Morentin Benito, Suárez-Mier M Paz, Monzó Ana, Molina Pilar, Lucena Joaquín S
Section of Forensic Pathology, Basque Institute of Legal Medicine, Bilbao, Spain.
Histopathology Service, Department of Madrid, National Institute of Toxicology and Forensic Sciences, Spain.
Forensic Sci Res. 2019 Aug 19;4(3):257-266. doi: 10.1080/20961790.2019.1633729. eCollection 2019.
This is a multicentre forensic study that identifies all sports-related sudden deaths (SRSDs) in young people, due to myocardial diseases (MDs) that occurred in a large area of Spain. The aim of the study is to assess the epidemiology, causes of death, and sport activities associated with these fatalities. This is a retrospective study based on forensic autopsies performed in the provinces of Biscay, Seville, Valencia and in the jurisdiction covered by the National Institute of Toxicology and Forensic Sciences in Madrid (Spain). The retrospective study encompasses from 2010 to 2017. All sudden cardiac deaths (SCDs) in persons 1-35 years old were selected. The total number of SCDs were divided into death occurred during exercise (SRSD) and death during rest, sleep or normal activities (non-SRSD). Each of these two groups was subdivided according to the cause of death into MD (primary cardiomyopathies and myocarditis) and non-MD. Clinic-pathological, toxicological and genetic characteristics of SRSD due to MD were analysed. Over the 8-year study period, we identified 645 cases of SCD in the young: 75 SRSD (11.6%) and 570 non-SRSD (88.4%). MD was diagnosed in 33 (44.0%) of the SRSD and in 112 (19.6%) of the non-SRSD cases. All cases of SRSD due to MD were males (mean age (24.0 ± 7.6) years) practicing recreational sports (85%). SRSDs were more frequent in arrhythmogenic cardiomyopathy (ACM) (37%) and hypertrophic cardiomyopathy (HCM) (24%), followed by myocarditis (15%) and idiopathic left ventricular hypertrophy (ILVH) (9%). Only in five cases of SRSD the MD responsible of death (HCM) had been diagnosed in life. Cardiovascular symptoms related to the disease were present in other seven patients (six of them with ACM). Postmortem genetic studies were performed in 15/28 (54%) primary cardiomyopathies with positive results in 12 (80%) cases. The most frequent sports disciplines were football (49%) followed by gymnastics (15%) and running (12%). In Spain, SRSD in young people due to MDs occurs in males who perform a recreational activity. Compared with control group we observed a strong association between MDs and exertion. One in three SRSDs are due to cardiomyopathy, especially ACM, which reinforces the need for preparticipation screening to detect these pathologies in recreational sport athletes. Further studies are warranted to understand the causes and circumstances of sudden death to facilitate the development of preventive strategies.
这是一项多中心法医研究，旨在识别西班牙大片地区发生的、由心肌疾病（MD）导致的所有与运动相关的年轻人猝死（SRSD）。该研究的目的是评估这些死亡事件的流行病学、死因以及与之相关的体育活动。这是一项基于在比斯开省、塞维利亚、巴伦西亚以及西班牙马德里国家毒理学和法医学研究所管辖区域所进行的法医尸检的回顾性研究。该回顾性研究涵盖2010年至2017年。选取了所有1至35岁的心脏性猝死（SCD）病例。SCD总数被分为运动期间发生的死亡（SRSD）以及休息、睡眠或正常活动期间发生的死亡（非SRSD）。这两组中的每一组又根据死因细分为MD（原发性心肌病和心肌炎）和非MD。对MD导致的SRSD的临床病理、毒理学和遗传学特征进行了分析。在8年的研究期间，我们在年轻人中识别出645例SCD病例：75例SRSD（11.6%）和570例非SRSD（88.4%）。MD在33例（44.0%）SRSD病例以及112例（19.6%）非SRSD病例中被诊断出来。所有MD导致的SRSD病例均为男性（平均年龄（24.0±7.6）岁），从事休闲运动（85%）。SRSD在致心律失常性心肌病（ACM）（37%）和肥厚型心肌病（HCM）（24%）中更为常见，其次是心肌炎（15%）和特发性左心室肥厚（ILVH）（9%）。仅在5例SRSD病例中，导致死亡的MD（HCM）在生前被诊断出来。其他7名患者（其中6名患有ACM）存在与该疾病相关的心血管症状。对28例原发性心肌病中的15例（54%）进行了死后遗传学研究，12例（80%）结果呈阳性。最常见的运动项目是足球（49%），其次是体操（15%）和跑步（12%）。在西班牙，由MD导致的年轻人SRSD发生在从事休闲活动的男性中。与对照组相比，我们观察到MD与运动之间存在密切关联。三分之一的SRSD是由心肌病导致的，尤其是ACM，这进一步凸显了在休闲运动运动员中进行赛前筛查以检测这些疾病的必要性。有必要进行进一步研究以了解猝死的原因和情况，从而促进预防策略的制定。
