van de Sande Danny Ajp, Liem Ing Han, Hoogsteen Jan, Kemps Hareld Mc
1 Department of Cardiology, Máxima Medical Center Veldhoven, The Netherlands.
2 Department of Nuclear Medicine, Máxima Medical Center Veldhoven, The Netherlands.
Eur J Prev Cardiol. 2017 Jun;24(9):1000-1007. doi: 10.1177/2047487317693135. Epub 2017 Feb 10.
Background Previous studies revealed a relatively high prevalence of electrocardiographic findings indicative for myocardial ischemia in asymptomatic athletes undergoing pre-participation screening. Myocardial perfusion scintigraphy is generally considered a valuable diagnostic and prognostic modality and often used for further diagnostic evaluation in these subjects. However, data on the diagnostic accuracy of myocardial perfusion scintigraphy in athletes are scarce. Objectives The main purpose of this study was to investigate the positive predictive value of myocardial perfusion scintigraphy for detection of coronary artery disease in asymptomatic athletes with abnormal exercise testing results during pre-participation screening. The secondary aim was to evaluate the prognostic value of myocardial perfusion scintigraphy. Methods Electronic charts of asymptomatic athletes who underwent myocardial perfusion scintigraphy following an abnormal exercise testing were retrospectively reviewed. Myocardial perfusion scintigraphy and exercise testing studies were revised. Athlete characteristics and cardiovascular risk factors were evaluated. Results One hundred and forty-three athletes were included. 29 athletes (20%) showed concordant abnormal exercise testing and myocardial perfusion scintigraphy results. Coronary imaging was performed in 20 of these 29 athletes. Four athletes showed significant coronary artery disease (positive predictive value = 20%). The positive predictive value increased to 33% when athletes were selected who should have undergone exercise testing according to the guideline recommendations. During a mean follow-up interval of 4.7 ± 2.2 years, eight cardiac events occurred. Athletes with an abnormal myocardial perfusion scintigraphy result had a fourfold increased risk at a future cardiac event (2.9%/year versus 0.75%/year, p = 0.031). Conclusions The positive predictive value of myocardial perfusion scintigraphy for the detection of significant coronary artery disease in asymptomatic athletes with a positive exercise testing result is low, even in a selection of athletes with a relatively high cardiovascular risk. Although an abnormal myocardial perfusion scintigraphy result was associated with a fourfold higher annual event rate, the absolute annual event rate in this group was still low. Efforts should be made to develop better diagnostic strategies to evaluate asymptomatic athletes with abnormal exercise testing results during pre-participation screening.
背景 先前的研究表明，在进行参赛前筛查的无症状运动员中，心电图显示心肌缺血的发生率相对较高。心肌灌注闪烁扫描通常被认为是一种有价值的诊断和预后评估方法，常用于这些受试者的进一步诊断评估。然而，关于运动员心肌灌注闪烁扫描诊断准确性的数据很少。目的 本研究的主要目的是调查心肌灌注闪烁扫描对在参赛前筛查中运动试验结果异常的无症状运动员检测冠状动脉疾病的阳性预测值。次要目的是评估心肌灌注闪烁扫描的预后价值。方法 对在运动试验异常后接受心肌灌注闪烁扫描的无症状运动员的电子病历进行回顾性审查。对心肌灌注闪烁扫描和运动试验研究进行了复查。评估了运动员的特征和心血管危险因素。结果 纳入了143名运动员。29名运动员（20%）的运动试验和心肌灌注闪烁扫描结果一致异常。这29名运动员中的20名进行了冠状动脉成像。4名运动员显示有显著冠状动脉疾病（阳性预测值 = 20%）。当选择根据指南建议应进行运动试验的运动员时，阳性预测值增加到33%。在平均4.7±2.2年的随访期间，发生了8起心脏事件。心肌灌注闪烁扫描结果异常的运动员未来发生心脏事件的风险增加了四倍（每年2.9%对0.75%，p = 0.031）。结论 心肌灌注闪烁扫描对运动试验结果阳性的无症状运动员检测显著冠状动脉疾病的阳性预测值较低，即使在选择心血管风险相对较高的运动员中也是如此。虽然心肌灌注闪烁扫描结果异常与每年事件发生率高出四倍相关，但该组的绝对年事件发生率仍然较低。应努力制定更好的诊断策略，以评估在参赛前筛查中运动试验结果异常的无症状运动员。
