Maron B J, Shirani J, Poliac L C, Mathenge R, Roberts W C, Mueller F O
Division of Cardiovascular Research, Minneapolis Heart Institute Foundation, MN 55407, USA.
JAMA. 1996 Jul 17;276(3):199-204.
To develop clinical, demographic, and pathological profiles of young competitive athletes who died suddenly.
Systematic evaluation of clinical information and circumstances associated with sudden deaths; interviews with family members, witnesses, and coaches; and analyses of postmortem anatomic, microscopic, and toxicologic data.
A total of 158 sudden deaths that occurred in trained athletes throughout the United States from 1985 through 1995 were analyzed. MAIN OUTCOME MEASURES--Characteristics and probable cause of death.
Of 158 sudden deaths among athletes, 24 (15%) were explained by noncardiovascular causes. Among the 134 athletes who had cardiovascular causes of sudden death, the median age was 17 years (range, 12-40 years), 120 (90%) were male, 70 (52%) were white, and 59 (44%) were black. The most common competitive sports involved were basketball (47 cases) and football (45 cases), together accounting for 68% of sudden deaths. A total of 121 athletes (90%) collapsed during or immediately after a training session (78 cases) or a formal athletic contest (43 cases), with 80 deaths (63%) occurring between 3 PM and 9 PM. The most common structural cardiovascular diseases identified at autopsy as the primary cause of death were hypertrophic cardiomyopathy (48 athletes [36%]), which was disproportionately prevalent in black athletes compared with white athletes (48% vs 26% of deaths; P = .01), and malformations involving anomalous coronary artery origin (17 athletes [13%]). Of 115 athletes who had a standard preparticipation medical evaluation, only 4 (3%) were suspected of having cardiovascular disease, and the cardiovascular abnormality responsible for sudden death was correctly identified in only 1 athlete (0.9%).
Sudden death in young competitive athletes usually is precipitated by physical activity and may be due to a heterogeneous spectrum of cardiovascular disease, most commonly hypertrophic cardiomyopathy. Preparticipation screening appeared to be of limited value in identification of underlying cardiovascular abnormalities.
建立年轻竞技运动员猝死的临床、人口统计学和病理学特征。
对与猝死相关的临床信息和情况进行系统评估；与家庭成员、目击者和教练进行访谈；分析尸检解剖、显微镜检查和毒理学数据。
分析了1985年至1995年期间在美国各地训练有素的运动员中发生的158例猝死病例。主要观察指标——死亡特征和可能原因。
在158例运动员猝死病例中，24例（15%）由非心血管原因导致。在134例因心血管原因猝死的运动员中，年龄中位数为17岁（范围为12至40岁），120例（90%）为男性，70例（52%）为白人，59例（44%）为黑人。涉及的最常见竞技运动项目是篮球（47例）和足球（45例），两者共占猝死病例的68%。共有121例运动员（90%）在训练课程（78例）或正式体育比赛（43例）期间或之后立即晕倒，80例死亡（63%）发生在下午3点至晚上9点之间。尸检确定为主要死因的最常见结构性心血管疾病是肥厚型心肌病（48例运动员[36%]），与白人运动员相比，肥厚型心肌病在黑人运动员中更为普遍（死亡病例中分别为48%和26%；P = 0.01），以及涉及冠状动脉起源异常的畸形（17例运动员[13%]）。在115例进行过标准赛前医学评估的运动员中，只有4例（3%）被怀疑患有心血管疾病，而在仅1例运动员（0.9%）中正确识别出了导致猝死的心血管异常。
年轻竞技运动员猝死通常由体育活动诱发，可能归因于多种心血管疾病，最常见的是肥厚型心肌病。赛前筛查在识别潜在心血管异常方面似乎价值有限。
