Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy.
Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy.
Eur J Prev Cardiol. 2023 Jan 24;30(2):107-116. doi: 10.1093/eurjpc/zwac224.
The non-ischaemic left ventricular scar (NILVS) is an emerging substrate of ventricular arrhythmias (VA) in the athlete. We tested the diagnostic value of VA reproducibility at repeated exercise testing (ET).
We included consecutive athletes who underwent cardiac magnetic resonance (CMR) for evaluation of VA and two consecutive ET off-therapy within 12 months. Those with a positive family history of premature sudden death/cardiomyopathy, syncope/pre-syncope, ECG or echocardiography abnormalities, or low-risk VA (exercise-suppressed infundibular or fascicular VA) were excluded. The NILVS was defined as subepicardial/midmyocardial stria of late gadolinium enhancement involving >5% of the LV mass. Reproducibility was defined as the occurrence of VA with the same pattern and behaviour during repeated ET. Of 325 athletes who underwent CMR for evaluation of VA, 75 were included, and 30 showed NILVS involving three [2-4] LV segments. At first ET, athletes with NILVS showed a higher prevalence of exercise-induced VA (93% vs. 53%, P < 0.001), while other VA characteristics did not differ between groups. At repeated ET, reproducibility was observed in 97% of athletes with vs. 13% without NILVS (P < 0.001). The remaining 87% of athletes with normal CMR either did not show any VA at repeated ET (59%) or showed arrhythmias with different patterns, mostly infundibular. Reproducibility yielded a positive predictive value for NILVS of 83% and a negative predictive value of 98%.
VA reproducibility at repeated ET predicted an underlying NILVS in athletes with VA and otherwise normal clinical work-up. This finding may improve risk stratification and appropriate CMR referral of athletes with apparently idiopathic VA.
非缺血性左心室瘢痕（NILVS）是运动员室性心律失常（VA）的新兴基质。我们测试了在重复运动试验（ET）中 VA 重现性的诊断价值。
我们纳入了连续接受心脏磁共振（CMR）评估 VA 并在 12 个月内连续两次 ET 停药的运动员。排除有早发性猝死/心肌病、晕厥/先兆晕厥、心电图或超声心动图异常或低危 VA（运动抑制的漏斗部或束支 VA）阳性家族史的患者。NILVS 定义为累及>5%左心室质量的心脏磁共振延迟钆增强下心外膜/心肌中层条纹。重现性定义为在重复 ET 期间出现相同模式和行为的 VA。在 325 名因 VA 接受 CMR 评估的运动员中，有 75 名被纳入研究，其中 30 名运动员存在 NILVS，累及 3 个[2-4]个 LV 节段。在第一次 ET 时，NILVS 患者的运动诱导性 VA 发生率更高（93% vs. 53%，P<0.001），而两组的其他 VA 特征无差异。在重复 ET 时，NILVS 患者的重现性为 97%，而无 NILVS 患者的重现性为 13%（P<0.001）。其余 87%的 CMR 正常的运动员要么在重复 ET 时没有出现任何 VA（59%），要么出现了不同模式的心律失常，主要是漏斗部 VA。重现性对 NILVS 的阳性预测值为 83%，阴性预测值为 98%。
在 VA 和其他临床检查正常的运动员中，重复 ET 时的 VA 重现性预测了潜在的 NILVS。这一发现可能会改善对有明显特发性 VA 的运动员的风险分层和适当的 CMR 转诊。
