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Subclinical coronary artery disease in veteran athletes: is a new preparticipation methodology required?

Dores, H; de Araújo Gonçalves, P; Monge, J; Costa, R; Tátá, L; Malhotra, A; Sharma, S; Cardim, N; Neuparth, N (2020) Subclinical coronary artery disease in veteran athletes: is a new preparticipation methodology required? Br J Sports Med, 54 (6). pp. 349-353. ISSN 1473-0480 https://doi.org/10.1136/bjsports-2018-099840
SGUL Authors: Sharma, Sanjay Malhotra, Aneil

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Abstract

OBJECTIVE: Preparticipation evaluation of veteran athletes should focus on accurate cardiovascular (CV) risk stratification and subclinical detection of coronary artery disease (CAD), which is the main cause of sudden cardiac death in this population. We aimed to investigate the effectiveness of current preparticipation methodology used to identify veteran athletes with high coronary atherosclerotic burden. METHODS: A total of 105 asymptomatic male athletes aged ≥40 years old, with low to moderate CV risk (Systematic Coronary Risk Estimation <5%) who trained ≥4 hours/week for at least 5 years, were studied. The screening protocol included clinical evaluation, ECG, transthoracic echocardiogram and exercise testing. Cardiac CT was performed to detect CAD, defined as a high atherosclerotic burden according to coronary artery calcium score and coronary CT angiography. RESULTS: The majority of the athletes (n=88) engaged in endurance sports, with a median volume of exercise of 66 (44; 103) metabolic equivalent task score/hour/week. Exercise testing was abnormal in 13 (12.4%) athletes, 6 (5.7%) with electrocardiographic criteria for myocardial ischaemia and 7 (6.7%) with exercise-induced ventricular arrhythmias. A high coronary atherosclerotic burden was present in 27 (25.7%) athletes, of whom 11 (40.7%) had CV risk factors and 6 had abnormal exercise tests, including 3 who were positive for myocardial ischaemia. CONCLUSIONS: Conventional methodology used in preparticipation evaluation of veteran athletes, based on clinical CV risk factors and exercise testing, was poor at identifying significant subclinical CAD. The inclusion of more objective markers, particularly data derived from cardiac CT, is promising for more accurate CV risk stratification of these athletes.

Item Type: Article
Additional Information: For figures please refer to the publisher version. This article has been accepted for publication in British Journal of Sports Medicine, 2018 following peer review, and the Version of Record can be accessed online at http://doi.org/10.1136/bjsports-2018-099840 © Authors (or their employer(s)) Reuse of this manuscript version (excluding any databases, tables, diagrams, photographs and other images or illustrative material included where a another copyright owner is identified) is permitted strictly pursuant to the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC-BY-NC 4.0) https://creativecommons.org/licenses/by-nc/4.0/
Keywords: athlete, evaluation, heart disease, risk factor, athlete, evaluation, heart disease, risk factor, 11 Medical And Health Sciences, 09 Engineering, 13 Education, Sport Sciences
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Br J Sports Med
ISSN: 1473-0480
Language: eng
Dates:
DateEvent
2 March 2020Published
9 November 2018Published Online
22 October 2018Accepted
Publisher License: Creative Commons: Attribution-Noncommercial 4.0
PubMed ID: 30413429
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/110527
Publisher's version: https://doi.org/10.1136/bjsports-2018-099840

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