Christou Georgios A, Deligiannis Asterios P, Kouidi Evangelia J
Laboratory of Sports Medicine, Sports Medicine Division, Aristotle University of Thessaloniki, Thessaloniki, Greece.
MSc Sports Cardiology, St George's University of London, London, United Kingdom.
Eur J Sport Sci. 2022 Apr;22(4):636-649. doi: 10.1080/17461391.2021.1883125. Epub 2021 Feb 28.
The overwhelming majority of sports-related sudden cardiac deaths in mature athletes is attributed to coronary artery disease (CAD). Coronary plaques of mature athletes appear to be more calcified compared to sedentary individuals and thus may be more stable and less likely to be associated with an acute coronary event. Cardiac computed tomography (CT), including unenhanced CT for coronary artery calcium scoring (CACS) and contrast-enhanced coronary CT angiography, is characterized by very high negative predictive value to rule out CAD. Cardiac CT has been shown to have additional diagnostic value for detection of CAD in athletes over and above exercise electrocardiogram. Moreover, measurement of CACS possibly enables a more precise cardiovascular risk stratification of mature athletes. The main advantage of cardiac CT is its noninvasive nature. Although cardiac CT appears to increase the overall cost of cardiac examinations, this additional cost is much lower than the cost of unnecessary invasive coronary angiographies that would be performed in case of false positive results of exercise electrocardiograms. Radiation exposure may not be a major concern for the application of this modality to pre-participation screening of athletes, since recent technical advancements have resulted in low radiation dose of cardiac CT. Coronary computed tomography angiography can be used in pre-participation screening of mature athletes to increase the negative predictive value for excluding coronary artery disease.The identification of coronary artery calcium score = 0 in an athlete can improve risk stratification, since this athlete can be reasonably managed as an individual with low cardiovascular risk.
成熟运动员中与运动相关的心脏性猝死绝大多数归因于冠状动脉疾病（CAD）。与久坐不动的个体相比，成熟运动员的冠状动脉斑块似乎钙化程度更高，因此可能更稳定，与急性冠状动脉事件相关的可能性更小。心脏计算机断层扫描（CT），包括用于冠状动脉钙化评分（CACS）的非增强CT和对比增强冠状动脉CT血管造影，其特点是排除CAD的阴性预测值非常高。心脏CT已被证明在检测运动员CAD方面比运动心电图具有额外的诊断价值。此外，CACS测量可能使成熟运动员的心血管风险分层更精确。心脏CT的主要优点是其无创性。虽然心脏CT似乎会增加心脏检查的总体成本，但这一额外成本远低于运动心电图出现假阳性结果时进行不必要的有创冠状动脉造影的成本。对于将这种检查方式应用于运动员的赛前筛查，辐射暴露可能不是主要问题，因为最近的技术进步已使心脏CT的辐射剂量降低。冠状动脉CT血管造影可用于成熟运动员的赛前筛查，以提高排除冠状动脉疾病的阴性预测值。运动员冠状动脉钙化评分为0可改善风险分层，因为该运动员可被合理地作为心血管风险较低的个体进行管理。
