Corrado D, Basso C, Schiavon M, Thiene G
Department of Cardiology, University of Padua, Italy.
N Engl J Med. 1998 Aug 6;339(6):364-9. doi: 10.1056/NEJM199808063390602.
For more than 20 years in Italy, young athletes have been screened before participating in competitive sports. We assessed whether this strategy results in the prevention of sudden death from hypertrophic cardiomyopathy, a common cardiovascular cause of death in young athletes.
We prospectively studied sudden deaths among athletes and nonathletes (35 years of age or less) in the Veneto region of Italy from 1979 to 1996. The causes of sudden death in both populations were compared, and the pathological findings in the athletes were related to their clinical histories and electrocardiograms. Cardiovascular reasons for disqualification from participation in sports were investigated and follow-up was performed in a consecutive series of 33,735 young athletes who underwent preparticipation screening in Padua during the same period.
Of 269 sudden deaths in young people, 49 occurred in competitive athletes (44 male and 5 female athletes; mean age, 23+/-7 years). The most common causes of sudden death in athletes were arrhythmogenic right ventricular cardiomyopathy (22.4 percent), coronary atherosclerosis (18.4 percent), and anomalous origin of a coronary artery (12.2 percent). Hypertrophic cardiomyopathy caused only 1 sudden death among the athletes (2.0 percent) but caused 16 sudden deaths in the nonathletes (7.3 percent). Hypertrophic cardiomyopathy was detected in 22 athletes (0.07 percent) at preparticipation screening and accounted for 3.5 percent of the cardiovascular reasons for disqualification. None of the disqualified athletes with hypertrophic cardiomyopathy died during a mean follow-up period of 8.2+/-5 years.
The results show that hypertrophic cardiomyopathy was an uncommon cause of death in these young competitive athletes and suggest that the identification and disqualification of affected athletes at screening before participation in competitive sports may have prevented sudden death.
在意大利，20多年来一直对年轻运动员进行参赛前筛查。我们评估了这一策略是否能预防肥厚型心肌病导致的猝死，肥厚型心肌病是年轻运动员常见的心血管死亡原因。
我们对1979年至1996年意大利威尼托地区运动员和非运动员（35岁及以下）的猝死情况进行了前瞻性研究。比较了两组人群的猝死原因，并将运动员的病理检查结果与其临床病史和心电图相关联。调查了因心血管原因被取消参赛资格的情况，并对同期在帕多瓦接受参赛前筛查的33735名年轻运动员进行了连续随访。
在269例年轻人猝死中，49例发生在竞技运动员中（44名男性和5名女性运动员；平均年龄23±7岁）。运动员猝死的最常见原因是致心律失常性右室心肌病（22.4%）、冠状动脉粥样硬化（18.4%）和冠状动脉异常起源（12.2%）。肥厚型心肌病仅导致1例运动员猝死（2.0%），但在非运动员中导致16例猝死（7.3%）。在参赛前筛查中，22名运动员（0.07%）被检测出患有肥厚型心肌病，占取消资格的心血管原因的3.5%。在平均8.2±5年的随访期内，没有因肥厚型心肌病被取消资格的运动员死亡。
结果表明，肥厚型心肌病在这些年轻竞技运动员中是一种不常见的死亡原因，并提示在参加竞技运动前筛查时识别并取消受影响运动员的资格可能预防了猝死。
