1
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Henning RJ. The differentiation of the competitive athlete with physiologic cardiac remodeling from the athlete with cardiomyopathy. Curr Probl Cardiol 2024; 49:102473. [PMID: 38447749 DOI: 10.1016/j.cpcardiol.2024.102473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 02/20/2024] [Indexed: 03/08/2024]
Abstract
There are currently 5 million active high school, collegiate, professional, and master athletes in the United States. Regular intense exercise by these athletes can promote structural, electrical and functional remodeling of the heart, which is termed the "athlete's heart." In addition, regular intense exercise can lead to pathological adaptions that promote or worsen cardiac disease. Many of the athletes in the United States seek medical care. Consequently, physicians must be aware of the normal cardiac anatomy and physiology of the athlete, the differentiation of the normal athlete heart from the athlete with cardiomyopathy, and the contemporary care of the athlete with a cardiomyopathy. In athletes with persistent cardiovascular symptoms, investigations should include a detailed history and physical examination, an ECG, a transthoracic echocardiogram, and in athletes in whom the diagnosis is uncertain, a maximal exercise stress test or a continuous ECG recording, and cardiac magnetic resonance imaging or cardiac computed tomography angiography when definition of the coronary anatomy or characterization of the aorta and the aortic great vessels is indicated. This article discusses the differentiation of the normal athlete with physiologic cardiac remodeling from the athlete with hypertrophic, dilated or arrhythmogenic ventricular cardiomyopathy (ACM). The ECG changes in trained athletes that are considered normal, borderline, or abnormal are listed. In addition, the normal echocardiographic measurements for athletes who consistently participate in endurance, power, combined or heterogeneous sports are enumerated and discussed. Algorithms are listed that are useful in the diagnosis of trained athletes with borderline or abnormal echocardiographic measurements suggestive of cardiomyopathies along with the major and minor criteria for the diagnosis of ACM in athletes. Thereafter, the treatment of athletes with hypertrophic, dilated, and arrhythmogenic right ventricular cardiomyopathies are reviewed. The distinction between physiologic changes and pathologic changes in the hearts of athletes has important therapeutic and prognostic implications. Failure by the physician to correctly diagnose an athlete with hypertrophic cardiomyopathy, dilated cardiomyopathy, or ACM, can lead to the sudden cardiac arrest and death of the athlete during training or sports competition. Conversely, an incorrect diagnosis by a physician of cardiac pathology in a normal athlete can lead to an unnecessary restriction of athlete training and competition with resultant significant emotional, psychological, financial, and long-term health consequences in the athlete.
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2
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Vadher A, Malik N, Pannikottu K, Kondur A, Kambhatla S. Anomalous Left Circumflex Artery Originating From Right Coronary Cusp as Culprit Vessel in ST-Elevation Myocardial Infarction (STEMI). Cureus 2024; 16:e66230. [PMID: 39238680 PMCID: PMC11375125 DOI: 10.7759/cureus.66230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2024] [Indexed: 09/07/2024] Open
Abstract
Congenital coronary artery anomalies are rare. The most common anomalous variation is Anomalous Left Circumflex Artery (ALCx) which is a congenital anomaly. ALCx usually originates from the right sinus of Valsalva or as a proximal branching of the Right Coronary Artery (RCA). The clinical presentation has a spectrum which varies from asymptomatic presentation to angina or myocardial infarction with no atherosclerotic lesion due to kinking/compression of the vessel to ST-segment elevation myocardial infarction (STEMI) due to atherosclerotic occlusion. A 45-year-old female with a past medical history of hypertension, hyperlipidemia, type 2 diabetes, tobacco abuse, and a history of ischemic stroke, presented to the hospital due to chest pain. Electrocardiogram revealed inferior ST-elevation myocardial infarction (STEMI) and the patient was taken to the catheterization lab. Angiography revealed 90% stenotic Left Circumflex Artery (LCx) which was anomalous, arising from the right coronary cusp, whereas other coronary arteries were diffusedly atherosclerotic. A drug-eluting stent was placed in the ALCx reducing the stenosis from 90% to 0% and the patient was discharged in a stable condition on dual antiplatelet therapy and statin with plans for possible coronary artery bypass graft due to multivessel disease (severe diffuse disease of LAD, 90% mid-RCA stenosis, 80% proximal RCA stenosis). The patient was eventually lost to follow-up. Typically, anomalous LCx originating from RCA is benign, but there are many cases where there is myocardial infarction or sudden cardiac death due to acute angle take-off at the origin site. This anatomical variation is more important during cardiac surgeries because during valve replacement surgeries, there are cases of ALCx compression resulting in myocardial infarction. Our patient developed STEMI secondary to atherosclerotic stenosis in anomalous LCx. Based on her diffuse atherosclerotic disease and risk factors, it is likely that her anomalous anatomy did not cause her atherosclerotic disease. Overall, clinicians should remain vigilant for these anatomic abnormalities in their practice.
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Affiliation(s)
| | - Nikhale Malik
- Internal Medicine, Garden City Hospital, Garden City, USA
| | | | - Ashok Kondur
- Cardiology, Garden City Hospital, Garden City, USA
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3
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Krishnan S, Guseh JS, Chukumerije M, Grant AJ, Dean PN, Hsu JJ, Husaini M, Phelan DM, Shah AB, Stewart K, Wasfy MM, Capers Q, Essien UR, Johnson AE, Levine BD, Kim JH. Racial Disparities in Sports Cardiology: A Review. JAMA Cardiol 2024:2820717. [PMID: 39018059 DOI: 10.1001/jamacardio.2024.1899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
Importance Racial disparities in cardiovascular health, including sudden cardiac death (SCD), exist among both the general and athlete populations. Among competitive athletes, disparities in health outcomes potentially influenced by social determinants of health (SDOH) and structural racism remain inadequately understood. This narrative review centers on race in sports cardiology, addressing racial disparities in SCD risk, false-positive cardiac screening rates among athletes, and the prevalence of left ventricular hypertrophy, and encourages a reexamination of race-based practices in sports cardiology, such as the interpretation of screening 12-lead electrocardiogram findings. Observations Drawing from an array of sources, including epidemiological data and broader medical literature, this narrative review discusses racial disparities in sports cardiology and calls for a paradigm shift in approach that encompasses 3 key principles: race-conscious awareness, clinical inclusivity, and research-driven refinement of clinical practice. These proposed principles call for a shift away from race-based assumptions towards individualized, health-focused care in sports cardiology. This shift would include fostering awareness of sociopolitical constructs, diversifying the medical team workforce, and conducting diverse, evidence-based research to better understand disparities and address inequities in sports cardiology care. Conclusions and Relevance In sports cardiology, inadequate consideration of the impact of structural racism and SDOH on racial disparities in health outcomes among athletes has resulted in potential biases in current normative standards and in the clinical approach to the cardiovascular care of athletes. An evidence-based approach to successfully address disparities requires pivoting from outdated race-based practices to a race-conscious framework to better understand and improve health care outcomes for diverse athletic populations.
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Affiliation(s)
- Sheela Krishnan
- Cardiovascular Services, Division of Cardiology, Maine Medical Center, Portland
| | - James Sawalla Guseh
- Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston
| | - Merije Chukumerije
- Sports and Exercise Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Cedars-Sinai Medical Group, Los Angeles, California
| | | | - Peter N Dean
- Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia, Charlottesville
| | - Jeffrey J Hsu
- Department of Medicine (Cardiology), David Geffen School of Medicine, University of California, Los Angeles
| | - Mustafa Husaini
- Division of Cardiovascular Medicine, Department of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Dermot M Phelan
- The Gragg Center for Cardiovascular Performance, Atrium Health Sanger Heart & Vascular Institute, Charlotte, North Carolina
| | - Ankit B Shah
- Sports & Performance Cardiology, Georgetown University School of Medicine, Chevy Chase, Maryland
| | - Katie Stewart
- Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston
| | - Meagan M Wasfy
- Division of Cardiology, Massachusetts General Hospital, Boston
| | - Quinn Capers
- Department of Medicine, The University of Texas Southwestern Medical Center, Dallas
| | - Utibe R Essien
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Amber E Johnson
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian, Dallas
- Department of Medicine and Cardiology, The University of Texas Southwestern Medical Center, Dallas
| | - Jonathan H Kim
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
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4
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Arthur MN, DeLong RN, Kucera K, Goettsch BP, Schattenkerk J, Bekker S, Drezner JA. Socioeconomic deprivation and racialised disparities in competitive athletes with sudden cardiac arrest from the USA. Br J Sports Med 2024; 58:494-499. [PMID: 38413131 DOI: 10.1136/bjsports-2023-107367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To explore the association of socioeconomic deprivation and racialised outcomes in competitive athletes with sudden cardiac arrest (SCA) in the USA. METHODS SCA cases from the National Center for Catastrophic Sports Injury Research (July 2014 to June 2021) were included. We matched Area Deprivation Index (ADI) scores (17 metrics to grade socioeconomic conditions) to the 9-digit zip codes for each athlete's home address. ADI is scored 1-100 with higher scores indicating greater neighbourhood socioeconomic deprivation. Analysis of variance was used to assess differences in mean ADI by racial groups. Tukey post hoc testing was used for pairwise comparisons. RESULTS 391 cases of SCA in competitive athletes (85.4% male; 16.9% collegiate, 68% high school, 10.7% middle school, 4.3% youth) were identified via active surveillance. 79 cases were excluded due to missing data (19 race, 60 ADI). Of 312 cases with complete data, 171 (54.8%) were white, 110 (35.3%) black and 31 (9.9%) other race. The mean ADI was 40.20 (95% CI 36.64, 43.86) in white athletes, 57.88 (95% CI 52.65, 63.11) in black athletes and 40.77 (95% CI 30.69, 50.86) in other race athletes. Mean ADI was higher in black versus white athletes (mean difference 17.68, 95% CI 10.25, 25.12; p=0.0036) and black versus other race athletes (mean difference 17.11, 95% CI 4.74, 29.47; p<0.0001). CONCLUSIONS Black athletes with SCA come from areas with higher neighbourhood socioeconomic deprivation than white or other race athletes with SCA. Our findings suggest that socioeconomic deprivation may be associated with racialised disparities in athletes with SCA.
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Affiliation(s)
- Megan Nicole Arthur
- Family Medicine, Boston University School of Medicine, Cambridge, Massachusetts, USA
| | - Randi N DeLong
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristen Kucera
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Barbara P Goettsch
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jared Schattenkerk
- Department of Internal Medicine, University of Washington, Seattle, Washington, USA
| | | | - Jonathan A Drezner
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
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5
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Amantea C, Pilia E, Rossi MF, Corona VF, Amato G, Ciccu C, Gavi F, Santoro PE, Borrelli I, Ricciardi W, Gualano MR, Moscato U. Sudden cardiac death among workers: a systematic review and meta-analysis. Syst Rev 2024; 13:84. [PMID: 38461297 PMCID: PMC10924409 DOI: 10.1186/s13643-024-02504-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/23/2024] [Indexed: 03/11/2024] Open
Abstract
OBJECTIVE Sudden cardiac death (SCD) is a rare and yet unexplained condition. The most frequent cause is myocardial infarction, while a small proportion is due to arrhythmogenic syndromes (e.g., channelopathies). This systematic review and meta-analysis aimed to provide a comprehensive overview of the prevalence and risk factors associated with SCD in workers. MATERIAL AND METHODS A search for eligible studies was performed utilizing three databases (PubMed, ISI Web of Knowledge, and Scopus). The inclusion criteria were fulfilled if sudden cardiac death due to channelopathy in workers was mentioned. RESULTS Out of the 1408 articles found across three databases, 6 articles were included in the systematic review but the meta-analysis was conducted on 3 studies The total sample included was 23,450 participants. The pooled prevalence of channelopathies in employees was 0.3% (95% CI 0.07-0.43%), of sudden cardiac death in employees was 2.8% (95% CI 0.37-5.20%), and of sudden cardiac death in employees with a diagnosis of cardiac channelopathies was 0.2% (95% CI 0.02- 0.30%). CONCLUSIONS SCD is a serious and potentially preventable condition that can occur among workers. By identifying and addressing work-related risk factors, providing appropriate screening and interventions, and promoting healthy lifestyle behaviors, we can work to reduce the incidence of SCD and improve the cardiovascular health and well-being of workers.
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Affiliation(s)
- Carlotta Amantea
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, 00168, Italy
| | - Enrico Pilia
- Department of Medical Sciences and Public Health, Section of Legal Medicine, University of Cagliari, Cagliari, Italy
| | - Maria Francesca Rossi
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, 00168, Italy
| | - Valerio Flavio Corona
- Department of Life Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, 00168, Italy.
| | - Giuseppe Amato
- Department of Medical Sciences and Public Health, Section of Legal Medicine, University of Cagliari, Cagliari, Italy
| | - Corrado Ciccu
- Department of Medical Sciences and Public Health, Section of Legal Medicine, University of Cagliari, Cagliari, Italy
| | - Filippo Gavi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, Rome, 00168, Italy
| | - Paolo Emilio Santoro
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, 00168, Italy
- Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, Rome, 00168, Italy
| | - Ivan Borrelli
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, 00168, Italy
| | - Walter Ricciardi
- Department of Life Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, 00168, Italy
| | - Maria Rosaria Gualano
- Saint Camillus International University of Health Sciences, UniCamillus, Via Sant'Alessandro 8, Rome, 00131, Italy
| | - Umberto Moscato
- Department of Life Science and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, Rome, 00168, Italy
- Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, Rome, 00168, Italy
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6
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Donovan DJ, Nelson JE, Monaco MA. The cardiac preparticipation sports evaluation. Curr Opin Pediatr 2023; 35:546-552. [PMID: 37555798 DOI: 10.1097/mop.0000000000001284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
PURPOSE OF REVIEW Sudden cardiac death (SCD) is the leading cause of death in young athletes during sports participation. Preparticipation cardiovascular screening aims to identify those at an increased risk of SCD. This review aims to provide a background of SCD in young athletes, to discuss the various screening recommendations of major medical societies, and to review recent evidence and current practice. RECENT FINDINGS Numerous studies have evaluated various preparticipation screening practices, particularly regarding the inclusion of ECG as part of an initial evaluation to identify conditions with an increased risk of SCD. Some analyses have shown ECG inclusion to provide increased screening sensitivity and specificity, though others have shown no benefit when compared with evaluation with history and physical examination alone. Furthermore, in countries for which more extensive screening protocols have been employed, postimplementation statistics have not shown a significant decrease in SCD. SUMMARY SCD in young athletes primarily results from underlying cardiac disease. Various preparticipation screening recommendations exist globally, with the common goal of decreasing the rates of SCD by identifying youth at risk during sports participation. Current guidelines in the United States support universal preparticipation evaluation using history and physical examination, with cardiology referral if abnormalities are identified.
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Affiliation(s)
- Denis J Donovan
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
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7
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Marijon E, Narayanan K, Smith K, Barra S, Basso C, Blom MT, Crotti L, D'Avila A, Deo R, Dumas F, Dzudie A, Farrugia A, Greeley K, Hindricks G, Hua W, Ingles J, Iwami T, Junttila J, Koster RW, Le Polain De Waroux JB, Olasveengen TM, Ong MEH, Papadakis M, Sasson C, Shin SD, Tse HF, Tseng Z, Van Der Werf C, Folke F, Albert CM, Winkel BG. The Lancet Commission to reduce the global burden of sudden cardiac death: a call for multidisciplinary action. Lancet 2023; 402:883-936. [PMID: 37647926 DOI: 10.1016/s0140-6736(23)00875-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/13/2023] [Accepted: 04/25/2023] [Indexed: 09/01/2023]
Abstract
Despite major advancements in cardiovascular medicine, sudden cardiac death (SCD) continues to be an enormous medical and societal challenge, claiming millions of lives every year. Efforts to prevent SCD are hampered by imperfect risk prediction and inadequate solutions to specifically address arrhythmogenesis. Although resuscitation strategies have witnessed substantial evolution, there is a need to strengthen the organisation of community interventions and emergency medical systems across varied locations and health-care structures. With all the technological and medical advances of the 21st century, the fact that survival from sudden cardiac arrest (SCA) remains lower than 10% in most parts of the world is unacceptable. Recognising this urgent need, the Lancet Commission on SCD was constituted, bringing together 30 international experts in varied disciplines. Consistent progress in tackling SCD will require a completely revamped approach to SCD prevention, with wide-sweeping policy changes that will empower the development of both governmental and community-based programmes to maximise survival from SCA, and to comprehensively attend to survivors and decedents' families after the event. International collaborative efforts that maximally leverage and connect the expertise of various research organisations will need to be prioritised to properly address identified gaps. The Commission places substantial emphasis on the need to develop a multidisciplinary strategy that encompasses all aspects of SCD prevention and treatment. The Commission provides a critical assessment of the current scientific efforts in the field, and puts forth key recommendations to challenge, activate, and intensify efforts by both the scientific and global community with new directions, research, and innovation to reduce the burden of SCD worldwide.
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Affiliation(s)
- Eloi Marijon
- Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France; Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France.
| | - Kumar Narayanan
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France; Medicover Hospitals, Hyderabad, India
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Silverchain Group, Melbourne, VIC, Australia
| | - Sérgio Barra
- Department of Cardiology, Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal
| | - Cristina Basso
- Cardiovascular Pathology Unit-Azienda Ospedaliera and Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marieke T Blom
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lia Crotti
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Cardiomyopathy Unit and Laboratory of Cardiovascular Genetics, Department of Cardiology, Milan, Italy
| | - Andre D'Avila
- Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Cardiology, Hospital SOS Cardio, Santa Catarina, Brazil
| | - Rajat Deo
- Department of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Florence Dumas
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France; Emergency Department, Cochin Hospital, Paris, France
| | - Anastase Dzudie
- Cardiology and Cardiac Arrhythmia Unit, Department of Internal Medicine, DoualaGeneral Hospital, Douala, Cameroon; Yaounde Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Audrey Farrugia
- Hôpitaux Universitaires de Strasbourg, France, Strasbourg, France
| | - Kaitlyn Greeley
- Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France; Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France
| | | | - Wei Hua
- Cardiac Arrhythmia Center, FuWai Hospital, Beijing, China
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research and UNSW Sydney, Sydney, NSW, Australia
| | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
| | - Juhani Junttila
- MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Rudolph W Koster
- Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Theresa M Olasveengen
- Department of Anesthesia and Intensive Care Medicine, Oslo University Hospital and Institute of Clinical Medicine, Oslo, Norway
| | - Marcus E H Ong
- Singapore General Hospital, Duke-NUS Medical School, Singapore
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George's University of London, London, UK
| | | | - Sang Do Shin
- Department of Emergency Medicine at the Seoul National University College of Medicine, Seoul, South Korea
| | - Hung-Fat Tse
- University of Hong Kong, School of Clinical Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region, China; Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zian Tseng
- Division of Cardiology, UCSF Health, University of California, San Francisco Medical Center, San Francisco, California
| | - Christian Van Der Werf
- University of Amsterdam, Heart Center, Amsterdam, Netherlands; Department of Clinical and Experimental Cardiology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christine M Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bo Gregers Winkel
- Department of Cardiology, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
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8
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Couto JF, Martins E. Recommendations for the Management of Cardiomyopathy Mutation Carriers: Evidence, Doubts, and Intentions. J Clin Med 2023; 12:4706. [PMID: 37510821 PMCID: PMC10380898 DOI: 10.3390/jcm12144706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Cardiomyopathies may be hereditary and associated with a familial predilection. Morbidity and mortality can be caused by heart failure, sudden death, or arrhythmias. Sometimes these events are the first manifestations of cardiovascular disease. Hypertrophic cardiomyopathy and arrhythmogenic cardiomyopathy are perhaps most thoroughly studied in that context. Dilated cardiomyopathy, although most frequently of secondary etiology, has a significant familial cluster. Noncompaction of the left ventricle can sometimes be seen in healthy individuals and, in other instances, is associated with severe LV dysfunction. Genetic testing is of utmost importance, since it might allow for the identification of individuals carrying mutations predisposing them to these diseases. In addition, certain variants may benefit from tailored therapeutic regimens, and thus searching for a causal mutation can impact clinical practice and is recommended for all patients with HCM or ACM. Patients with DCM and positive family history should be included as well. Regular follow-ups are advised, even in those with negative phenotypes, because these disorders are often age dependent. During pregnancy and in the case of athletes, special consideration should be made as well. We intend to summarize the most current evidence regarding their management.
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Affiliation(s)
- José F Couto
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Elisabete Martins
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Centro Hospitalar Universitário São João, Member of the European Reference Network for Rare, Low-Prevalence, or Complex Diseases of the Heart (ERN GUARD-Heart), 4200-319 Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
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9
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Ostrominski JW, Guo R, Elliott PM, Ho CY. Cardiac Myosin Inhibitors for Managing Obstructive Hypertrophic Cardiomyopathy: JACC: Heart Failure State-of-the-Art Review. JACC. HEART FAILURE 2023; 11:735-748. [PMID: 37407153 DOI: 10.1016/j.jchf.2023.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 07/07/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is frequently caused by pathogenic variants in genes encoding sarcomere proteins and is characterized by left ventricular (LV) hypertrophy, hypercontractility, and-in many cases-left ventricular outflow tract (LVOT) obstruction. Despite standard management, obstructive HCM (oHCM) can still cause substantial morbidity, highlighting the critical need for more effective disease-specific therapeutic approaches. Over the past decade, improved understanding of the molecular pathobiology of HCM has culminated in development of cardiac myosin inhibitors (CMIs), a novel drug class that in recent randomized clinical trials has been shown to decrease LVOT obstruction, improve exercise capacity, and ameliorate symptom burden in patients with oHCM. Although promising, areas of uncertainty remain, including the long-term safety and efficacy of CMIs and whether they have the potential to modify progression of disease. Herein, we review key milestones in the clinical development of CMIs, contextualize CMIs with established oHCM therapies, and discuss future challenges and opportunities for the use of CMIs across the HCM spectrum.
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Affiliation(s)
- John W Ostrominski
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ruby Guo
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Perry M Elliott
- Centre for Heart Muscle Disease, Institute of Cardiological Sciences, University College London and St Bartholomew's Hospital, London, United Kingdom
| | - Carolyn Y Ho
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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10
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Cornelissen A, Guo L, Neally SJ, Kleinberg L, Forster A, Nair R, Gadhoke N, Ghosh SKB, Sakamoto A, Sato Y, Kawakami R, Mori M, Kawai K, Fernandez R, Dikongue A, Abebe B, Kutys R, Romero ME, Kolodgie FD, Baumer Y, Powell-Wiley TM, Virmani R, Finn AV. Relationships between neighborhood disadvantage and cardiovascular findings at autopsy in subjects with sudden death. Am Heart J 2023; 256:37-50. [PMID: 36372247 DOI: 10.1016/j.ahj.2022.10.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/19/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Neighborhood disadvantage is associated with a higher risk of sudden cardiac death. However, autopsy findings have never been investigated in this context. Here, we sought to explore associations between neighborhood disadvantage and cardiovascular findings at autopsy in cases of sudden death in the State of Maryland. METHODS State of Maryland investigation reports from 2,278 subjects within the CVPath Sudden Death Registry were screened for street addresses and 9-digit zip codes. Area deprivation index (ADI), used as metric for neighborhood disadvantage, was available for 1,464 subjects; 650 of whom self-identified as Black and 814 as White. The primary study outcome measurements were causes of death and gross and histopathologic findings of the heart. RESULTS Subjects from most disadvantaged neighborhoods (i.e., ADI ≥ 8; n = 607) died at younger age compared with subjects from less disadvantaged neighborhoods (i.e., ADI ≤ 7; n = 857; 46.07 ± 14.10 vs 47.78 ± 13.86 years; P = 0.02) and were more likely Black or women. They were less likely to die from cardiac causes of death (61.8% vs 67.7%; P = 0.02) and had less severe atherosclerotic plaque features, including plaque burden, calcification, intraplaque hemorrhage, and thin-cap fibroatheromas. In addition, subjects from most disadvantaged neighborhoods had lower frequencies of plaque rupture (18.8% vs 25.1%, P = 0.004). However, these associations were omitted after adjustment for traditional risk factors and race. CONCLUSION Neighborhood disadvantage did not associate with cause of death or coronary histopathology after adjustment for cardiovascular risk factors and race, implying that social determinants of health other than neighborhood disadvantage play a more prominent role in sudden cardiac death.
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Affiliation(s)
| | - Liang Guo
- CVPath Institute, Gaithersburg, MD, US
| | - Sam J Neally
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Institutes of Health, Bethesda, MD, US
| | | | | | | | | | | | | | - Yu Sato
- CVPath Institute, Gaithersburg, MD, US
| | | | | | | | | | | | | | | | | | | | - Yvonne Baumer
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Institutes of Health, Bethesda, MD, US
| | - Tiffany M Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, Cardiovascular Branch, National Institutes of Health, Bethesda, MD, US
| | | | - Aloke V Finn
- CVPath Institute, Gaithersburg, MD, US; School of Medicine, University of Maryland School of Medicine, Baltimore, MD, US.
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11
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Vriz O, Landi I, Eltayeb A, Limongelli G, Mos L, Delise P, Bossone E, Andrea AD. Mitral Valve Prolapse and Sudden Cardiac Death in Athletes at High Risk. Curr Cardiol Rev 2023; 19:e201222212066. [PMID: 36545732 PMCID: PMC10280998 DOI: 10.2174/1573403x19666221220163431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/23/2022] [Accepted: 10/31/2022] [Indexed: 12/24/2022] Open
Abstract
Mitral valve prolapse (MVP) is the most frequent valvulopathy in the general population, with usually a favourable prognosis. Although it can be associated with some complications, ventricular arrhythmias (VA) and sudden cardiac death (SCD) are the most worrying. The estimated risk of SCD in MVP is between 0.2% to 1.9% per year, including MVP patients with and without severe mitral regurgitation (MR). The association between SCD and MVP is expressed by a phenotype called "malignant MVP" characterized by transthoracic echocardiography (TTE) findings such as bileaflet myxomatous prolapse and mitral annulus disjunction (MAD), ECG findings such as repolarization abnormalities, complex ventricular arrhythmias (c-VAs) and LV fibrosis of papillary muscles (PMs) and inferobasal wall visualized by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Therefore, attention is raised for patients with "arrhythmic MVP" characterized from an ECG point of view by frequent premature ventricular contractions (PVCs) arising from one or both PMs as well as by T-wave inversion in the inferolateral leads. In athletes, SCD is the most frequent medical cause of death and in young subjects (< 35 years) usually is due to electrical mechanism affecting who has a silent cardiovascular disease and are not considered per se a cause of increased mortality. In MVP, SCD was reported to happen during sports activity or immediately after and valve prolapse was the only pathological aspect detected. The aim of the present paper is to explore the association between SCD and MVP in athletes, focusing attention on ECG, TTE in particular, and CMR findings that could help to identify subjects at high risk for complex arrhythmias and eventually SCD. In addition, it is also examined if sports activity might predispose patients with MVP to develop major arrhythmias.
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Affiliation(s)
- Olga Vriz
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Irene Landi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Abdalla Eltayeb
- Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Giuseppe Limongelli
- Department of Translational Medical Sciences, Inherited and Rare Cardiovascular Disease Unit, University of Campania “Luigi Vanvitelli”, AORN dei Colli, Monaldi Hospital, Naples, Italy
| | - Lucio Mos
- Dipartimento di Cardiologia, Ospedale San Daniele del Friuli, Udine, Italy
| | | | - Eduardo Bossone
- Azienda Ospedaliera di Rilevanza Nazionale “A. Cardarelli” Hospital, Naples, Italy
| | - Antonello D` Andrea
- Department of Cardiology, Umberto I Hospital, Luigi Vanvitelli University - Nocera Inferiore (ASL Salerno), Caserta, Italy
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12
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Abstract
PURPOSE OF REVIEW The athlete's heart exhibits unique structural and functional adaptations in the setting of strenuous and repetitive athletic training which may be similarly found in pathologic states. The purpose of this review is to highlight the morphologic and functional changes associated with the athlete's heart, with a focus upon the insights that echocardiography provides into exercise-induced cardiac remodeling. RECENT FINDINGS Recent studies are aiming to investigate the long-term effects and clinical consequences of an athlete's heart. The "gray-zone" continues to pose a clinical challenge and may indicate scenarios where additional imaging modalities, or longitudinal follow-up, provide a definitive answer. Echocardiography is likely to remain the first-line imaging modality for the cardiac evaluation of elite athletes. Multimodality imaging combined with outcome and long-term follow-up studies both during training and after retirement in both men and women may help further clarify the remaining mysteries in the coming years.
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13
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Certainties and Uncertainties of Cardiac Magnetic Resonance Imaging in Athletes. J Cardiovasc Dev Dis 2022; 9:jcdd9100361. [PMID: 36286312 PMCID: PMC9604894 DOI: 10.3390/jcdd9100361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/16/2022] Open
Abstract
Prolonged and intensive exercise induces remodeling of all four cardiac chambers, a physiological process which is coined as the “athlete’s heart”. This cardiac adaptation, however, shows overlapping features with non-ischemic cardiomyopathies, such as dilated, arrhythmogenic and hypertrophic cardiomyopathy, also associated with athlete’s sudden cardiac death. Cardiac magnetic resonance (CMR) is a well-suited, highly reproducible imaging modality that can help differentiate athlete’s heart from cardiomyopathy. CMR allows accurate characterization of the morphology and function of cardiac chambers, providing full coverage of the ventricles. Moreover, it permits an in-depth understanding of the myocardial changes through specific techniques such as mapping or late gadolinium enhancement. In this narrative review, we will focus on the certainties and uncertainties of the role of CMR in sports cardiology. The main aspects of physiological adaptation due to regular and intensive sports activity and the application of CMR in highly trained athletes will be summarized.
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14
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Wassenaar JW, Clark DE, Dixon DD, George-Durrett K, Parikh A, Li DL, Baker MT, Gupta DK, Hughes SG, Soslow JH, Dendy JM. Reduced Circumferential Strain in Athletes with Prior COVID-19. Radiol Cardiothorac Imaging 2022; 4:e210310. [PMID: 35996735 PMCID: PMC9387168 DOI: 10.1148/ryct.210310] [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: 12/04/2022]
Abstract
Purpose To characterize global and segmental circumferential systolic strain (CS)
measured by cardiac MRI in athletes after SARS-CoV-2 infection. Materials and Methods This retrospective observational cohort study included 188 soldiers and
collegiate athletes referred for cardiac MRI after SARS-CoV-2 infection
(C19+) between July 2020 and February 2021 and a control group of 72
soldiers, collegiate, and high school athletes who underwent cardiac MRI
from May 2019 to February 2020, prior to the first SARS-CoV-2 case
detected in our region (C19-). Global and segmental CS were measured by
feature tracking, then compared between each group using unadjusted and
multivariable- adjusted models. Acute myocarditis was diagnosed
according to the modified Lake Louise criteria and the location of
pathologic late gadolinium enhancement (LGE) was ascertained. Results Among the 188 C19+ athletes (median age, 25 years [IQR, 23-30]; 131 men),
the majority had mild illness. Global CS significantly differed between
C19+ and C19- groups, with a median of -24.0 (IQR -25.8, -21.4) versus.
-25.0 (-28.0, -22.4), respectively (p = .009). This difference in CS
persisted following adjustment for age, sex, body mass index, heart
rate, and systolic blood pressure β coefficient 1.29 [95% CI:
0.20, 2.38], p = .02). In segmental analysis, the basal- and mid-
inferoseptal, septal and inferolateral segments were significantly
different (p < .05), which had a higher frequency of post-COVID
late gadolinium enhancement. The global and segmental differences were
similar after exclusion of athletes with myocarditis. Conclusion Among athletes, SARS-CoV-2 infection was associated with a small but
statistically significant reduced CS.
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Affiliation(s)
- Jean W Wassenaar
- Vanderbilt University Medical Center, Division of Cardiovascular Medicine, Department of Internal Medicine, Nashville, TN, USA
| | - Daniel E Clark
- Vanderbilt University Medical Center, Division of Cardiovascular Medicine, Department of Internal Medicine, Nashville, TN, USA
| | - Debra D Dixon
- Vanderbilt University Medical Center, Division of Cardiovascular Medicine, Department of Internal Medicine, Nashville, TN, USA
| | - Kristen George-Durrett
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Thomas P. Graham Division of Pediatric Cardiology, Department of Pediatrics, Nashville, TN, USA
| | - Amar Parikh
- Vanderbilt University Medical Center, Division of Cardiovascular Medicine, Department of Internal Medicine, Nashville, TN, USA
| | - Dan L Li
- Vanderbilt University Medical Center, Division of Cardiovascular Medicine, Department of Internal Medicine, Nashville, TN, USA
| | - Michael T Baker
- Vanderbilt University Medical Center, Division of Cardiovascular Medicine, Department of Internal Medicine, Nashville, TN, USA
| | - Deepak K Gupta
- Vanderbilt University Medical Center, Division of Cardiovascular Medicine, Department of Internal Medicine, Nashville, TN, USA
| | - Sean G Hughes
- Vanderbilt University Medical Center, Division of Cardiovascular Medicine, Department of Internal Medicine, Nashville, TN, USA
| | - Jonathan H Soslow
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Thomas P. Graham Division of Pediatric Cardiology, Department of Pediatrics, Nashville, TN, USA
| | - Jeffrey M Dendy
- Vanderbilt University Medical Center, Division of Cardiovascular Medicine, Department of Internal Medicine, Nashville, TN, USA
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15
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Alshoubi A, Kurtz B, Dean A, Willey A, Keshishian E. Rare Variant of Left Circumflex Coronary Artery Originating From the Right Coronary Artery. Cureus 2022; 14:e27265. [PMID: 36039210 PMCID: PMC9403215 DOI: 10.7759/cureus.27265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/05/2022] Open
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16
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Arabadjian M, Yu G, Vorderstrasse A, Sherrid MV, Dickson VV. Quality of life and physical functioning in black and white adults with hypertrophic cardiomyopathy. Heart Lung 2022; 56:142-147. [PMID: 35901604 DOI: 10.1016/j.hrtlng.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 06/24/2022] [Accepted: 07/01/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is a common and clinically heterogeneous inherited cardiac disease. Quality of life (QOL) and physical functioning are important clinically but are underexplored in diverse populations with HCM. OBJECTIVES To examine predictors for and compare QOL and physical functioning in Black and White adults with HCM. METHODS We analyzed a sub-sample from a longitudinal prospective study on HCM. Eligibility criteria included self-identified Black and White adults (≥18 years) with clinical HCM. QOL was measured with the Minnesota Living with Heart Failure Questionnaire (MLWHF);physical functioning included age-adjusted exercise capacity and NYHA class. Covariates included HCM structural characteristics and common comorbidities. We analyzed data from 434 individuals, 57 (13.1%) of whom self-identified as Black/African American. RESULTS In this sample, the Black cohort had higher MLWHF scores, 31.2 (27.2) v. 23.9 (22.1), p=0.042, signifying worse QOL, but there were no intergroup differences when QOL was dichotomized. Mean metabolic equivalents (METs) on symptom-limited stress testing were similar, though the Black cohort was younger, 54.6 (13.4) v.62.5 (14.8) years, p=0.001. No one from the Black cohort achieved an "excellent-for-age" exercise capacity, and 64.1% had a "below-average-for-age" exercise capacity vs 47% in the White cohort, though this was not statistically significant, p=0.058. There was no difference between groups in advanced NYHA class. Female gender was associated with worse QOL and physical functioning irrespective of covariates. CONCLUSIONS This study is a starting point that underscores the need for a more comprehensive examination of well-being and physical functioning in Black populations with HCM.
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Affiliation(s)
- Milla Arabadjian
- New York University Rory Meyers College of Nursing, New York, NY, United States.
| | - Gary Yu
- New York University Rory Meyers College of Nursing, New York, NY, United States
| | - Allison Vorderstrasse
- University of Massachusetts Elaine Marieb College of Nursing, Amherst, MA, United States
| | - Mark V Sherrid
- Hypertrophic Cardiomyopathy Program, NYU Langone Health, New York, NY, United States
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17
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Abstract
Individuals with HCM have historically been held from participation in sports beyond mild-intensity exercise. Exercise improves functional capacity and indices of cardiac function even in those with HCM. Emerging data have demonstrated the safety of exercise in individuals with HCM. Improvement in risk stratification and a shared decision-making approach has led to a guideline endorsement for HCM providers to develop an informed plan for exercise and competitive athletics among the HCM population.
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Affiliation(s)
- Matthew W Martinez
- Department of Cardiovascular Medicine, Atlantic Health, Morristown Medical Center, Morristown, NJ 07960, USA; Sports Cardiology and Hypertrophic Cardiomyopathy.
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18
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What Aspects of Phenotype Determine Risk for Sudden Cardiac Death in Pediatric Hypertrophic Cardiomyopathy? J Cardiovasc Dev Dis 2022; 9:jcdd9050124. [PMID: 35621835 PMCID: PMC9143993 DOI: 10.3390/jcdd9050124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/13/2022] [Accepted: 04/16/2022] [Indexed: 11/17/2022] Open
Abstract
Sudden cardiac death due to hypertrophic cardiomyopathy (HCM), is the most common autopsy-proven cause of unexpected medical death in children after infancy. This mode of death is preventable by implantation of an internal cardiac defibrillator (ICD), a procedure that has considerable morbidity in childhood patients, and even mortality. Since HCM is an inheritable disease (usually autosomal dominant, occasionally recessive), family screening may identify subjects at risk. This review summarizes published studies carried out to identify which phenotypic markers are important risk factors in childhood patients with HCM and reviews the performance of existing risk-stratification algorithms (HCM Risk-Kids, PRIMaCY) against those of single phenotypic markers. A significant proportion of HCM-patients diagnosed in childhood are associated with RASopathies such as Noonan syndrome, but a knowledge gap exists over risk stratification in this patient group. In conclusion, pediatric risk-stratification algorithms for sudden cardiac death perform better in children than adult HCM risk-stratification strategies. However, current multivariable algorithms overestimate risk substantially without having high sensitivity, and remain ‘a work in progress’. To include additional phenotypic parameters that can be reproducibly measured such as ECG-markers, e.g., ECG risk score (which has high sensitivity and negative predictive value), tissue Doppler diastolic function measurements, and quantification of myocardial scarring on cardiac magnetic resonance imaging, has the potential to improve risk-stratification algorithms. Until that work has been achieved, these are three factors that the clinician can combine with the current algorithm-calculated per cent risk, in order better to assess risk.
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19
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Patlolla SH, Schaff HV, Nishimura RA, Geske JB, Dunlay SM, Ommen SR. Sex and Race Disparities in Hypertrophic Cardiomyopathy: Unequal Implantable Cardioverter-Defibrillator Use During Hospitalization. Mayo Clin Proc 2022; 97:507-518. [PMID: 34893323 DOI: 10.1016/j.mayocp.2021.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 07/16/2021] [Accepted: 07/26/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To evaluate if there are sex and race disparities in use of implantable cardioverter-defibrillator (ICD) devices for prevention of sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). PATIENTS AND METHODS Using the National Inpatient Sample from January 2003 through December 2014, we identified all adult admissions with a diagnosis of HCM and an ICD implantation. Race was classified as White versus non-White. Trends in ICD use, predictors of ICD implantation, device-related complications, hospitalization costs, and lengths of stay were evaluated. RESULTS Among a total of 23,535 adult hospitalizations for HCM, ICD implantation was performed in 3954 (16.8%) admissions. Over the study period, there was an overall increasing trend in ICD use (11.6% in 2003 to 17.0% in 2014, P<.001). Compared with admissions not receiving an ICD, those receiving an ICD had shorter median lengths of in-hospital stay but higher hospitalization costs (P<.001). Compared with men and White race, female sex (odds ratio, 0.72; 95% CI, 0.66 to 0.78; P<.001) and non-White race (odds ratio, 0.87; 95% CI, 0.79 to 0.96; P<.001) were associated with lower adjusted odds of receiving an ICD. Women and non-White hospitalizations had higher rates of device related complications, longer lengths of in-hospital stay, and higher hospitalization costs compared with men and White race, respectively (all P<.01). CONCLUSION Among HCM hospitalizations, ICD devices are underused in women and racial minorities independent of demographics, hospital characteristics, and comorbidities. Women and racial minorities also had higher rates of complications and greater resource use compared with men and those belonging to the White race, respectively.
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Affiliation(s)
- Sri Harsha Patlolla
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN; Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN
| | | | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Jeffrey B Geske
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Shannon M Dunlay
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Steve R Ommen
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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20
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Teległów A, Marchewka J, Tota Ł, Mucha D, Ptaszek B, Makuch R, Mucha D. Changes in blood rheological properties and biochemical markers after participation in the XTERRA Poland triathlon competition. Sci Rep 2022; 12:3349. [PMID: 35232974 PMCID: PMC8888667 DOI: 10.1038/s41598-022-07240-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 02/10/2022] [Indexed: 11/23/2022] Open
Abstract
The importance of physical activity in preventing chronic cardiovascular and metabolic diseases and the role of exercise as an adjunct therapy are widely recognized. Triathlon is a typically endurance discipline. Prolonged and intensive exercise is known to cause changes in blood rheological properties and biochemical markers; sometimes athletes participating in strenuous competitions need medical attention. To understand the phenomena occurring in the body in such situations, we decided to study participants’ biomarkers after the XTERRA Poland 2017 triathlon competition. The study involved 10 triathletes. The XTERRA Poland 2017 event comprised 1500-m swimming, 36-km cycling, and 10-km mountain running. Blood samples were collected 2 days before, immediately after, and 16 h after the competition. Immediately after the race, white blood cells count, platelets, and uric acid levels were significantly (P < 0.001) increased; haematocrit, Na+, Cl–, and IgA were decreased. On the following day, Na+, Cl–, and C-reactive protein levels were significantly (P < 0.001) increased; white blood cells count, red blood cells count, haemoglobin, haematocrit, mean corpuscular volume, platelets, IgG, and IgA were decreased. Assessing rheological parameters such as erythrocyte deformability and aggregation is useful for monitoring adverse effects of intensive and exhaustive exercise. The study illustrates the change in blood rheological properties and biochemical markers after intensive physical effort. Despite these differences, the indicators were within the reference range for the general population, which may demonstrate normal body function in the studied triathletes.
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Affiliation(s)
- Aneta Teległów
- Institute of Clinical Rehabilitation, University of Physical Education in Krakow, Krakow, Poland
| | - Jakub Marchewka
- Institute of Clinical Rehabilitation, University of Physical Education in Krakow, Krakow, Poland
| | - Łukasz Tota
- Institute of Biomedical Sciences, University of Physical Education in Krakow, Krakow, Poland
| | - Dawid Mucha
- Institute of Health Sciences, Podhale State College of Applied Science in Nowy Targ, Nowy Targ, Poland
| | - Bartłomiej Ptaszek
- Institute of Applied Sciences, University of Physical Education in Krakow, Krakow, Poland
| | - Robert Makuch
- Kazimierz Pulaski University of Technology and Humanities in Radom, Radom, Poland.
| | - Dariusz Mucha
- Institute of Biomedical Sciences, University of Physical Education in Krakow, Krakow, Poland
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21
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Ntusi NAB, Sliwa K. Associations of Race and Ethnicity With Presentation and Outcomes of Hypertrophic Cardiomyopathy: JACC Focus Seminar 6/9. J Am Coll Cardiol 2021; 78:2573-2579. [PMID: 34887143 DOI: 10.1016/j.jacc.2021.10.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/29/2021] [Accepted: 10/05/2021] [Indexed: 12/26/2022]
Abstract
Significant racial and ethnicity-based disparities in clinical presentation, management, and outcome of hypertrophic cardiomyopathy (HCM) are reported. Black patients with HCM are more likely to present with heart failure but are less commonly referred for symptom management, sudden cardiac death stratification, surgical septal myectomy, or for implantable cardioverter-defibrillators, all interventions that increase survival. Prevalence of bystander cardiopulmonary resuscitation is lower for Black patients than for White patients. Black patients with HCM have decreased survival after hospital discharge following out-of-hospital cardiac arrest. Biomedical and social interventions are urgently needed to reduce ethnicity-based disparities, which have an impact on outcomes in HCM and other cardiovascular diseases. There is also a need to focus on implementation science to support durable adoption of evidence-based therapies in Black patients and communities.
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Affiliation(s)
- Ntobeko A B Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Karen Sliwa
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
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22
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Athlete Preparticipation Physical Evaluation. Sports Med Arthrosc Rev 2021; 29:200-206. [PMID: 34730121 DOI: 10.1097/jsa.0000000000000330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Preparticipation evaluations (PPE) are both a traditional and legal requirement by many governing bodies for sport. The ideal goal of the PPE is safe participation in sport for athletes. This article provides an overview of common PPE elements and current best practice recommendations. Descriptions of every possible examination are published elsewhere and are beyond the intent of this article. Additional considerations for transgender, masters athletes, and Special Olympians are also outside the scope of this review, but are well covered in The Preparticipation Physical Evaluation, fifth edition monograph.
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23
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Verwijs SM, Pinto YM, Kuster DW, van der Velden J, Limpens J, van Hattum JC, van der Crabben SN, Lekanne Deprez RH, Wilde AA, Jørstad HT. Beneficial Effects of Cardiomyopathy-Associated Genetic Variants on Physical Performance: A Hypothesis-Generating Scoping Review. Cardiology 2021; 147:90-97. [PMID: 34706369 PMCID: PMC8985030 DOI: 10.1159/000520471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 08/26/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Genetic variants associated with cardiomyopathies (CMPs) are prevalent in the general population. In young athletes, CMPs account for roughly a quarter of sudden cardiac death, with further unexplained clustering in specific sports. Consequently, most CMPs form a contraindication for competitive sports. We hypothesized that genetic variants might (paradoxically) improve physical performance early in life while impairing cardiac function later in life. METHODS Systematic PubMed search was done to investigate whether genetic variants in genes associated with CMPs could be related to beneficial performance phenotypes. SUMMARY In a limited number of studies (n = 6), 2,860 individuals/subjects with genetic variants were able to outperform those without said variants, as measured by running speed (∼38 m/min in heterozygous [HET] mice, n = 6, vs. ∼32 m/min in wild type [WT] mice, n = 7, p = 0.004) and distance (966 ± 169 km HET mice vs. 561 ± 144 km WT mice, p = 0.0035, n = 10), elite athlete status in endurance athletes (n = 1,672, p = 1.43 × 10-8), maximal oxygen uptake in elite athletes (absolute difference not provided, n = 32, p = 0.005), maximal oxygen uptake in unrelated individuals (n = 473, p = 0.0025), personal records in highly trained marathon runners (2:26:28 ± 0:06:23 min HET, n = 32, vs. 2:28:53 ± 0:05:50 min without polymorphism, n = 108, p = 0.020), and peripheral muscle force contraction in patients following a cardiac rehabilitation program (absolute values not provided, n = 260). Key Message: Beneficial effects in genetic variants associated with CMPs could hypothetically play a role in the selection of young athletes, consequently explaining the prevalence of such genetic variants in athletes and the general population.
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Affiliation(s)
- Sjoerd M. Verwijs
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Yigal M. Pinto
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Diederik W.D. Kuster
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Jolanda van der Velden
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Jacqueline Limpens
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Juliette C. van Hattum
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | | | - Ronald H. Lekanne Deprez
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Arthur A.M. Wilde
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Harald T. Jørstad
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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Abstract
Anomalous origin of right coronary artery with interarterial course (ARCA-IA) is a risk factor for sudden death and other cardiac complications. Surgical correction remains its gold standard treatment. We describe clinical characteristics, workup, surgical techniques and outcomes of ARCA-IA at our center. A retrospective analysis of cardiovascular database was performed. From March 2005 through January 2011, 11 patients with mean age of 53 ± 18 years were diagnosed with ARCA-IA. Reported symptoms included chest pain (64%), arrhythmia [27%; i.e. atrial flutter (9%), recurrent supraventricular tachycardia (9%), ventricular tachycardia (9%)], syncope (18%), dyspnea (9%) and aborted sudden cardiac death (9%). Chest pain (n = 7) was episodic and lasted longer than 6 months before diagnosis. Initial diagnosis was made at coronary computed tomography in two patients and at cardiac catheterization in nine patients. Four patients had positive stress test and were subsequently found to have ARCA-IA at cardiac catheterization. There was no operative mortality. Surgery (bypass with ligation of native vessel or translocation and reimplantation) was performed in seven patients. Three patients refused surgery, and in one patient, surgery was not considered due to comorbidities. Symptom relief was noted in all surgical patients. At mean follow-up of 36 months, two patients had noncardiac-related deaths whereas nine were asymptomatic. There were no deaths reported in patients treated surgically. Definitive surgery is indicated in symptomatic ARCA-IA and is associated with excellent long-term outcome. RCA dominance in ARCA-IA is an adverse marker with increased symptoms; this hypothesis should be tested in larger studies.
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Electrocardiographic and Echocardiographic Findings in Black Athletes: A General Review. Clin J Sport Med 2021; 31:321-329. [PMID: 31233430 DOI: 10.1097/jsm.0000000000000754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/09/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Participation in regular physical activity produces electrophysiological and structural cardiac changes in electrocardiograms (ECGs) and echocardiographs (ECHOs) of athletes, and the term "athlete's heart" is used to describe these physiological cardiovascular adaptations. Extent and type of sporting discipline, age, sex, body dimensions, and ethnicity have an influence on cardiac remodeling. OBJECTIVE As the recent scientific literature increasingly reports on ethnicity-specific ECG and ECHO findings in black athletes, it is the aim of this review to provide an overview of ECG and ECHO findings among athletes of black African/Afro-Caribbean descent. DATA SOURCES A systematic search of PubMed and MEDLINE databases up to and including August 2017 was conducted using the following terms/phrases "black OR African OR Afro-Caribbean athlete heart," "black OR African OR Afro-Caribbean athlete electrocardiogram," and "black OR African OR Afro-Caribbean athlete echocardiogram." The search generated a total of 130 papers, out of which 16 original articles fitted our criteria and were selected for this review. MAIN RESULTS The various studies reviewed revealed that about 10% to 30% of black African/Afro-Caribbean athletes had abnormal ECG. R/S voltage criteria exceeding hypertrophic indices were found in about 60% to 89% of black African/Afro-Caribbean athletes. ST-segment elevation (17%-90%) and T-wave inversions were also common findings among this ethnicity. About 10% to 12% of black African/Afro-Caribbean athletes had a left ventricular wall thickness ranging from 13 to 15 mm. Cavity dimensions ranged from 40 to 66 mm in black African/Afro-Caribbean athletes with a relative wall thickness >0.44. CONCLUSIONS Updated ethnic-specific guidelines are required to discriminate physiological from pathologic hypertrophy and repolarization changes. Future studies should focus on homogeneous cohorts of African athletes.
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Sokunbi OJ, Okoromah CAN, Ekure EN, Olawale OA, Eke WS. Electrocardiographic pattern of apparently healthy African adolescent athletes in Nigeria. BMC Pediatr 2021; 21:97. [PMID: 33632178 PMCID: PMC7905616 DOI: 10.1186/s12887-021-02557-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 02/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background Strategies to prevent sudden cardiac death (SCD) among young athletes have become topical worldwide and unrecognized cardiac pathology has been identified as a leading cause. Black ethnicity has been reported as an independent predictor of abnormal electrocardiography (ECG) findings among athletes and the frequency and significance of training-related ECG findings versus findings suggestive of an underlying pathology in the young African athletes is crucial. Methods This cross sectional study aimed to determine the prevalence and distribution of ECG patterns in young athletes and controls. A total of 360 participants (180 athletes and 180 controls) were recruited from six secondary schools in Lagos, Nigeria between November 2014 and July 2015. Evaluation included interviewer-administered questionnaires for relevant history, physical examination and resting 12 - lead ECG for each participant. Results Abnormal ECG patterns were found in 48.3% of athletes and 35.6% of controls. Training-related ECG findings occurred in 33.3% of athletes and 18.3% of controls. Athletes and controls had 7.7% prevalence of training un-related ECG patterns respectively. Left ventricular hypertrophy was the most common ECG finding among the athletes and male athletes had a higher prevalence of ECG abnormalities compared to females. Conclusion Adolescent athletes in Nigeria have a high prevalence of training-related ECG patterns and athletes and non-athletes alike have similar proportions of ECG findings suggestive of underlying structural heart disease. Cardiovascular evaluation including ECG should be performed for young athletes prior to competition at any level and should also be considered as part of pre-school entry assessment for all children. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02557-8.
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Affiliation(s)
- Ogochukwu J Sokunbi
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Lagos / Lagos University Teaching Hospital, Lagos, Nigeria.
| | - Christy A N Okoromah
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Lagos / Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ekanem N Ekure
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Lagos / Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olajide A Olawale
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Lagos / Lagos University Teaching Hospital, Lagos, Nigeria
| | - Wuraola S Eke
- Department of Nursing Services, Lagos University Teaching Hospital, Lagos, Nigeria
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Drezner JA, Malhotra A, Prutkin JM, Papadakis M, Harmon KG, Asif IM, Owens DS, Marek JC, Sharma S. Return to play with hypertrophic cardiomyopathy: are we moving too fast? A critical review. Br J Sports Med 2021; 55:1041-1047. [PMID: 33472848 PMCID: PMC8408577 DOI: 10.1136/bjsports-2020-102921] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2020] [Indexed: 12/31/2022]
Abstract
The diagnosis of a potentially lethal cardiovascular disease in a young athlete presents a complex dilemma regarding athlete safety, patient autonomy, team or institutional risk tolerance and medical decision-making. Consensus cardiology recommendations previously supported the ‘blanket’ disqualification of athletes with hypertrophic cardiomyopathy (HCM) from competitive sport. More recently, epidemiological studies examining the relative contribution of HCM as a cause of sudden cardiac death (SCD) in young athletes and reports from small cohorts of older athletes with HCM that continue to exercise have fueled debate whether it is safe to play with HCM. Shared decision-making is endorsed within the sports cardiology community in which athletes can make an informed decision about treatment options and potentially elect to continue competitive sports participation. This review critically examines the available evidence relevant to sports eligibility decisions in young athletes diagnosed with HCM. Histopathologically, HCM presents an unstable myocardial substrate that is vulnerable to ventricular tachyarrhythmias during exercise. Studies support that young age and intense competitive sports are risk factors for SCD in patients with HCM. We provide an estimate of annual mortality based on our understanding of disease prevalence and the incidence of HCM-related SCD in different athlete populations. Adolescent and young adult male athletes and athletes participating in a higher risk sport such as basketball, soccer and American football exhibit a greater risk. This review explores the potential harms and benefits of sports disqualification in athletes with HCM and details the challenges and limitations of shared decision-making when all parties may not agree.
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Affiliation(s)
- Jonathan A Drezner
- Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
| | - Aneil Malhotra
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Jordan M Prutkin
- Department of Internal Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Michael Papadakis
- Cardiology, Clinical Academic Group, St George's, University of London, London, UK
| | - Kimberly G Harmon
- Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
| | - Irfan M Asif
- Center for Health Promotion, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David S Owens
- Department of Internal Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Joseph C Marek
- Cardiology, Advocate Heart Institute, Downers Grove, Illinois, USA
| | - Sanjay Sharma
- Cardiology, Clinical Academic Group, St George's, University of London, London, UK
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28
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Eberly LA, Day SM, Ashley EA, Jacoby DL, Jefferies JL, Colan SD, Rossano JW, Semsarian C, Pereira AC, Olivotto I, Ingles J, Seidman CE, Channaoui N, Cirino AL, Han L, Ho CY, Lakdawala NK. Association of Race With Disease Expression and Clinical Outcomes Among Patients With Hypertrophic Cardiomyopathy. JAMA Cardiol 2021; 5:83-91. [PMID: 31799990 DOI: 10.1001/jamacardio.2019.4638] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Importance Racial differences are recognized in multiple cardiovascular parameters, including left ventricular hypertrophy and heart failure, which are 2 major manifestations of hypertrophic cardiomyopathy. The association of race with disease expression and outcomes among patients with hypertrophic cardiomyopathy is not well characterized. Objective To assess the association between race, disease expression, care provision, and clinical outcomes among patients with hypertrophic cardiomyopathy. Design, Setting, and Participants This retrospective cohort study included data on black and white patients with hypertrophic cardiomyopathy from the US-based sites of the Sarcomeric Human Cardiomyopathy Registry from 1989 through 2018. Exposures Self-identified race. Main Outcomes and Measures Baseline characteristics; genetic architecture; adverse outcomes, including cardiac arrest, cardiac transplantation or left ventricular assist device implantation, implantable cardioverter-defibrillator therapy, all-cause mortality, atrial fibrillation, stroke, and New York Heart Association (NYHA) functional class III or IV heart failure; and septal reduction therapies. The overall composite outcome consists of the first occurrence of any component of the ventricular arrhythmic composite end point, cardiac transplantation, left ventricular assist device implantation, NYHA class III or IV heart failure, atrial fibrillation, stroke, or all-cause mortality. Results Of 2467 patients with hypertrophic cardiomyopathy at the time of analysis, 205 (8.3%) were black (130 male [63.4%]; mean [SD] age, 40.0 [18.6] years) and 2262 (91.7%) were white (1351 male [59.7%]; mean [SD] age, 45.5 [20.5] years). Compared with white patients, black patients were younger at the time of diagnosis (mean [SD], 36.5 [18.2] vs 41.9 [20.2] years; P < .001), had higher prevalence of NYHA class III or IV heart failure at presentation (36 of 205 [22.6%] vs 174 of 2262 [15.8%]; P = .001), had lower rates of genetic testing (111 [54.1%] vs 1404 [62.1%]; P = .03), and were less likely to have sarcomeric mutations identified by genetic testing (29 [26.1%] vs 569 [40.5%]; P = .006). Implantation of implantable cardioverter-defibrillators did not vary by race; however, invasive septal reduction was less common among black patients (30 [14.6%] vs 521 [23.0%]; P = .007). Black patients had less incident atrial fibrillation (35 [17.1%] vs 608 [26.9%]; P < .001). Black race was associated with increased development of NYHA class III or IV heart failure (hazard ratio, 1.45; 95% CI, 1.08-1.94) which persisted on multivariable Cox proportional hazards regression (hazard ratio, 1.97; 95% CI, 1.34-2.88). There were no differences in the associations of race with stroke, ventricular arrhythmias, all-cause mortality, or the overall composite outcome. Conclusions and Relevance The findings suggest that black patients with hypertrophic cardiomyopathy are diagnosed at a younger age, are less likely to carry a sarcomere mutation, have a higher burden of functionally limited heart failure, and experience inequities in care with lower use of invasive septal reduction therapy and genetic testing compared with white patients. Further study is needed to assess whether higher rates of heart failure may be associated with underlying ancestry-based disease pathways, clinical management, or structural inequities.
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Affiliation(s)
- Lauren A Eberly
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sharlene M Day
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Euan A Ashley
- Stanford Center for Inherited Heart Disease, Palo Alto, California
| | - Daniel L Jacoby
- Section of Cardiovascular Medicine, Yale University, New Haven, Connecticut
| | - John Lynn Jefferies
- Heart Institute and the Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Joseph W Rossano
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute and The University of Sydney, Sydney, New South Wales, Australia
| | - Alexandre C Pereira
- Heart Institute (Instituto do Coração da Universidade de São Paulo), University of São Paulo Medical School, São Paulo, Brazil
| | - Iacopo Olivotto
- Cardiomyopathy Unit and Genetic Unit, Careggi University Hospital, Florence, Italy
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute and The University of Sydney, Sydney, New South Wales, Australia
| | - Christine E Seidman
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nadine Channaoui
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Allison L Cirino
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Larry Han
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Carolyn Y Ho
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Neal K Lakdawala
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Ashraf S, Salman SH, Ali N, Kulshreshtha S, Saad M. A Rare Presentation of Angina and Arrhythmia in Absent Left Main Coronary Artery. Cureus 2020; 12:e12142. [PMID: 33489554 PMCID: PMC7811751 DOI: 10.7759/cureus.12142] [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: 11/09/2022] Open
Abstract
Coronary artery anomalies (CAAs) are congenital disorders with multiple variations in the number, shape, and location of the Ostia of the coronary arterial system. The congenitally absent left main coronary artery (LMCA) is a rare anomaly that can present with benign or fatal complications ahead in life. Diagnosis and management of CAAs are sometimes challenging in low-risk patients. We present a unique case report of a 69-year-old Hispanic female who presented to the hospital with exercise-induced arrhythmia and angina symptoms. The patient complained of several episodes of chest pain, dizziness, and palpitations for a duration of two months. Electrocardiogram (EKG) and nuclear stress tests were equivocal. The angiogram revealed the separate origin of the left anterior descending artery (LAD) and left circumflex coronary artery (LCX) from the left coronary sinus. This anomaly should be considered in differentials when evaluating patients with angina symptoms. Congenital absence of LMCA is a rare condition that remains asymptomatic in the majority of the cases. It can present with exertional chest pain, palpitations, syncope, and sudden cardiac death (SCD). Occurrences of angina and arrhythmia should be carefully evaluated, and symptoms should be followed up closely. A coronary angiogram and electrophysiological testing can assist in the diagnosis.
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30
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Yang Z, Zhang Q, Yu H, Li L, He Y, Zhu S, Li C, Zhang S, Luo B, Gao Y. A Novel COX10 Deletion Polymorphism as a Susceptibility Factor for Sudden Cardiac Death Risk in Chinese Populations. DNA Cell Biol 2020; 40:10-17. [PMID: 33180568 DOI: 10.1089/dna.2020.6086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Identifying common genetic variations that are related to sudden cardiac death (SCD) is crucial since it can facilitate the diagnosis and risk stratification of SCD. It has been reported that COX10 mutations might be related with SCD. In this study, we performed a systematic variant screening on the COX10 to filter potential functional genetic variations. Based on the screening results, an insertion/deletion polymorphism (rs397763766) in 3'untranslated regions of COX10 was selected as the candidate variant. We conducted a case-control study to investigate the association between rs397763766 and SCD susceptibility in Chinese populations. Logistic regression analysis showed that the deletion allele of rs397763766 was associated with an increased risk for SCD (odds ratio = 1.61, 95% confidence interval = 1.25-2.07, p = 1.87 × 10-4) susceptibility than insertion allele. Further genotype-phenotype analysis using human cardiac tissue samples suggested that COX10 expression level in genotypes containing deletion allele was higher than that in ins/ins genotype. The results were further reinforced by RNA sequencing data from 1000 Genomes Project. Luciferase activity assay indicated that COX10 expression could be regulated by rs397763766 through interfering binding with miR-15b, thus conferring risk of SCD. In conclusion, the novel rs397763766 polymorphism might be a potential marker for molecular diagnosis and genetic counseling of SCD.
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Affiliation(s)
- Zhenzhen Yang
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China.,Institute of Forensic Sciences, Henan University of Economics and Law, Zhengzhou, China
| | - Qing Zhang
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China
| | - Huan Yu
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China
| | - Lijuan Li
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China
| | - Yan He
- Department of Epidemiology, Medical College of Soochow University, Suzhou, China
| | - Shaohua Zhu
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China
| | - Chengtao Li
- Shanghai Key Laboratory of Forensic Medicine, Institute of Forensic Sciences, Ministry of Justice, Shanghai, China
| | - Suhua Zhang
- Shanghai Key Laboratory of Forensic Medicine, Institute of Forensic Sciences, Ministry of Justice, Shanghai, China
| | - Bin Luo
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Yuzhen Gao
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China
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31
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Teległów A, Borowiec R, Marchewka J, Tota Ł, Mucha D. Impact of vigorous effort on blood morphological indicators in triathletes participating in the XTERRA Poland 2017 competition. REHABILITACJA MEDYCZNA 2020. [DOI: 10.5604/01.3001.0014.5097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The aim of the study was to determine the influence of participation in the XTERRA Poland 2017 triathlon on blood morphology indicators. Material and methods: The study was performed in a group among 10 triathletes aged 30-40 years. Blood was collected 24 hours before, immediately after , and 16 hours after the competition. Blood morphological indicators were evaluated using the ABXMicros60 analyser. Results: Comparison of the results among the first (24 hours before the competition), second (immediately after the competition), and third assessment (16 hours after the competition) revealed statistically significant changes for WBC [109/l], RBC [1012/l], HGB [g/l], HCT [l/l], MCV [fl] and PLT [109/l]. Conclusions: The intensity of effort in the XTERRA Poland 2017 triathlon competitors was confirmed in the results of blood morphology. Blood counts in those practicing triathlon well characterise the actual scope and direction of exercise changes and allow for the diagnosis of transient adaptive effects. The results of the research confirmed that vigorous physical effort during the triathlon increased leukocyte and platelet counts, but 16 hours after completing the competition, their value was close to baseline level. Most likely, this phenomenon was caused by the intense effort, stress or even eating a large meal before the competition. Analysing the red blood cell system showed a tendency towards decrease in the number of red blood cells, HGB and HCT both after the competition and 16 hours after its completion, which results from increased post-exercise haemolysis or the risk of anaemia.
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Affiliation(s)
- Aneta Teległów
- Institute of Clinical Rehabilitation, University School of Physical Education in Kraków, Poland / Instytut Rehabilitacji Klinicznej, AWF w Krakowie
| | - Renata Borowiec
- Graduate of the Faculty of Motor Rehabilitation, University School of Physical Education in Kraków, Poland / Wydział Rehabilitacji Ruchowej, AWF w Krakowie
| | - Jakub Marchewka
- Institute of Clinical Rehabilitation, University School of Physical Education in Kraków, Poland / Instytut Rehabilitacji Klinicznej, AWF w Krakowie
| | - Łukasz Tota
- Institute of Biomedical Sciences, University School of Physical Education in Kraków, Poland / Instytut Nauk Biomedycznych, AWF w Krakowie
| | - Dariusz Mucha
- Institute of Biomedical Sciences, University School of Physical Education in Kraków, Poland / Instytut Nauk Biomedycznych, AWF w Krakowie
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32
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Addis DR, Townsley MM. Imaging Considerations for the Athletically Conditioned Heart: An Echocardiography-Focused Overview of the 2020 American Society of Echocardiography Recommendations on the Use of Multimodality Cardiovascular Imaging in Young Adult Competitive Athletes. J Cardiothorac Vasc Anesth 2020; 34:2867-2870. [DOI: 10.1053/j.jvca.2020.06.077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 12/21/2022]
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Tchanana GMK, Ngantcha M, Yuyun MF, Ajijola OA, Mbouh S, Tchameni SCT, Suliman A, Bonny A. Incidence of recreational sports-related sudden cardiac arrest in participants over age 12 in a general African population. BMJ Open Sport Exerc Med 2020; 6:e000706. [PMID: 32879735 PMCID: PMC7445330 DOI: 10.1136/bmjsem-2019-000706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2020] [Indexed: 11/21/2022] Open
Abstract
Background The incidence of sports-related sudden cardiac arrest (SrSCA) in sub-Saharan Africa is unknown. Objective To determine the incidence of sudden cardiac arrest (SCA) in non-competitive athletes in an urban population of Cameroon, a country in sub-Saharan Africa. Methods Two study populations in Cameroon were used. A 12-month, multisource surveillance system of 86 189 inhabitants over 12 years old recorded all deaths in two administrative districts of Douala City. All fields of sports, emergency medical service, local medical examiners and district hospital mortuaries were surveyed. Two blinded cardiologists used a verbal autopsy protocol to determine the cause of death. SCA was identified for all deaths occurring within 1 hour of onset of symptoms. A cross-sectional study was conducted among 793 persons in Yaoundé City, which is the second study population aimed at determining the proportion of people who are physically active. Results The mean age in the cross-sectional study was 27.3±10.7, with more men (56.2%). The cross-sectional study showed that 69.0% (95% CI 65.8 to 72.2) of the population could be considered to have at least 3 hours of physical activity per week. The surveillance found that among 288 all-cause deaths, 27 (9.4%) were due to SCA. One SrSCA was registered in a 35-year-old woman while running. Merging both sources revealed an SrSCA incidence of 1.7 (95% CI 0.2 to 12.0) cases per 100 000 athletes per year. Conclusion This pioneer study reports the incidence estimates of SrSCA in a sub-Saharan African general population and should be regarded as a first step to a big problem.
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Affiliation(s)
| | | | - Matthew F Yuyun
- Harvard Medical School and VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Olujimi A Ajijola
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, Los Angeles, California, USA
| | - Samuel Mbouh
- Youth and Sport Institute, University of Yaoundé 1, Yaoundé, Cameroon
| | | | | | - Aimé Bonny
- Medicine, Centre Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, Île-de-France, France.,Cardiology Department, University of Douala, Douala, Cameroon
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34
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Ozo U, Sharma S. The Impact of Ethnicity on Cardiac Adaptation. Eur Cardiol 2020; 15:e61. [PMID: 32944090 DOI: 10.15420/ecr.2020.01] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/22/2020] [Indexed: 01/15/2023] Open
Abstract
Regular intensive exercise is associated with a plethora of electrical, structural and functional adaptations within the heart to promote a prolonged and sustained increase in cardiac output. Bradycardia, increased cardiac dimensions, enhanced ventricular filling, augmentation of stroke volume and high peak oxygen consumption are recognised features of the athlete's heart. The type and magnitude of these adaptations to physical exercise are governed by age, sex, ethnicity, sporting discipline and intensity of sport. Some athletes, particularly those of African or Afro-Caribbean (black) origin reveal changes that overlap with diseases implicated in sudden cardiac death. In such instances, erroneous interpretation has potentially serious consequences ranging from unfair disqualification to false reassurance. This article focuses on ethnic variation in the physiological cardiac adaption to exercise.
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35
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An Integrated Review of Hypertrophic Cardiomyopathy in Black Populations: Underrecognized and Understudied. J Cardiovasc Nurs 2020; 36:104-115. [PMID: 33565785 DOI: 10.1097/jcn.0000000000000718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac disorder globally, affecting 0.2% to 0.5% of individuals. Existing clinical HCM guidelines do not address diverse populations, specifically minority groups who often experience health disparities. OBJECTIVE The aim of this study was to describe the state of the science of HCM in black populations. METHODS This integrated review guided by Whittemore and Knafl's methodology included literature search of multiple databases, data evaluation, and analysis. Publications between 2000 and 2020 were included if they addressed HCM cardiac anatomic manifestations, disease course, symptoms, quality of life, or outcomes in black populations. RESULTS Six articles met the inclusion criteria. Overall, blacks are underrepresented in HCM research. Certain HCM structural phenotypes are more commonly exhibited in blacks, and physiology drives HCM treatment. Sudden death events and all-cause mortality do not differ between blacks and whites with HCM. Fewer blacks with HCM undergo genetic testing than whites with HCM. The lack of diversity in general genomic databases has resulted in reclassification of several genetic variants identified as more common in blacks. CONCLUSIONS Blacks are underrepresented in HCM research, even those focused on elucidating HCM manifestations, disease course, and outcomes in black populations. This may be due in part to HCM research that is largely generated from specialty centers that can require patients to navigate complex healthcare systems to reach expert HCM care. Longitudinal studies with large samples of blacks with HCM are necessary to elucidate how HCM affects this population.
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36
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Limongelli G, Nunziato M, D'Argenio V, Esposito MV, Monda E, Mazzaccara C, Caiazza M, D'Aponte A, D'Andrea A, Bossone E, Maggio FD, Buono P, Pica PW, Capua LD, Penco M, Romano S, Paolo FD, Pelliccia A, Frisso G, Salvatore F. Yield and clinical significance of genetic screening in elite and amateur athletes. Eur J Prev Cardiol 2020; 28:1081-1090. [PMID: 32615795 DOI: 10.1177/2047487320934265] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/25/2020] [Indexed: 11/17/2022]
Abstract
AIMS The purpose of this study was to assess the value of genetic testing in addition to a comprehensive clinical evaluation, as part of the diagnostic work-up of elite and/or amateur Italian athletes referred for suspicion of inherited cardiac disease, following a pre-participation screening programme. METHODS Between January 2009-December 2018, of 5892 consecutive participants, 61 athletes were investigated: 30 elite and 31 amateur athletes. Elite and amateur athletes were selected, on the basis of clinical suspicion for inherited cardiac disease, from two experienced centres for a comprehensive cardiovascular evaluation. Furthermore, the elite and amateur athletes were investigated for variants at DNA level up to 138 genes suspected to bear predisposition for possible cardiac arrest or even sudden cardiac death. RESULTS Of these 61 selected subjects, six (10%) had diagnosis made possible by a deeper clinical evaluation, while genetic testing allowed a definite diagnosis in eight (13%). The presence of >3 clinical markers (i.e. family history, electrocardiogram and/or echocardiographic abnormalities, exercise-induced ventricular arrhythmias) was associated with a higher probability of positive genetic diagnosis (75%), compared with the presence of two or one clinical markers (14.2%, 8.1%, respectively, p-value = 0.004). CONCLUSION A combined clinical and genetic evaluation, based on the subtle evidence of clinical markers for inherited disease, was able to identify an inherited cardiac disease in about one-quarter of the examined athletes.
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Affiliation(s)
- Giuseppe Limongelli
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Italy.,Monaldi Hospital, AO Colli, Italy
| | - Marcella Nunziato
- CEINGE - Biotecnologie Avanzate, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Italy
| | - Valeria D'Argenio
- CEINGE - Biotecnologie Avanzate, Italy.,San Raffaele Open University, Italy
| | - Maria V Esposito
- CEINGE - Biotecnologie Avanzate, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Italy
| | - Emanuele Monda
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Italy.,Monaldi Hospital, AO Colli, Italy
| | - Cristina Mazzaccara
- CEINGE - Biotecnologie Avanzate, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Italy
| | - Martina Caiazza
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Italy.,Monaldi Hospital, AO Colli, Italy
| | - Antonello D'Aponte
- Department of Experimental Medicine, University of Campania 'Luigi Vanvitelli', Italy
| | - Antonello D'Andrea
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Italy.,Monaldi Hospital, AO Colli, Italy
| | | | - Federica Di Maggio
- CEINGE - Biotecnologie Avanzate, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Italy
| | - Pasqualina Buono
- CEINGE - Biotecnologie Avanzate, Italy.,Department of Movement Sciences and Wellness (DiSMEB), University of Naples Parthenope, Italy
| | - Paolo W Pica
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Italy.,Monaldi Hospital, AO Colli, Italy
| | - Luca De Capua
- Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Italy.,Monaldi Hospital, AO Colli, Italy
| | - Maria Penco
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
| | - Silvio Romano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
| | | | | | - Giulia Frisso
- CEINGE - Biotecnologie Avanzate, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Italy
| | - Francesco Salvatore
- CEINGE - Biotecnologie Avanzate, Italy.,Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Italy
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Harris AM, DeGiorgio M. Identifying and Classifying Shared Selective Sweeps from Multilocus Data. Genetics 2020; 215:143-171. [PMID: 32152048 PMCID: PMC7198270 DOI: 10.1534/genetics.120.303137] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/29/2020] [Indexed: 11/18/2022] Open
Abstract
Positive selection causes beneficial alleles to rise to high frequency, resulting in a selective sweep of the diversity surrounding the selected sites. Accordingly, the signature of a selective sweep in an ancestral population may still remain in its descendants. Identifying signatures of selection in the ancestor that are shared among its descendants is important to contextualize the timing of a sweep, but few methods exist for this purpose. We introduce the statistic SS-H12, which can identify genomic regions under shared positive selection across populations and is based on the theory of the expected haplotype homozygosity statistic H12, which detects recent hard and soft sweeps from the presence of high-frequency haplotypes. SS-H12 is distinct from comparable statistics because it requires a minimum of only two populations, and properly identifies and differentiates between independent convergent sweeps and true ancestral sweeps, with high power and robustness to a variety of demographic models. Furthermore, we can apply SS-H12 in conjunction with the ratio of statistics we term [Formula: see text] and [Formula: see text] to further classify identified shared sweeps as hard or soft. Finally, we identified both previously reported and novel shared sweep candidates from human whole-genome sequences. Previously reported candidates include the well-characterized ancestral sweeps at LCT and SLC24A5 in Indo-Europeans, as well as GPHN worldwide. Novel candidates include an ancestral sweep at RGS18 in sub-Saharan Africans involved in regulating the platelet response and implicated in sudden cardiac death, and a convergent sweep at C2CD5 between European and East Asian populations that may explain their different insulin responses.
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Affiliation(s)
- Alexandre M Harris
- Department of Biology, Pennsylvania State University, University Park, Pennsylvania 16802
- Molecular, Cellular, and Integrative Biosciences at the Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, Pennsylvania 16802
| | - Michael DeGiorgio
- Department of Computer and Electrical Engineering and Computer Science, Florida Atlantic University, Boca Raton, Florida 33431
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Zhao D, Post WS, Blasco-Colmenares E, Cheng A, Zhang Y, Deo R, Pastor-Barriuso R, Michos ED, Sotoodehnia N, Guallar E. Racial Differences in Sudden Cardiac Death. Circulation 2020; 139:1688-1697. [PMID: 30712378 DOI: 10.1161/circulationaha.118.036553] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Blacks have a higher incidence of out-of-hospital sudden cardiac death (SCD) in comparison with whites. However, the racial differences in the cumulative risk of SCD and the reasons for these differences have not been assessed in large-scale community-based cohorts. The objective of this study is to compare the lifetime cumulative risk of SCD among blacks and whites, and to evaluate the risk factors that may explain racial differences in SCD risk in the general population. METHODS This is a cohort study of 3832 blacks and 11 237 whites participating in the Atherosclerosis Risk in Communities Study (ARIC). Race was self-reported. SCD was defined as a sudden pulseless condition from a cardiac cause in a previously stable individual, and SCD cases were adjudicated by an expert committee. Cumulative incidence was computed using competing risk models. Potential mediators included demographic and socioeconomic factors, cardiovascular risk factors, presence of coronary heart disease, and electrocardiographic parameters as time-varying factors. RESULTS The mean (SD) age was 53.6 (5.8) years for blacks and 54.4 (5.7) years for whites. During 27.4 years of follow-up, 215 blacks and 332 whites experienced SCD. The lifetime cumulative incidence of SCD at age 85 years was 9.6, 6.6, 6.5, and 2.3% for black men, black women, white men, and white women, respectively. The sex-adjusted hazard ratio for SCD comparing blacks with whites was 2.12 (95% CI, 1.79-2.51). The association was attenuated but still statistically significant in fully adjusted models (hazard ratio, 1.38; 95% CI, 1.11-1.71). In mediation analysis, known factors explained 65.3% (95% CI 37.9-92.8%) of the excess risk of SCD in blacks in comparison with whites. The single most important factor explaining this difference was income (50.5%), followed by education (19.1%), hypertension (22.1%), and diabetes mellitus (19.6%). Racial differences were evident in both genders but stronger in women than in men. CONCLUSIONS Blacks had a much higher risk for SCD in comparison with whites, particularly among women. Income, education, and traditional risk factors explained ≈65% of the race difference in SCD. The high burden of SCD and the racial-gender disparities observed in our study represent a major public health and clinical problem.
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Affiliation(s)
- Di Zhao
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (D.Z., W.S.P., E.B.-C., E.D.M., E.G.)
| | - Wendy S Post
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (D.Z., W.S.P., E.B.-C., E.D.M., E.G.).,Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., A.C., E.D.M.)
| | - Elena Blasco-Colmenares
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (D.Z., W.S.P., E.B.-C., E.D.M., E.G.)
| | - Alan Cheng
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., A.C., E.D.M.).,Medtronic Inc, Minneapolis, MN (A.C.)
| | - Yiyi Zhang
- Division of General Medicine, Department of Medicine, Columbia University, New York, NY (Y.Z.)
| | - Rajat Deo
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia (R.D.)
| | - Roberto Pastor-Barriuso
- National Center for Epidemiology, Carlos III Institute of Health and Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain (R.P.-B.)
| | - Erin D Michos
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (D.Z., W.S.P., E.B.-C., E.D.M., E.G.).,Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., A.C., E.D.M.)
| | - Nona Sotoodehnia
- Division of Cardiology, Cardiovascular Health Research Unit, University of Washington, Seattle (N.S.)
| | - Eliseo Guallar
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (D.Z., W.S.P., E.B.-C., E.D.M., E.G.)
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Marziliano N, Orrù V, Secci T, Uras S, Reverberi C, Fiscella A, Fiscella D, Merlini PA, Scarano MI, Intrieri M. Compound sarcomeric mutations causing hypertrophic cardiomyopathy in a young Sardinian soccer player: a family affair. J Sports Med Phys Fitness 2020; 59:2084-2085. [DOI: 10.23736/s0022-4707.19.09882-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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40
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Tripathi B, Khan S, Arora S, Kumar V, Naraparaju V, Lahewala S, Sharma P, Atti V, Jain V, Shah M, Patel B, Ram P, Deshmukh A. Burden and trends of arrhythmias in hypertrophic cardiomyopathy and its impact of mortality and resource utilization. J Arrhythm 2019; 35:612-625. [PMID: 31410232 PMCID: PMC6686349 DOI: 10.1002/joa3.12215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 05/25/2019] [Accepted: 06/09/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) accounts for significant morbidity and mortality worldwide. Arrhythmias are considered the main cause of mortality, however, there is paucity of data relating to trends of arrhythmia and associated outcomes in HCM patients. METHODS Nationwide Inpatient Sample from 2003 to 2014 was analyzed. HCM related hospitalizations were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9-CM) code 425.1 and 425.11 in all diagnosis fields. RESULTS Overall, there was an increase in number of hospitalizations related to arrhythmias among HCM patients from 7784 in 2003 to 8380 in 2014 (relative increase 10.5%, P < 0.001). The increase was most significant in patients ≥ 80 years and those with higher comorbidity burden. Atrial fibrillation (AF) was the most frequently occurring arrhythmia however atrial flutter (AFL) witnessed the highest rise during the study period. In general, there was a down trend in mortality with the greatest reduction occurring in patients with ventricular fibrillation/flutter (VF/VFL). The mean length of stay was higher if patients had arrhythmia, which led to increased cost of care from $16105 in 2003 to $19310 in 2014 (relative increase 22.9%, P < 0.001). CONCLUSION There is overall decline in HCM related hospitalizations but rise in hospitalization among HCM patients with arrhythmias. HCM with arrhythmia accounts for significant inpatient mortality coupled with prolonged hospital stay and increased cost of care. However, there is an encouraging downtrend in the mortality most likely because of improved clinical practice, cardiac screening and primary and secondary prevention strategies.
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Affiliation(s)
| | - Safi Khan
- Guthrie Robert Packer HospitalSayrePennsylvania
| | | | - Varun Kumar
- Guthrie Robert Packer HospitalSayrePennsylvania
| | | | | | | | | | - Varun Jain
- St. Francis Medical CenterHartfordConnecticut
| | - Mahek Shah
- Lehigh Valley HospitalAllentownPennsylvania
| | | | - Pradhum Ram
- Einstein Medical CenterPhiladelphiaPennsylvania
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41
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Landwehr T, Sinicina I, Graw M. Todesfälle beim Sport. Rechtsmedizin (Berl) 2019. [DOI: 10.1007/s00194-019-0311-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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42
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Demola P, Crocamo A, Ceriello L, Botti A, Cremonini I, Pattoneri P, Corradi D, Visioli F, Goldoni M, Pelà G. Hemodynamic and ECG responses to stress test in early adolescent athletes explain ethnicity-related cardiac differences. Int J Cardiol 2019; 289:125-130. [PMID: 31072636 DOI: 10.1016/j.ijcard.2019.04.084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/10/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Ethnicity is an important determinant of athletes' cardiovascular adaptation. Black adolescent and adult athletes exhibit a left ventricular (LV) hypertrophy with a concentric remodelling higher than their Caucasian counterparts. Scant data, however, are available on race-related differences in hemodynamic response of adolescent athletes to exercise and its relation with heart remodelling. We evaluated if race-specific, sport-related structural and electrical remodelling in adolescent athletes of Caucasian and African ethnicity exclusively depends on race itself rather than on different cardiovascular responses to physical exercise. METHODS We examined 90 adolescent athletes, 60 Caucasian (WA) and 30 Black (BA). All participants underwent thorough clinical, echocardiographic and stress test evaluations. RESULTS BA had greater indexed LV mass (LVM/BSA) with increased relative wall thickness (RWT) implying a concentric remodelling. BA showed higher systolic blood pressure (SBP) compared to WA during the whole exercise test. ECG data showed that BA vs WA had a significant shorter QRS duration in each step considered with a significant greater QT dispersion. BA reached a higher relative pressure peak as compared to WA. RWT was strongly influenced by ethnicity and less by SBP at peak of exercise (PE), although LVM/BSA was significantly related to SBP at PE and just marginally to age and not significantly to race. CONCLUSIONS Black adolescent athletes showed higher SBP during all steps of exercise associated to a different trend. Ethnicity was the main determinant of RWT, suggesting that LV geometry is principally race-related rather than influenced by a different hemodynamic profile to physical activity.
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Affiliation(s)
- Pierluigi Demola
- Department of Medicine and Surgery, University Medical School and University Hospital of Parma, Italy
| | - Antonio Crocamo
- Department of Medicine and Surgery, University Medical School and University Hospital of Parma, Italy
| | - Laura Ceriello
- Department of Medicine and Surgery, University Medical School and University Hospital of Parma, Italy
| | - Andrea Botti
- Department of Medicine and Surgery, University Medical School and University Hospital of Parma, Italy
| | - Isabella Cremonini
- Department of Medicine and Surgery, University Medical School and University Hospital of Parma, Italy
| | | | - Domenico Corradi
- Department of Medicine and Surgery, University Medical School and University Hospital of Parma, Italy
| | - Francesco Visioli
- Department of Molecular Medicine, University of Padova, Italy; IMDEA-Food, CEI UAM+CSIC, Madrid, Spain
| | - Matteo Goldoni
- Department of Medicine and Surgery, University Medical School and University Hospital of Parma, Italy
| | - Giovanna Pelà
- Department of Medicine and Surgery, University Medical School and University Hospital of Parma, Italy.
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Endres BD, Kerr ZY, Stearns RL, Adams WM, Hosokawa Y, Huggins RA, Kucera KL, Casa DJ. Epidemiology of Sudden Death in Organized Youth Sports in the United States, 2007-2015. J Athl Train 2019; 54:349-355. [PMID: 31013114 DOI: 10.4085/1062-6050-358-18] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
CONTEXT Sudden death in sport at the high school and collegiate levels has been described extensively in the literature. However, few epidemiologic data exist on the incidence of sudden death specifically in American youth sport before secondary school athletics. OBJECTIVE To describe the epidemiology of sudden death in organized youth sports in the United States from 2007 through 2015. DESIGN Descriptive epidemiology study. SETTING Organized American youth sports. PATIENTS OR OTHER PARTICIPANTS Cases of sudden death that occurred in youth athletes 17 years of age and younger in non-high school organized sports were included. DATA COLLECTION AND ANALYSIS Information on sudden deaths between August 1, 2007, and December 31, 2015, was obtained via LexisNexis and other publicly available news or media reports. Total youth sport participation rates from 2007 to 2015 were provided by the Sport & Fitness Industry Association. Athlete age, sex, sport, level of play, event type, date of death, setting, and official and speculated causes of death were examined. Data are presented as deaths per year, percentage of total sudden deaths, and deaths per 10 million participants. RESULTS From 2007 to 2015, 45 sudden deaths were reported in American youth sports. The mean age of patients was 13 ± 2 years. The overall incidence rate was 1.83 deaths/10 million athlete-years. Males experienced a greater number of sudden deaths than females (n = 36/45, 80%). Basketball had the highest number of sudden deaths from 2007 to 2015, with a total of 16 occurrences. The most frequent cause of sudden death was cardiac related (n = 34/45, 76%). Most sudden deaths occurred during practices (n = 32/45, 71%). CONCLUSIONS Sudden deaths in organized youth sports in the United States from 2007 through 2015 were most often experienced during practices by males, were cardiac related, and occurred while playing basketball. These findings are similar to those in high school and collegiate sports. This study affirms the need for further epidemiologic research into sudden deaths at the organized youth sport level.
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Affiliation(s)
- Brad D Endres
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | | | - Rebecca L Stearns
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - William M Adams
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Yuri Hosokawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa City, Japan
| | - Robert A Huggins
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
| | - Kristen L Kucera
- National Center for Catastrophic Sport Injury Research, University of North Carolina at Chapel Hill
| | - Douglas J Casa
- Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs
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Thijssen CGE, Bons LR, Gökalp AL, Van Kimmenade RRJ, Mokhles MM, Pelliccia A, Takkenberg JJM, Roos-Hesselink JW. Exercise and sports participation in patients with thoracic aortic disease: a review. Expert Rev Cardiovasc Ther 2019; 17:251-266. [DOI: 10.1080/14779072.2019.1585807] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Carlijn G. E. Thijssen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lidia R. Bons
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arjen L. Gökalp
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Mostafa M. Mokhles
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Antonio Pelliccia
- Department of Cardiology, Institute of Sports Medicine & Science, Rome, Italy
| | - Johanna J. M. Takkenberg
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jolien W. Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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45
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Riding NR, Sharma S, McClean G, Adamuz C, Watt V, Wilson MG. Impact of geographical origin upon the electrical and structural manifestations of the black athlete's heart. Eur Heart J 2019; 40:50-58. [PMID: 30169663 DOI: 10.1093/eurheartj/ehy521] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 08/08/2018] [Indexed: 07/13/2024] Open
Abstract
Aims Black athletes demonstrate an increased prevalence of repolarization anomalies and left ventricular hypertrophy compared to their white counterparts. Recent international recommendations for electrocardiogram (ECG) interpretation in athletes now account for some of these observations, but little attention is given to whether the heart of the black athlete is universal, or whether substantial differences exist according to geographic origin. Our aim was to examine the impact of geographical origin upon the electrical-and structural manifestations of the black athlete's heart. Methods and results A total of 1698 male competitive athletes participating in mixed sports presented at our organization for 12 lead-ECG led pre-participation screening, with 1222 athletes undergoing systematic echocardiography. Black athletes were categorized against United Nations defined geographical regions (North, East, Middle and West Africa, African American/Caribbean, South American, and West Asia) and compared with a cohort of non-black athletes who shared a close geographical boarder with Africa (South European White and Arabic North African). The prevalence of an abnormal ECG suggestive of cardiac pathology significantly varied by geographical origin. Repolarization abnormalities were significantly more common among West (6.4%) and Middle African (8.5%) athletes than East (1.5%) and North Africans (1.2%) (P < 0.05). Left ventricular hypertrophy was significantly more common among African-American/Caribbean (9.5%) and West African (5%) athletes than West Asian (0.8%), East African (0%), and North African (0%) athletes (P < 0.05). This result remained after accounting for body size. Conclusion The collective term 'black' should not imply that the hearts of all black athletes are universally comparable. There is considerable variability in the cardiac electrical and structural remodelling response to exercise that appears to be dependent on geographic origin.
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Affiliation(s)
- Nathan R Riding
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Sports City Street, Doha, Qatar
| | - Sanjay Sharma
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Gavin McClean
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Sports City Street, Doha, Qatar
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Tom Reilly Building, Liverpool, UK
| | - Carmen Adamuz
- Department of Sports Medicine, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Sports City Street, Doha, Qatar
| | - Victoria Watt
- Department of Sports Medicine, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Sports City Street, Doha, Qatar
| | - Mathew G Wilson
- Athlete Health and Performance Research Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Sports City Street, Doha, Qatar
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, Tom Reilly Building, Liverpool, UK
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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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Andreenko EY, Yavelov IS, Loukianov ММ, Vernohaeva AN, Drapkina OM, Boytsov SA. Ischemic Heart Disease in Subjects of Young Age: Current State of the Problem. Features of Etiology, Clinical Manifestation and Prognosis. ACTA ACUST UNITED AC 2018; 58:24-34. [PMID: 30625075 DOI: 10.18087/cardio.2018.11.10195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 11/24/2018] [Indexed: 11/18/2022]
Abstract
In addition to conventional risk factors in young patients with ischemic heart disease (IHD) numerous other risk factors including genetics play an important role in its causation. Molecular genetic testing is recommended for the detection of monogenic diseases with a high risk of developing IHD, such as familial hypercholesterolemia. In majority ofyoung patients, the first manifestation of IHD is an acute coronary syndrome. Young patients with IHD more often have normal coronary arteries or single-vessel coronary disease, and in up to 20% of them cause of myocardial ischemia is not related to atherosclerosis. In general, young patients with IHD have better prognosis. However, there are sex differences in IHD outcomes the prognosis of patients with premature IHD and reason for this is still unclear.
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Affiliation(s)
- E Yu Andreenko
- National Medical Research Center for Preventive Medicine.
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Detection and Classification of Hard and Soft Sweeps from Unphased Genotypes by Multilocus Genotype Identity. Genetics 2018; 210:1429-1452. [PMID: 30315068 DOI: 10.1534/genetics.118.301502] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 10/08/2018] [Indexed: 11/18/2022] Open
Abstract
Positive natural selection can lead to a decrease in genomic diversity at the selected site and at linked sites, producing a characteristic signature of elevated expected haplotype homozygosity. These selective sweeps can be hard or soft. In the case of a hard selective sweep, a single adaptive haplotype rises to high population frequency, whereas multiple adaptive haplotypes sweep through the population simultaneously in a soft sweep, producing distinct patterns of genetic variation in the vicinity of the selected site. Measures of expected haplotype homozygosity have previously been used to detect sweeps in multiple study systems. However, these methods are formulated for phased haplotype data, typically unavailable for nonmodel organisms, and some may have reduced power to detect soft sweeps due to their increased genetic diversity relative to hard sweeps. To address these limitations, we applied the H12 and H2/H1 statistics proposed in 2015 by Garud et al., which have power to detect both hard and soft sweeps, to unphased multilocus genotypes, denoting them as G12 and G2/G1. G12 (and the more direct expected homozygosity analog to H12, denoted G123) has comparable power to H12 for detecting both hard and soft sweeps. G2/G1 can be used to classify hard and soft sweeps analogously to H2/H1, conditional on a genomic region having high G12 or G123 values. The reason for this power is that, under random mating, the most frequent haplotypes will yield the most frequent multilocus genotypes. Simulations based on parameters compatible with our recent understanding of human demographic history suggest that expected homozygosity methods are best suited for detecting recent sweeps, and increase in power under recent population expansions. Finally, we find candidates for selective sweeps within the 1000 Genomes CEU, YRI, GIH, and CHB populations, which corroborate and complement existing studies.
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Burns J, Jean-Pierre P. Disparities in the Diagnosis of Hypertrophic Obstructive Cardiomyopathy: A Narrative Review of Current Literature. Cardiol Res Pract 2018; 2018:3750879. [PMID: 30370151 PMCID: PMC6189670 DOI: 10.1155/2018/3750879] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/05/2018] [Accepted: 09/17/2018] [Indexed: 11/18/2022] Open
Abstract
Hypertrophic obstructive cardiomyopathy (HOCM) is a disorder of abnormal thickening of the myocardium that affects 0.2% of the population. HOCM is a frequently implicated cause of sudden cardiac death (SCD) in young athletes. In this manner, this condition has the capacity for tremendous emotional, social, financial, and medical burdens for families and communities across the country. Multiple factors including genetics and hormonal elements are believed to play a role in the development of this cardiomyopathy. HOCM is an autosomal dominant trait with variable expressivity. It is associated with several genetic changes in the myosin heavy chain genes. Current treatment includes optimization of cardiac risk factors and medical management with beta-adrenergic blockade with definitive treatment of surgical intervention to reduce cardiac workload. The demographic most likely to be diagnosed with HOCM based upon clinical registry data is Caucasian boys and men. However, a growing body of data supports increased prevalence in African American populations and percentages equal to, if not higher than, Caucasian males in Hispanic populations. Similarly, males of African American ethnicity that participate in basketball are the most likely demographic to be affected by HOCM based on the data available from the National Collegiate Athletic Association (NCAA). Further, though rates of diagnosis may be up to 1.5 times higher in males than in females, an increasing number of studies demonstrate an increased prevalence of HOCM in females, often presenting with worse symptoms and an increased incidence of disease progression. Similarly, data suggest that age of diagnosis is associated with various prognostic factors including annual mortality. In addition, consideration of the social determinants of health undoubtedly impacts the rate of diagnosis, access to care, and HOCM-related complications in underserved populations. Effective screening including auscultation and electrocardiography (EKG) with confirmatory echocardiography in these communities supports equitable surveillance and management of HOCM.
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Affiliation(s)
- Joseph Burns
- Florida International University, Herbert Wertheim College of Medicine, Miami, FL 33199, USA
| | - Philippe Jean-Pierre
- Florida International University, Department of Biological Sciences, Miami, FL 33199, USA
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Abstract
Hypertrophic cardiomyopathy (HCM) is a heart disease characterized by hypertrophy of the left ventricular myocardium and is most often caused by mutations in sarcomere genes. The structural and functional abnormalities are not explained by flow-limiting coronary artery disease or loading conditions. The disease affects at least 0.2% of the population worldwide and is the most common cause of sudden cardiac death in young people and competitive athletes because of fatal ventricular arrhythmia. In some patients, however, HCM has a benign course. Therefore, it is of utmost importance to properly evaluate patients and single out those who would benefit from an implanted cardioverter defibrillator. In this article, we review and summarize the sudden cardiac death risk stratification algorithms, methods of preventing death due to HCM, and novel factors that may improve the existing prediction models.
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