TY - JOUR
T1 - Coronary Computed Tomography Angiography in the Clinical Workflow of Athletes With Anomalous Origin of Coronary Arteries From the Contralateral Valsalva Sinus
AU - Marano, Riccardo
AU - Merlino, Biagio
AU - Savino, Giancarlo
AU - Natale, Luigi
AU - Rovere, Giuseppe
AU - Paciolla, Fabiano
AU - Muciaccia, Massimo
AU - Flammia, Francesco C.
AU - Larici, Anna Rita
AU - Palmieri, Vincenzo
AU - Zeppilli, Paolo
AU - Manfredi, Riccardo
PY - 2021
Y1 - 2021
N2 - Purpose: This study aimed to assess the role of coronary computed tomography-angiography (CCTA) in the workflow of competitive sports eligibility in a cohort of athletes with anomalous origin of the left-coronary artery (AOLCA)/anomalous origin of the right-coronary artery (AORCA) in an attempt to outline relevant computed tomography features likely to impact diagnostic assessment and clinic management. Materials and Methods: Patients with suspected AOLCA/AORCA at transthoracic echocardiography or with inconclusive transthoracic echocardiography underwent CCTA to rule out/confirm and characterize the anatomic findings: partially interarterial course or full-INT, high-take-off, acute-take-off-angle (ATO), slit-like origin, intramural course (IM), interarterial-course-length, and lumen-reduction/hypoplasia (HYPO). Results: CCTA identified 28 athletes: 6 AOLCA (3 males; 20.3 +/- 11.0 y) and 22 AORCA (18 males; 29.1 +/- 16.5 y). Symptoms were present only in 13 athletes (46.4%; 10 AORCA). Four patients (3 AORCA) had abnormal rest electrocardiogram, 11 (40.7%; 9 AORCA) had abnormal stress-electrocardiogram. The INT course was observed in 15 athletes (53.6%): 6/6 AOLCA and 9/22 AORCA (40.9%). Slit-like origin was present in 7/22 AORCA (31.8%) and never in AOLCA. Suspected IM resulted in 3 AOLCA (50%), always with HYPO/ATO, and in 6/22 AORCA (27.3%) with HYPO. No statistically significant differences were found between asymptomatic/symptomatic patients in the prevalence of partially INT/INT courses, high-take-off/ATO, and slit-like ostium. A slightly significant relationship between suspected proximal-IM (r=0.47, P<0.05) and proximal-HYPO of anomalous vessel (r=0.65, P<0.01) resulted in AORCA and was confirmed on AOLCA/AORCA pooled analysis (r=0.58, P<0.01 for HYPO). All AOLCA/AORCA athletes were disqualified from competitive sports and warned to avoid vigorous physical efforts. Surgery was recommended to all AOLCA athletes and to 13 AORCA (3 asymptomatic), but only 6 underwent surgery. No major cardiovascular event/ischemic symptoms/signs developed during a mean follow-up of 49.6 +/- 39.5 months. Conclusion: CCTA provides essential information for safe/effective clinical management of athletes, with important prognostic/sport-activity implications.
AB - Purpose: This study aimed to assess the role of coronary computed tomography-angiography (CCTA) in the workflow of competitive sports eligibility in a cohort of athletes with anomalous origin of the left-coronary artery (AOLCA)/anomalous origin of the right-coronary artery (AORCA) in an attempt to outline relevant computed tomography features likely to impact diagnostic assessment and clinic management. Materials and Methods: Patients with suspected AOLCA/AORCA at transthoracic echocardiography or with inconclusive transthoracic echocardiography underwent CCTA to rule out/confirm and characterize the anatomic findings: partially interarterial course or full-INT, high-take-off, acute-take-off-angle (ATO), slit-like origin, intramural course (IM), interarterial-course-length, and lumen-reduction/hypoplasia (HYPO). Results: CCTA identified 28 athletes: 6 AOLCA (3 males; 20.3 +/- 11.0 y) and 22 AORCA (18 males; 29.1 +/- 16.5 y). Symptoms were present only in 13 athletes (46.4%; 10 AORCA). Four patients (3 AORCA) had abnormal rest electrocardiogram, 11 (40.7%; 9 AORCA) had abnormal stress-electrocardiogram. The INT course was observed in 15 athletes (53.6%): 6/6 AOLCA and 9/22 AORCA (40.9%). Slit-like origin was present in 7/22 AORCA (31.8%) and never in AOLCA. Suspected IM resulted in 3 AOLCA (50%), always with HYPO/ATO, and in 6/22 AORCA (27.3%) with HYPO. No statistically significant differences were found between asymptomatic/symptomatic patients in the prevalence of partially INT/INT courses, high-take-off/ATO, and slit-like ostium. A slightly significant relationship between suspected proximal-IM (r=0.47, P<0.05) and proximal-HYPO of anomalous vessel (r=0.65, P<0.01) resulted in AORCA and was confirmed on AOLCA/AORCA pooled analysis (r=0.58, P<0.01 for HYPO). All AOLCA/AORCA athletes were disqualified from competitive sports and warned to avoid vigorous physical efforts. Surgery was recommended to all AOLCA athletes and to 13 AORCA (3 asymptomatic), but only 6 underwent surgery. No major cardiovascular event/ischemic symptoms/signs developed during a mean follow-up of 49.6 +/- 39.5 months. Conclusion: CCTA provides essential information for safe/effective clinical management of athletes, with important prognostic/sport-activity implications.
KW - cardiac
KW - computed tomography angiography
KW - coronary vessel anomalies
KW - death
KW - diagnostic imaging
KW - personalized medicine
KW - sudden
KW - cardiac
KW - computed tomography angiography
KW - coronary vessel anomalies
KW - death
KW - diagnostic imaging
KW - personalized medicine
KW - sudden
UR - http://hdl.handle.net/10807/273350
U2 - 10.1097/RTI.0000000000000523
DO - 10.1097/RTI.0000000000000523
M3 - Article
SN - 0883-5993
VL - 36
SP - 122
EP - 130
JO - Journal of Thoracic Imaging
JF - Journal of Thoracic Imaging
ER -