Rajan Deepthi, Garcia Rodrigue, Svane Jesper, Tfelt-Hansen Jacob
The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
The Department of Cardiology, University Hospital of Poitiers, 2 rue de la Milétrie, 86021 Poitiers, France.
Eur Heart J. 2022 Mar 21;43(12):1198-1206. doi: 10.1093/eurheartj/ehab833.
Sudden cardiac death (SCD) is a tragic incident accountable for up to 50% of deaths from cardiovascular disease. Sports-related SCD (SrSCD) is a phenomenon which has previously been associated with both competitive and recreational sport activities. SrSCD has been found to occur 5-33-fold less frequently in women than in men, and the sex difference persists despite a rapid increase in female participation in sports. Establishing the reasons behind this difference could pinpoint targets for improved prevention of SrSCD. Therefore, this review summarizes existing knowledge on epidemiology, characteristics, and causes of SrSCD in females, and elaborates on proposed mechanisms behind the sex differences. Although literature concerning the aetiology of SrSCD in females is limited, proposed mechanisms include sex-specific variations in hormones, blood pressure, autonomic tone, and the presentation of acute coronary syndromes. Consequently, these biological differences impact the degree of cardiac hypertrophy, dilation, right ventricular remodelling, myocardial fibrosis, and coronary atherosclerosis, and thereby the occurrence of ventricular arrhythmias in male and female athletes associated with short- and long-term exercise. Finally, cardiac examinations such as electrocardiograms and echocardiography are useful tools allowing easy differentiation between physiological and pathological cardiac adaptations following exercise in women. However, as a significant proportion of SrSCD causes in women are non-structural or unexplained after autopsy, channelopathies may play an important role, encouraging attention to prodromal symptoms and family history. These findings will aid in the identification of females at high risk of SrSCD and development of targeted prevention for female sport participants.
心源性猝死（SCD）是一种悲剧性事件，占心血管疾病死亡人数的50%。与运动相关的心源性猝死（SrSCD）是一种此前与竞技和休闲体育活动都有关联的现象。已发现SrSCD在女性中的发生率比男性低5至33倍，尽管女性参与体育运动的人数迅速增加，但这种性别差异仍然存在。查明这种差异背后的原因可以确定改善SrSCD预防的目标。因此，本综述总结了关于女性SrSCD的流行病学、特征和病因的现有知识，并阐述了性别差异背后的潜在机制。尽管关于女性SrSCD病因的文献有限，但潜在机制包括激素、血压、自主神经张力以及急性冠状动脉综合征表现方面的性别特异性差异。因此，这些生物学差异会影响心脏肥大、扩张、右心室重塑、心肌纤维化和冠状动脉粥样硬化的程度，进而影响与短期和长期运动相关的男女运动员室性心律失常的发生。最后，心电图和超声心动图等心脏检查是有用的工具，可以轻松区分女性运动后心脏的生理和病理适应性变化。然而，由于女性SrSCD的很大一部分病因在尸检后是非结构性的或无法解释的，离子通道病可能起重要作用，这促使人们关注前驱症状和家族史。这些发现将有助于识别SrSCD高危女性，并为女性运动参与者制定有针对性的预防措施。
