Colivicchi F, Ammirati F, Biffi A, Verdile L, Pelliccia A, Santini M
Division of Cardiology, 'S. Filippo Neri' Hospital, Rome, Italy.
Eur Heart J. 2002 Jul;23(14):1125-30. doi: 10.1053/euhj.2001.3042.
Exercise-related syncopal spells in athletes receive great attention and are a source of anxiety in the sporting world. The aim of the present study is to describe the clinical presentation, the yield of the initial diagnostic work-up and the long-term outcome of a series of consecutive competitive athletes with recurrent exercise-related syncopal spells.
The study cohort included 33 athletes (20 females, mean age 21.4+/-3.2 years) referred for recurrent unexplained episodes of exercise-related syncope (mean number of spells before evaluation 4.66+/-1.97). All athletes underwent an extensive evaluation, including echocardiography, 24-h electrocardiographic monitoring, exercise testing, cardiac electrophysiological study and head-up tilt testing. The echocardiographic examination revealed the presence of a mitral valve prolapse in two cases (6.0%). During maximal exercise testing, four athletes (12.1%) developed hypotension associated with pre-syncope. Twenty-two subjects (66.6%) showed a positive response to head-up tilt testing. During follow-up (33.5+/-17.2 months) 11/33 athletes (33.3%) showed at least one recurrence of exercise-related syncope (mean time to first recurrence 20.4+/-14.5 months). No other adverse event of any kind was noted during follow-up. The Kaplan-Meier estimates of first recurrence of exercise-related syncope after 12, 36 and 60 months were 9.1%, 24.4% and 42.9%. The number and frequency of exercise-related syncopal spells before evaluation were found to be univariate predictors of syncope recurrence (P<0.001). However, in the multivariate analysis, the number of exercise-related syncopal spells before evaluation was found to be the only independent predictor of syncope recurrence (P<0.05).
These findings support the idea that recurrent exercise related-syncope is not associated with an adverse outcome in athletes without cardiac disease.
运动员与运动相关的晕厥发作备受关注，是体育界焦虑的一个来源。本研究的目的是描述一系列连续的患有复发性与运动相关晕厥发作的竞技运动员的临床表现、初始诊断检查的结果以及长期预后。
研究队列包括33名运动员（20名女性，平均年龄21.4±3.2岁），因复发性不明原因的与运动相关的晕厥前来就诊（评估前晕厥发作的平均次数为4.66±1.97次）。所有运动员都接受了广泛的评估，包括超声心动图、24小时心电图监测、运动试验、心脏电生理研究和头高位倾斜试验。超声心动图检查发现2例（6.0%）存在二尖瓣脱垂。在最大运动试验期间，4名运动员（12.1%）出现与晕厥前期相关的低血压。22名受试者（66.6%）对头高位倾斜试验呈阳性反应。在随访期间（33.5±17.2个月），11/33名运动员（33.3%）至少出现一次与运动相关的晕厥复发（首次复发的平均时间为20.4±14.5个月）。随访期间未发现任何其他不良事件。运动相关晕厥首次复发在12个月、36个月和60个月后的Kaplan-Meier估计值分别为9.1%、24.4%和42.9%。评估前与运动相关的晕厥发作的次数和频率被发现是晕厥复发的单因素预测指标（P<0.001）。然而，在多变量分析中，评估前与运动相关的晕厥发作次数被发现是晕厥复发的唯一独立预测指标（P<0.05）。
这些发现支持这样一种观点，即对于没有心脏病的运动员，复发性与运动相关的晕厥与不良预后无关。
