Cardiovascular Sciences Research Centre, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK.
Department of Medicine, Surgery and Health, University of Trieste, Trieste, Italy.
Eur J Prev Cardiol. 2024 Sep 6;31(12):1518-1525. doi: 10.1093/eurjpc/zwae146.
The relationship between ethnicity and causes of sudden cardiac death (SCD) in athletes is poorly understood.
To investigate aetiology of SCD among different ethnicities in a large cohort of athletes.
Between 1994 and November 2022, 7880 cases of SCD were consecutively referred from all over the United Kingdom to our national cardiac pathology centre; 848 (11%) were athletes. All cases underwent detailed autopsy evaluation by expert cardiac pathologists. Clinical information was obtained from referring coroners. Most of athletes were white (n = 758; 89%). Black and Asian athletes were in number of 51 (6%) and 39 (5%), respectively. A structurally normal heart, indicative of sudden arrhythmic death syndrome (SADS) was the most common autopsy finding (n = 385; 45%), followed by myocardial diseases (n = 275; 32%), atherosclerotic coronary artery disease (CAD) (n = 58; 7%), and coronary artery anomalies (n = 29; 3%). In most of cases, death occurred during exercise (n = 737; 87%). Arrhythmogenic cardiomyopathy (ACM) was more common in black (n = 13; 25%) than in white (n = 109; 14%) and Asian (n = 3; 8%) athletes (P = 0.03 between black and white athletes; P = 0.04 between black and Asian athletes); in contrast, CAD was more common in Asians (n = 6; 15% vs. n = 51; 7% in whites vs. n = 1; 2%; in blacks, P = 0.02 between Asian and black athletes). Among white athletes, ACM was more common in individuals who died during exercise than in the ones who died at rest (P = 0.005). Such a difference was not observed in Asian and black athletes. In Asian athletes, CAD was the diagnosis at autopsy in 18% of individuals who died during exercise and in none of individuals who died at rest.
A structurally normal heart at autopsy and myocardial diseases are the most common findings in athletes who died suddenly. While ACM is more common in black athletes, atherosclerotic CAD is more common in Asian athletes, with a strong association with exercise-induced SCD. ACM appears to be a driver of exercise-induced SCD in white athletes, however this is not the case in black and Asian athletes.
运动员中种族与心源性猝死（SCD）病因之间的关系尚不清楚。
在一个大型运动员队列中研究不同种族的 SCD 病因。
1994 年至 2022 年 11 月期间，连续有 7880 例 SCD 病例从英国各地转介到我们的国家心脏病理学中心；其中 848 例（11%）为运动员。所有病例均由专家心脏病理学家进行详细的尸检评估。临床信息由转介的验尸官获得。大多数运动员为白人（n = 758；89%）。黑人和亚洲运动员的数量分别为 51 名（6%）和 39 名（5%）。结构正常的心脏，提示为心律失常性猝死综合征（SADS），是最常见的尸检发现（n = 385；45%），其次是心肌疾病（n = 275；32%）、动脉粥样硬化性冠状动脉疾病（CAD）（n = 58；7%）和冠状动脉异常（n = 29；3%）。大多数情况下，死亡发生在运动期间（n = 737；87%）。致心律失常性右室心肌病（ACM）在黑人（n = 13；25%）中比在白人（n = 109；14%）和亚洲人（n = 3；8%）运动员中更常见（黑人与白人运动员之间的 P = 0.03；黑人与亚洲运动员之间的 P = 0.04）；相反，CAD 在亚洲人中更为常见（n = 6；15%，而白人 n = 51；7%，黑人 n = 1；2%）。在白人运动员中，在运动时死亡的个体中 ACM 比在休息时死亡的个体更为常见（P = 0.005）。在亚洲和黑人运动员中未观察到这种差异。在亚洲运动员中，CAD 是运动时死亡的个体的尸检诊断，而在休息时死亡的个体中没有 CAD。
尸检时结构正常的心脏和心肌疾病是突然死亡的运动员中最常见的发现。虽然 ACM 在黑种人运动员中更为常见，但动脉粥样硬化性 CAD 在亚洲运动员中更为常见，并且与运动引起的 SCD 强烈相关。ACM 似乎是白人运动员运动引起的 SCD 的驱动因素，但在黑人和亚洲运动员中并非如此。
