Thiene G, Basso C, Corrado D
Istituto di Anatomia Patologica, Università degli Studi, Padova.
Cardiologia. 1999 Jun;44(6):497-505.
A wide spectrum of cardiovascular abnormalities may cause sudden death in young athletes, and even minor lesions may be life-threatening by jeopardizing the electrical order of the heart during effort. The culprit diseases are clinically covert and difficult to diagnose or suspect. Early identification during systematic preparticipation screening might reduce the risk and incidence of sudden death. In the time interval 1979-1996, 49 young athletes died suddenly in the Veneto Region. The prevalence of sudden death was calculated as 0.75/100,000/year among young nonathletes and 1.6/100,000/year among young athletes (p < 0.01). Among athletes, arrhythmogenic right ventricular cardiomyopathy was the leading cause, followed by atherosclerotic coronary artery disease and congenital coronary anomalies. Hypertrophic cardiomyopathy has been a very uncommon cause of fatal events, due to the identification and disqualification of affected subjects at the preparticipation screening. Only arrhythmogenic right ventricular cardiomyopathy and congenital anomalies of coronary arteries occurred more frequently in athletes than in nonathletes, as to indicate that these diseases are particularly prone to cardiac arrest during effort. The rarity of prodroma in patients affected by coronary artery disease, both acquired and congenital, particularly the absence of chest pain, stresses the difficulty in suspecting these lesions. On the opposite, most of athletes with arrhythmogenic right ventricular cardiomyopathy had something that might have alerted, either in terms of family history or electrical disorders. Our data are strongly in favor of an effective role of the Italian protocol for preparticipation screening in preventing sudden death in young athletes affected by hypertrophic cardiomyopathy. With increased awareness of diagnostic criteria, also athletes with concealed arrhythmogenic right ventricular cardiomyopathy will be identified in the future and sudden death possibly prevented.
多种心血管异常情况可能导致年轻运动员猝死，即使是轻微病变也可能在运动时危及心脏电活动顺序，从而危及生命。这些致病疾病在临床上较为隐匿，难以诊断或怀疑。在系统的赛前筛查中尽早识别可能会降低猝死风险和发生率。在1979年至1996年期间，威尼托地区有49名年轻运动员突然死亡。年轻非运动员的猝死患病率计算为每年0.75/10万，年轻运动员为每年1.6/10万（p<0.01）。在运动员中，致心律失常性右室心肌病是主要原因，其次是动脉粥样硬化性冠状动脉疾病和先天性冠状动脉异常。肥厚型心肌病一直是致命事件的非常罕见的原因，这是由于在赛前筛查中识别出受影响的受试者并取消其资格。只有致心律失常性右室心肌病和冠状动脉先天性异常在运动员中比在非运动员中更频繁发生，这表明这些疾病在运动时特别容易发生心脏骤停。无论是获得性还是先天性冠状动脉疾病患者，前驱症状都很罕见，尤其是没有胸痛，这凸显了怀疑这些病变的困难。相反，大多数致心律失常性右室心肌病运动员在家族史或电紊乱方面都有一些可能引起警觉的情况。我们的数据强烈支持意大利赛前筛查方案在预防肥厚型心肌病年轻运动员猝死方面的有效作用。随着对诊断标准认识的提高，未来也将识别出隐匿性致心律失常性右室心肌病运动员，并可能预防猝死。
