Sports Medicine Unit, Catholic University of the Sacred Heart, Rome, Italy.
Department of Radiological Sciences, Institute of Radiology, Catholic University of the Sacred Heart, Rome, Italy.
Int J Cardiol. 2018 Feb 1;252:13-20. doi: 10.1016/j.ijcard.2017.10.117. Epub 2017 Nov 8.
Although anomalous origin of left (AOLCA) and right coronary artery (AORCA) from the wrong sinus may cause sudden death (SD) in athletes, early diagnosis and management of these anomalies are still challenging. We analysed clinical/instrumental profiles of athletes identified with AOLCA/AORCA focusing our attention on diagnosis, management and follow-up.
We report 23 athletes (17 males, mean age 27±17yrs.), 6 with AOLCA and 17 with AORCA. Diagnosis was made by trans-thoracic echocardiography (TTE) in 21/23(91%). Symptoms were present only in 10(41%). Only 3 had an abnormal rest-ECG and 9(39%) an abnormal stress test ECG (3 ST-depression, 4 ventricular arrhythmias, 1 supraventricular arrhythmias, 1 rate-dependent left-bundle-branch-block). Anatomy of the anomalous coronary artery showed no significant correlation with clinical presentation, except for a tendency to higher occurrence of proximal hypoplasia in symptomatic athletes (83% vs 40%, p=0.09). All athletes were disqualified from competitive-sports and advised to avoid strenuous effort. Surgery was recommended to all athletes with AOLCA and 6 with AORCA, but only 6 underwent surgery. No major cardiac events or ischemic symptoms/signs occurred during a mean follow-up of 65±70months.
Early diagnosis of AOLCA/AORCA in athletes is feasible by TTE. Typical symptoms/signs of myocardial ischemia are present only in one third of cases thus underlying the need of a high index of clinical suspicion to achieve the diagnosis. After exercise restriction, none had major cardiac events or ischemia symptoms/signs recurrence. There was no correlation between anatomical characteristics and clinical presentation with the possible exception of coronary hypoplasia.
尽管左冠状动脉（AOLCA）和右冠状动脉（AORCA）异常起源于错误的窦可能导致运动员猝死（SD），但这些异常的早期诊断和管理仍然具有挑战性。我们分析了被诊断为 AOLCA/AORCA 的运动员的临床/仪器特征，重点关注诊断、管理和随访。
我们报告了 23 名运动员（17 名男性，平均年龄 27±17 岁），6 名患有 AOLCA，17 名患有 AORCA。23 名患者中有 21 名（91%）通过经胸超声心动图（TTE）诊断。10 名（41%）有症状。仅 3 名患者静息心电图异常，9 名（39%）运动心电图异常（3 例 ST 段压低，4 例室性心律失常，1 例室上性心律失常，1 例速率依赖性左束支传导阻滞）。异常冠状动脉的解剖结构与临床表现无显著相关性，仅在有症状的运动员中近端发育不良的发生率较高（83% vs 40%，p=0.09）。所有运动员均被取消竞技体育资格，并建议避免剧烈运动。所有 AOLCA 患者和 6 名 AORCA 患者均被建议手术，但只有 6 名患者接受了手术。在平均 65±70 个月的随访中，无重大心脏事件或缺血症状/体征发生。
经 TTE 可早期诊断运动员的 AOLCA/AORCA。只有三分之一的病例有典型的心肌缺血症状/体征，因此需要高度的临床怀疑指数来做出诊断。限制运动后，无重大心脏事件或缺血症状/体征复发。解剖特征与临床表现之间可能无相关性，但冠状动脉发育不良除外。
