B-PO04-152 RISK OF SUDDEN CARDIAC DEATH IN COMPETITIVE ATHLETES DURING THE CONVALESCENT PHASE FOLLOWING COVID-19 INFECTION

Background and objectives: An Italian nationwide pre-participation screening approach for prevention of sudden cardiac death in athletes (SCD-A) in competitive sportspeople showed promising results but did not achieve international consensus, due to cost-effectiveness and the shortfall of a monitoring plan. From this perspective, we tried to provide an epidemiological update of SCD-A in Italy through a year-long internet-based search. Materials and Methods: One year-long Google search was performed using mandatory and non-mandatory keywords. Data were collected according to prevalent SCD-A definition and matched with sport-related figures from Italian National Institute of Statistics (ISTAT) and Italian National Olympic Committee (CONI). Results: Ninety-eight cases of SCD-A in 2019 were identified (48.0% competitive, 52.0% non-competitive athletes). Male/female ratio was 13:1. The most common sports were soccer (33.7%), athletics (15.3%) and fitness (13.3%). A conclusive diagnosis was achieved only in 37 cases (33 of cardiac origin), with the leading diagnosis being coronary artery disease in 27 and a notably higher occurrence among master athletes. Combining these findings with ISTAT and CONI data, the SCD-A incidence rate in the whole Italian sport population was found to be 0.47/100,000 persons per year (1.00/100,000 in the competitive and 0.32/100,000 in the non-competitive population). The relative risk of SCD-A is 3.1 (CI 2.1–4.7; p < 0.0001) for competitive compared to non-competitive athletes; 9.9 for male (CI 4.6–21.4; p < 0.0001) with respect to female. Conclusions: We provided an updated incidence rate of SCD-A in both competitive and non-competitive sport in Italy. A higher risk of SCD-A among competitive and male athletes was confirmed, thus corroborating the value of Italian pre-participation screening in this population.

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4100Exercise related sudden cardiac death in the young in Sweden 2000–2010 – a nationwide study showing decreasing incidence in competitive athletes

European Heart Journal ◽

10.1093/eurheartj/ehz745.0112 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Wisten ◽

M Borjesson ◽

P Krantz ◽

E L Stattin

Keyword(s):

Family History ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Arrhythmogenic Right Ventricular Cardiomyopathy ◽

County Council ◽

Medical Society ◽

Positive Development ◽

Swedish Population ◽

Recreational Athletes ◽

Competitive Athletes

Abstract Background Sudden cardiac death (SCD) is uncommon, but accounts for a majority of natural, unexpected sudden death in the young population. Exercise, although clearly health promoting for the vast majority of individuals, is also historically well known as a potential trigger of SCD. Previous studies have reported varying results concerning the comparative risk of SCD in competitive athletes versus non-athletes. Purpose The aim was to study all exercise related SCD in 10–35 years old in Sweden during the 11-year period 2000–2010, regarding the frequency, etiology, prevalence of symptoms, family history and/or ECG-changes; and to estimate the SCD incidence in the young and specifically in competitive athletes and to compare it with data from the previous decade. Methods We have previously identified all cases of SCD in 1–35 years old during 2000–2010 by systematic search in the Swedish Cause of Death Registry and the database of Forensic Medicine (n=552). From this cohort, we identified 514 cases in 10–35-years old, 373 (73%) men, and 141 (27%) women. For each case, information on circumstances at death, pathogenesis, athletic activity, medical history, symptoms, substance use, and heredity was assembled from autopsy-, police- and medical records. Results Exercise-related SCD occurred in 12% (62/514), a majority being men (56/62; 90%). Two thirds were recreational athletes, one-third competitive athletes. In total, 48% had either previous cardiac disease (27%), family history (27%), symptoms (32%), or an abnormal ECG (45%) before death. The most prevalent diagnosis was sudden arrhythmic death syndrome (SADS) (15/62; 24%). Exercise-related SCD was more frequent in men with hypertrophic cardiomyopathy (p=0.0008) and arrhythmogenic right ventricular cardiomyopathy (p=0.001), compared to non-exercise related SCD. The SCD incidence in competitive athletes was 9.4/million per year in men, and 0.6/million per year in women, which was around half the incidence compared to the years 1992–99. The SCD incidence in the general population was 22.3/million per year in men and 9.6/million per year in women. However, the risk of exercise-related SCD was twice as high in competitive athletes compared to recreational athletes. Conclusions 12% of SCD cases in the young Swedish population are exercise-related, with SADS being the most common etiology. The risk of exercise-related SCD is higher for competitive athletes compared to non-athletes. Specifically, exercise seems to trigger SCD in men with ARVC and HCM. About 50% have a pre-mortal risk profile. Importantly, the incidence of SCD in competitive athletes has been approximately halved in the 2000's compared to the 1990's. Theoretically, increased awareness, safety measures and cardiac screening may all have attributed to this positive development. We advocate a uniform evaluation of all exercise-related SCD in young athletes, including optimal histology and genetic analysis at autopsy. Acknowledgement/Funding Grants from Marcus Borgström, Uppsala University, the Swedish Medical Society, and from Norrbotten County Council

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The Role of Screening for Sudden Cardiac Death in Young Competitive Athletes: A Critical Review

Current Physical Medicine and Rehabilitation Reports ◽

10.1007/s40141-014-0072-z ◽

2015 ◽

Vol 3 (1) ◽

pp. 9-17

Author(s):

Irfan M. Asif ◽

Kimberly G. Harmon

Keyword(s):

Sudden Cardiac Death ◽

Critical Review ◽

Cardiac Death ◽

Competitive Athletes

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Relationship of race to sudden cardiac death in competitive athletes with hypertrophic cardiomyopathy

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(02)02976-5 ◽

2003 ◽

Vol 41 (6) ◽

pp. 974-980 ◽

Cited By ~ 190

Author(s):

Barry J Maron ◽

Kevin P Carney ◽

Harry M Lever ◽

Jannet F Lewis ◽

Ivan Barac ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Competitive Athletes ◽

Relationship Of

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Echocardiogram: morphological and functional evaluation including new echocardiographic techniques

The ESC Textbook of Sports Cardiology ◽

10.1093/med/9780198779742.003.0015 ◽

2019 ◽

pp. 120-140

Author(s):

Stefano Caselli ◽

Flavio D’Ascenzi

Keyword(s):

Differential Diagnosis ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Functional Evaluation ◽

Correct Interpretation ◽

Pathological Conditions ◽

Upper Limits ◽

Competitive Athletes ◽

Echocardiographic Examination

Echocardiography is the most important imaging technique for the characterization of athlete’s heart as it allows evaluation of morphological and functional cardiac adaptations induced by exercise. It is usually performed when abnormalities are found on clinical examination and/or on resting or stress echocardiograms, and is particularly helpful for differential diagnosis of pathological conditions at risk for sudden cardiac death such as hypertrophic, dilated, arrhythmogenic, or non-compaction cardiomyopathies. This chapter reviews useful methods for performing a standard echocardiographic examination in competitive athletes and for correct interpretation of findings by discussing determinants and upper limits of cardiac adaptations, reference values, and specific clues for the differential diagnosis of pathological conditions.

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