Mavrogeni Sophie I, Tsarouhas Konstantinos, Spandidos Demetrios A, Kanaka-Gantenbein Christina, Bacopoulou Flora
Onassis Cardiac Surgery Center, 17674 Athens, Greece.
Exercise Physiology and Sports Medicine Clinic, Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 11527 Athens, Greece.
Exp Ther Med. 2019 Feb;17(2):1143-1148. doi: 10.3892/etm.2018.7041. Epub 2018 Nov 30.
Athletic pre-participation screening is essential for minimizing the risk for sudden cardiac death (SCD) in athletes participating in either competitive or leisure sporting activities. The primary causes of SCD in young athletes (<35 years of age) include hypertrophic cardiomyopathy, congenital anomalies of the coronary artery and arrhythmogenic right ventricular cardiomyopathy. Other abnormalities, such as malignant arrhythmia due to blunt trauma to the chest (commotio cordis), myocarditis, valvular disease, aortic rupture (in Marfan syndrome) and ion channelopathies (catecholaminergic polymorphic ventricular tachycardia, Brugada syndrome, long or short QT syndrome), also contribute to a lesser degree to SCD. Currently, clinical assessment, electrocardiogram (ECG) and echocardiography are the cornerstones of the pre-participation athletic evaluation. However, their low sensitivity raises queries as regards the need for the application of more sophisticated modalities, such as cardiovascular magnetic resonance (CMR). CMR offers precise biventricular assessment and is greatly reproducible without the inherent limitations of echocardiography; i.e., low quality of images due to the lack of appropriate acoustic window or operator's experience. Furthermore, myocardium replacement fibrosis, indicative of patients' increased risk for future cardiac events, can be effectively detected by late gadolinium enhanced (LGE) images, acquired 15 min post-contrast injection. Finally, diffuse myocardial fibrosis not identified by LGE, can also be detected by pre-contrast (native) T1, post-contrast T1 mapping and extracellular volume images, which provide detailed information about the underlying pathophysiologic background. Therefore, CMR is recommended in all football players with a positive family or personal history of syncope or SCD, abnormal/doubtful ECG or echocardiogram.
运动前参与筛查对于将参加竞技或休闲体育活动的运动员发生心源性猝死（SCD）的风险降至最低至关重要。年轻运动员（<35岁）心源性猝死的主要原因包括肥厚型心肌病、冠状动脉先天性异常和致心律失常性右室心肌病。其他异常情况，如胸部钝性创伤（心脏震荡）导致的恶性心律失常、心肌炎、瓣膜病、主动脉破裂（马凡综合征）和离子通道病（儿茶酚胺能多形性室性心动过速、Brugada综合征、长QT或短QT综合征），对心源性猝死的影响程度相对较小。目前，临床评估、心电图（ECG）和超声心动图是运动前评估的基石。然而，它们的低敏感性引发了对于应用更复杂检查方法（如心血管磁共振成像（CMR））必要性的质疑。CMR能够提供精确的双心室评估，且具有高度可重复性，不存在超声心动图的固有局限性，即由于缺乏合适的声学窗口或操作者经验导致图像质量低下。此外，延迟钆增强（LGE）图像（在注射造影剂15分钟后采集）能够有效检测到心肌替代纤维化，这表明患者未来发生心脏事件的风险增加。最后，LGE未识别出的弥漫性心肌纤维化也可通过造影前（原始）T1、造影后T1映射和细胞外容积图像检测到，这些图像提供了有关潜在病理生理背景的详细信息。因此，对于所有有晕厥或心源性猝死家族史或个人史、心电图或超声心动图异常/可疑的足球运动员，建议进行CMR检查。
