TY - JOUR
T1 - Coronary atherosclerosis in apparently healthy master athletes discovered during pre-PARTECIPATION screening. Role of coronary CT angiography (CCTA).
AU - Gervasi, Salvatore Francesco
AU - Palumbo, Laura
AU - Cammarano, Michela
AU - Orvieto, Sebastiano
AU - Di Rocco, Arianna
AU - Vestri, Annarita
AU - Marano, Riccardo
AU - Savino, Giancarlo
AU - Bianco, Massimiliano
AU - Zeppilli, Paolo
AU - Palmieri, Vincenzo
PY - 2019
Y1 - 2019
N2 - Background: Pre-participation screening (PPS) of athletes aged over 35 years (master athletes, MA) is a major concern in Sports Cardiology. In this population, sports-related sudden cardiac death is rare but usually due to coronary atherosclerosis (CA). Coronary CT Angiography (CCTA) has changed the approach to diagnosis/management of CA, but its role in this context still needs to be assessed.
Methods and results: We retrospectively examined 167 MA who underwent CCTA in our hospital since 2006, analyzing symptoms, stress-test ECG, cardiovascular risk profiles (SCORE) and CCTA findings. Among the whole enrolled population, 153 (91.6%) MA underwent CCTA for equivocal/positive stress-test ECG with/without symptoms, 13 (7.8%) just for clinical symptoms, 1 (0.6%) for the family history. The CCTA
showed the presence of CA in 69 MA (41.3%), congenital coronary anomalies (anomalous origin or deep myocardial bridge) in 8 (4.8%), both in 7 (4.2%). A negative CCTA was observed in 83 MA (49.7%). The risk-SCORE (age, hypertension, hypercholesterolemia, smoking) was a good indicator for the presence of moderate/severe CA on CCTA. However,mild/moderate CAwas present in 17.8% ofMA clinically stratified at a low risk-SCORE.
Conclusion:While coronary angiography ismore indicated in athletes with positive stress-test ECG and high clinical risk, the CCTA may be useful in the evaluation of MAwith an abnormal stress test ECG and/or clinical symptoms engaged in competitive sports with a high cardiovascular involvement. Age, gender, presence of symptoms and clinical risk-SCORE assessment may help sports physicians and cardiologists to decide whether to request a CCTA or not.
AB - Background: Pre-participation screening (PPS) of athletes aged over 35 years (master athletes, MA) is a major concern in Sports Cardiology. In this population, sports-related sudden cardiac death is rare but usually due to coronary atherosclerosis (CA). Coronary CT Angiography (CCTA) has changed the approach to diagnosis/management of CA, but its role in this context still needs to be assessed.
Methods and results: We retrospectively examined 167 MA who underwent CCTA in our hospital since 2006, analyzing symptoms, stress-test ECG, cardiovascular risk profiles (SCORE) and CCTA findings. Among the whole enrolled population, 153 (91.6%) MA underwent CCTA for equivocal/positive stress-test ECG with/without symptoms, 13 (7.8%) just for clinical symptoms, 1 (0.6%) for the family history. The CCTA
showed the presence of CA in 69 MA (41.3%), congenital coronary anomalies (anomalous origin or deep myocardial bridge) in 8 (4.8%), both in 7 (4.2%). A negative CCTA was observed in 83 MA (49.7%). The risk-SCORE (age, hypertension, hypercholesterolemia, smoking) was a good indicator for the presence of moderate/severe CA on CCTA. However,mild/moderate CAwas present in 17.8% ofMA clinically stratified at a low risk-SCORE.
Conclusion:While coronary angiography ismore indicated in athletes with positive stress-test ECG and high clinical risk, the CCTA may be useful in the evaluation of MAwith an abnormal stress test ECG and/or clinical symptoms engaged in competitive sports with a high cardiovascular involvement. Age, gender, presence of symptoms and clinical risk-SCORE assessment may help sports physicians and cardiologists to decide whether to request a CCTA or not.
KW - Competitive sports eligibility
KW - Congenital coronary anomalies
KW - Coronary artery disease
KW - Coronary atherosclerosis
KW - Coronary computed tomography angiography
KW - Master athletes
KW - Competitive sports eligibility
KW - Congenital coronary anomalies
KW - Coronary artery disease
KW - Coronary atherosclerosis
KW - Coronary computed tomography angiography
KW - Master athletes
UR - http://hdl.handle.net/10807/132042
U2 - 10.1016/j.ijcard.2018.11.099
DO - 10.1016/j.ijcard.2018.11.099
M3 - Article
SN - 0167-5273
VL - 2019
SP - 99
EP - 107
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -