Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
Am J Cardiol. 2013 Feb 15;111(4):557-62. doi: 10.1016/j.amjcard.2012.10.044. Epub 2012 Dec 6.
The aim of this study was to analyze using noninvasive cardiac examinations a series of young athletes discovered to have ventricular arrhythmias (VAs) during the preparticipation screening program for competitive sports. One hundred forty-five athletes (mean age 17 ± 5 years) were evaluated. The study protocol included electrocardiography (ECG), exercise testing, 2-dimensional and Doppler echocardiography, 24-hour Holter monitoring, signal-averaged ECG, and in selected cases contrast-enhanced cardiac magnetic resonance imaging. Results of ECG were normal in most athletes (85%). VAs were initially detected prevalently during exercise testing (85%) and in the remaining cases on ECG and Holter monitoring. Premature ventricular complexes disappeared during exercise in 56% of subjects. Premature ventricular complexes during Holter monitoring averaged 4,700 per day, predominantly monomorphic (88%), single, and/or in couplets (79%). The most important echocardiographic findings were mitral valve prolapse in 29 patients (20%), congenital heart disease in 4 (3%), and right ventricular regional kinetic abnormalities in 5 (3.5%). On cardiac magnetic resonance imaging, right ventricular regional kinetic abnormalities were detected in 9 of 30 athletes and were diagnostic of arrhythmogenic right ventricular cardiomyopathy in only 1 athlete. Overall, 30% of athletes were judged to have potentially dangerous VAs. In asymptomatic athletes with prevalently normal ECG, most VAs can be identified by adding an exercise test during preparticipation screening. In conclusion, cardiac screening with noninvasive examinations remains a fundamental tool for the identification of a possible pathologic substrate and for the characterization of electrical instability.
本研究旨在通过非侵入性心脏检查分析一系列在竞技运动参与前筛查计划中发现存在室性心律失常 (VA) 的年轻运动员。共评估了 145 名运动员（平均年龄 17 ± 5 岁）。研究方案包括心电图 (ECG)、运动试验、二维和多普勒超声心动图、24 小时 Holter 监测、信号平均心电图，以及在选定病例中进行对比增强心脏磁共振成像。大多数运动员（85%）的心电图结果正常。VA 最初主要在运动试验（85%）中发现，其余病例在心电图和 Holter 监测中发现。56%的患者在运动时提前出现的室性早搏消失。Holter 监测中平均每天出现 4700 次提前的室性早搏，主要是单形性（88%）、单个和/或成对（79%）。最重要的超声心动图发现是 29 名患者（20%）存在二尖瓣脱垂，4 名患者（3%）存在先天性心脏病，5 名患者（3.5%）存在右心室局部运动异常。在 30 名运动员中，有 9 名运动员的右心室局部运动异常可通过心脏磁共振成像发现，仅有 1 名运动员被诊断为心律失常性右心室心肌病。总体而言，30%的运动员被认为存在潜在危险的 VA。在心电图普遍正常的无症状运动员中，通过在参与前筛查中添加运动试验，可以识别大多数 VA。总之，使用非侵入性检查进行心脏筛查仍然是识别可能的病理基础和电不稳定性的基本工具。
