Salvatore Francesco Gervasi1, Laura Palumbo1, Michela Cammarano1, Sebastiano Orvieto1, Arianna Di Rocco2, Annarita Vestri2, Riccardo Marano3, Giancarlo Savino4, Massimiliano Bianco5, Paolo Zeppilli6, Vincenzo Palmieri5. 1. Sports Medicine Unit, Orthopedics, Aging and Rehabilitation Area; Università Cattolica del Sacro Cuore, Roma, Italy. 2. Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy. 3. Department of Radiological, Radiotherapic and Hematological Sciences, Radiology Area; Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy. 4. Department of Radiological, Radiotherapic and Hematological Sciences, Radiology Area; Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy. 5. Sports Medicine Unit, Orthopedics, Aging and Rehabilitation Area; Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy. 6. Sports Medicine Unit, Orthopedics, Aging and Rehabilitation Area; Università Cattolica del Sacro Cuore, Roma, Italy. Electronic address: paolo.zeppilli@unicatt.it.
Abstract
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 CA was present in 17.8% of MA clinically stratified at a low risk-SCORE. CONCLUSION: While coronary angiography is more indicated in athletes with positive stress-test ECG and high clinical risk, the CCTA may be useful in the evaluation of MA with 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.
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 CA was present in 17.8% of MA clinically stratified at a low risk-SCORE. CONCLUSION: While coronary angiography is more indicated in athletes with positive stress-test ECG and high clinical risk, the CCTA may be useful in the evaluation of MA with 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.
Authors: Anna Palmisano; Fatemeh Darvizeh; Giulia Cundari; Giuseppe Rovere; Giovanni Ferrandino; Valeria Nicoletti; Francesco Cilia; Silvia De Vizio; Roberto Palumbo; Antonio Esposito; Marco Francone Journal: Radiol Med Date: 2021-08-22 Impact factor: 3.469
Authors: Antonio Esposito; Marco Francone; Daniele Andreini; Vitaliano Buffa; Filippo Cademartiri; Iacopo Carbone; Alberto Clemente; Andrea Igoren Guaricci; Marco Guglielmo; Ciro Indolfi; Ludovico La Grutta; Guido Ligabue; Carlo Liguori; Giuseppe Mercuro; Saima Mushtaq; Danilo Neglia; Anna Palmisano; Roberto Sciagrà; Sara Seitun; Davide Vignale; Gianluca Pontone; Nazario Carrabba Journal: Radiol Med Date: 2021-06-23 Impact factor: 3.469