Coronary atherosclerosis in apparently healthy master athletes discovered during pre-PARTECIPATION screening. Role of coronary CT angiography (CCTA)

Background: Pre-participation screening (PPS) of athletes aged over 35 years (master athletes, MA) is a major\r\nconcern in Sports Cardiology. In this population, sports-related sudden cardiac death is rare but usually due to\r\ncoronary atherosclerosis (CA). Coronary CT Angiography (CCTA) has changed the approach to diagnosis/\r\nmanagement of CA, but its role in this context still needs to be assessed.\r\nMethods and results: We retrospectively examined 167 MA who underwent CCTA in our hospital since 2006,\r\nanalyzing symptoms, stress-test ECG, cardiovascular risk profiles (SCORE) and CCTA findings.\r\nAmong the whole enrolled population, 153 (91.6%) MA underwent CCTA for equivocal/positive stress-test\r\nECG with/without symptoms, 13 (7.8%) just for clinical symptoms, 1 (0.6%) for the family history. The CCTA\r\nshowed the presence of CA in 69 MA (41.3%), congenital coronary anomalies (anomalous origin or deep\r\nmyocardial bridge) in 8 (4.8%), both in 7 (4.2%). A negative CCTA was observed in 83 MA (49.7%).\r\nThe risk-SCORE (age, hypertension, hypercholesterolemia, smoking) was a good indicator for the presence\r\nofmoderate/severe CA on CCTA. However,mild/moderate CAwas present in 17.8% ofMA clinically stratified\r\nat a low risk-SCORE.\r\nConclusion:While coronary angiography ismore indicated in athleteswith positive stress-test ECG and high clinical\r\nrisk, the CCTA may be useful in the evaluation of MAwith an abnormal stress test ECG and/or clinical symptoms engaged\r\nin competitive sports with a high cardiovascular involvement. Age, gender, presence of symptoms and clinical\r\nrisk-SCORE assessment may help sports physicians and cardiologists to decide whether to request a CCTA or not.