete delegation.ResultsCMOs for 117/207 (56.5%) countries participating in the 2016 Olympic Games were identified. 94/117 countries (80.3%) completed the survey, representing 45.4% of all countries and 8805/11 358 (77.5%) of all 2016 Olympic athletes. Most of the countries surveyed (70.2%) perform annual cardiovascular screening. Among the survey respondents, all or most athletes from each country were screened at least once with the following components: personal history (86.2% of countries), family history (85.1%), physical examination (87.2%), resting ECG (74.5%), echocardiogram (31.9%) and stress test (30.8%). Athletes were more likely to be screened with ECG in countries with relatively larger athlete delegation (OR 2.05, 95% CI 1.10 to 3.80, p=0.023) and with higher GDP per capita (OR 1.69, 95% CI 1.11 to 2.57, p=0.014).ConclusionMost of the responding countries perform annual cardiovascular screening of Olympic athletes, but there are differences in the components used. Athletes from countries with larger athlete delegations and higher GDP per capita were more likely to be screened with ECG.
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295
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Weissler-Snir A, Adler A, Williams L, Gruner C, Rakowski H. Prevention of sudden death in hypertrophic cardiomyopathy: bridging the gaps in knowledge. Eur Heart J 2018; 38:1728-1737. [PMID: 27371714 DOI: 10.1093/eurheartj/ehw268] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 06/01/2016] [Indexed: 12/12/2022] Open
Abstract
Sudden cardiac death (SCD) is the most devastating complication of hypertrophic cardiomyopathy (HCM). Although the annual rate of SCD in the general HCM population is <1% per year according to contemporary series, there is still a small subset of patients who are at increased risk of SCD. The greatest challenge in the management of HCM is identifying those at increased risk as an implantable cardioverter defibrillator is a potentially life-saving therapy. In this review, we sought to summarize the available data on SCD in HCM and provide a clinical perspective on the current differing and somewhat conflicting European and American recommendations on risk stratification, with balanced guidance with regards to rational clinical decision making. Additionally, we sought to learn more on the actual implementation of the guidelines by HCM experts worldwide.
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Affiliation(s)
- Adaya Weissler-Snir
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Arnon Adler
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Lynne Williams
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Christiane Gruner
- Division of Cardiology, Cardiovascular Centre, University Hospital Zurich, Zurich, Switzerland
| | - Harry Rakowski
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
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296
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AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current Evidence, Knowledge Gaps, Recommendations, and Future Directions: Erratum. Clin J Sport Med 2018; 28:324. [PMID: 29762263 DOI: 10.1097/jsm.0000000000000382] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Chen AS, Bent RE, Wheeler M, Knowles JW, Haddad F, Froelicher V, Ashley E, Perez MV. Large Q and S waves in lead III on the electrocardiogram distinguish patients with hypertrophic cardiomyopathy from athletes. Heart 2018; 104:1871-1877. [PMID: 29680808 DOI: 10.1136/heartjnl-2017-312647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 04/03/2018] [Accepted: 04/05/2018] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To identify electrocardiographic findings, especially deep Q and S waves in lead III, that differentiate athletes from patients with hypertrophic cardiomyopathy (HCM). METHODS Digital ECGs of athletes and patients with HCM followed at the Stanford Center for Inherited Cardiovascular Disease were studied retrospectively. All patients with HCM had an echocardiogram performed. A multivariable logistic regression model was used to calculate ORs for various demographic and ECG characteristics. Linear regression was used to correlate ECG characteristics with echocardiogram findings. RESULTS We studied 1124 athletes and 240 patients with HCM. The average Q+S wave amplitude in lead III (IIIQ+S) was significantly higher in patients with HCM compared with athletes (0.71±0.69 mV vs 0.21±0.17 mV, p<0.001). In patients with HCM, IIIQ+S directly correlated with interventricular septal (IVS) thickness on echocardiography (ρ=0.45, p<0.001). In a multivariable analysis adjusted for demographic and ECG characteristics, higher IIIQ+S values remained independently associated with HCM compared with athletes (OR=4.2 per 0.5 mV, p<0.001). In subgroup analyses of young patients, African-American subjects and subjects without left axis deviation (LAD), IIIQ+S remained associated with HCM. The addition of IIIQ+S>1.0 mV as an abnormal finding to the International Criteria for athletic ECG interpretation improved sensitivity from 64.2% to 70.4%, with a minimal decrease in specificity. CONCLUSION Large Q and S waves in lead III distinguished athletes from patients with HCM, independent of axis and well-known ECG markers associated with HCM. The correlation between IVS thickness in patients with HCM and IIIQ+S suggests a partial explanation for this association.
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Affiliation(s)
- Alvin S Chen
- Stanford University School of Medicine, Stanford Center for Inherited Cardiovascular Disease, Stanford University, Stanford, California, USA
| | - Rachel E Bent
- Stanford University School of Medicine, Stanford Center for Inherited Cardiovascular Disease, Stanford University, Stanford, California, USA
| | - Matthew Wheeler
- Stanford University School of Medicine, Stanford Center for Inherited Cardiovascular Disease, Stanford University, Stanford, California, USA
| | - Joshua W Knowles
- Stanford University School of Medicine, Stanford Center for Inherited Cardiovascular Disease, Stanford University, Stanford, California, USA
| | - Francois Haddad
- Stanford University School of Medicine, Stanford Center for Inherited Cardiovascular Disease, Stanford University, Stanford, California, USA
| | - Victor Froelicher
- Stanford University School of Medicine, Stanford Center for Inherited Cardiovascular Disease, Stanford University, Stanford, California, USA
| | - Euan Ashley
- Stanford University School of Medicine, Stanford Center for Inherited Cardiovascular Disease, Stanford University, Stanford, California, USA
| | - Marco V Perez
- Stanford University School of Medicine, Stanford Center for Inherited Cardiovascular Disease, Stanford University, Stanford, California, USA
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298
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Maron BJ, Estes NM, Maron MS. Is It Fair to Screen Only Competitive Athletes for Sudden Death Risk, or Is It Time to Level the Playing Field? Am J Cardiol 2018; 121:1008-1010. [PMID: 29472006 DOI: 10.1016/j.amjcard.2017.12.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/19/2017] [Accepted: 12/29/2017] [Indexed: 10/18/2022]
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299
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Medical assessment in athletes. Med Clin (Barc) 2018; 150:268-274. [PMID: 29096970 DOI: 10.1016/j.medcli.2017.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 08/31/2017] [Accepted: 09/04/2017] [Indexed: 11/21/2022]
Abstract
Practicing sports at a professional level requires the body to be in good health. The fact of carrying out a continuous and high intensity physical activity in the presence of pathological conditions and/or a maladaptation of the body can be detrimental to the athletes' health and, therefore, to their performance. Many of the problems that arise in the sports field could be prevented with a periodic and well-structured medical assessment. In this review, we describe the protocol of the medical service of a high-level sports club for the assessment of its professional athletes.
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300
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Sweeting J, Semsarian C. Sudden Cardiac Death in Athletes. Heart Lung Circ 2018; 27:1072-1077. [PMID: 29705387 DOI: 10.1016/j.hlc.2018.03.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 03/21/2018] [Indexed: 11/25/2022]
Abstract
Sudden cardiac death (SCD) in athletes is a rare but tragic complication of a number of cardiovascular diseases. Inherited causes such as the structural and arrhythmogenic genetic heart conditions are often found or suspected to be the underlying cause of death at post mortem examination. Physical activity and intense exercise may trigger cardiac arrhythmias in individuals with these conditions leading to SCD. Prevention and treatment strategies include individual athlete management strategies, coupled with public health measures such as universal cardiopulmonary resuscitation (CPR) training and availability of automatic external defibrillators (AEDs) in public places, thereby preventing SCD in both athletes and the general population. Where an athlete is known to have a cardiac condition, some restrictions from participation may be prudent, however, new evidence is emerging that perhaps current restrictions are too strict and could be relaxed in some cases. An athlete-centred model of care is essential to ensure the clinical implications and athlete preferences are balanced providing the best outcome for all concerned.
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Affiliation(s)
- Joanna Sweeting
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
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