A greater degree of LV hypertrabeculation is seen in healthy African athletes, combined with biventricular EF reduction at rest. Recognition of this phenomenon is necessary to avoid misdiagnosis of LVNC.

Advanced cardiac imaging, using cardiac magnetic resonance imaging (MRI) and multidetector computed tomography (CT), is increasingly used in the work-up of athletes with suspected abnormalities on screening. Both imaging modalities produce highly accurate and reproducible structural and functional cardiac information. Cardiac MRI has the advantage of imaging without radiation exposure or the use of iodine-containing contrast agents, but is sometimes not possible due to claustrophobia or other contraindications. Although cardiac MRI can rule out coronary artery anomalies, multidetector CT is superior to cardiac MRI for visualising the full extent of the coronary arteries and atherosclerotic coronary artery disease. For patients less than 35 years of age, cardiac MRI is the first option after initial echocardiography for further assessment of cardiomyopathies, myocarditis and coronary anomalies, which are major causes of sudden cardiac death in young athletes. For athletes over 35 years of age the most common cause of sudden cardiac death is coronary artery disease, whereby cardiovascular screening requires further diagnostic modalities and may include multidetector CT.

Background and aim To investigate sex differences with respect to presence and location of atherosclerosis in acute ischemic stroke patients. Methods Participants with acute ischemic stroke were included from the Dutch acute stroke trial, a large prospective multicenter cohort study performed between May 2009 and August 2013. All patients received computed tomography/computed tomography-angiography within 9 h of stroke onset. We assessed presence of atherosclerosis in the intra- and extracranial internal carotid and vertebrobasilar arteries. In addition, we determined the burden of intracranial atherosclerosis by quantifying internal carotid and vertebrobasilar artery calcifications, resulting in calcium volumes. Prevalence ratios between women and men were calculated with Poisson regression analysis and adjusted prevalence ratio for potential confounders (age, hypertension, hyperlipidemia, diabetes, smoking, and alcohol use). Results We included 1397 patients with a mean age of 67 years, of whom 600 (43%) were women. Presence of atherosclerosis in intracranial vessel segments was found as frequently in women as in men (71% versus 72%, adjusted prevalence ratio 0.95; 95% CI 0.89–1.01). In addition, intracranial calcification volume did not differ between women and men in both intracranial internal carotid (large burden 35% versus 33%, adjusted prevalence ratio 0.93; 95% CI 0.73–1.19) and vertebrobasilar arteries (large burden 26% versus 40%, adjusted prevalence ratio 0.69; 95% CI 0.41–1.12). Extracranial atherosclerosis was less common in women than in men (74% versus 81%, adjusted prevalence ratio 0.86; 95% CI 0.81–0.92). Conclusions In patients with acute ischemic stroke the prevalence of intracranial atherosclerosis does not differ between women and men, while extracranial atherosclerosis is less often present in women compared with men.

Lipomatous hypertrophy of the interatrial septum is a benign disorder that is characterized by the fat deposition in the interatrial septum. It typically occurs in elderly, obese patients and may cause arrhythmia. We report a case in which lipomatous hypertrophy of the interatrial septum was found incidentally.

Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Radboud University Medical CenterAcademic Alliance Fund Maastricht - Nijmegen Background Current sports medical examinations do not appropriately detect occult coronary atherosclerosis in athletes, whereas coronary atherosclerosis is more prevalent in middle-aged and older athletes compared to physically active controls. Therefore, new diagnostic approaches need to be developed to identify individuals at risk. Cardiac troponin (cTn) is the standard biomarker to assess myocardial injury. Exercise is known to increase cTn concentrations and a delayed recovery of cTn concentrations after exercise cessation is suggested to be indicative of occult obstructive coronary artery disease. We hypothesized that the magnitude of exercise-induced cTn elevations may be associated with the degree of coronary atherosclerosis. Purpose To compare serial measures of exercise-induced cTnT elevations across middle-aged and older athletes with different degrees of coronary atherosclerosis. Methods A subgroup of 59 men from the Measuring Athlete’s Risk of Coronary events-2 study (MARC-2, n=291) were invited for this add-on study. All participants had undergone a cardiac computed tomography (CT) scan and coronary CT angiography to determine the prevalence and magnitude of coronary atherosclerosis. Athletes were stratified based on the degree of coronary atherosclerosis: I) n=20 with a coronary artery calcium score (CACS) of 0, II) n=20 with CACS ≥300 or ≥75th MESA-percentile, and III) n=19 with a >50% stenosis in any coronary artery, but without ischemia on a stress imaging tests. Participants performed an individualized exercise test (>1 hour, cycling) until volitional exhaustion. High-sensitivity cTnT concentrations were measured at baseline, after 30 minutes of exercise and at 0, 30, 60, 120, and 180 minutes post-exercise. Results Participants (age 60.8 [57.9-72.6] years, BMI 24.5 [23.9-27.3]) exercised for 76±14 minutes, up to 97.6 [94.4-101.8] % of their expected maximum heart rate. Exercise duration and workload did not differ across groups. Baseline hs-cTnT was detectable in everyone. Exercise induced a 1.98±1.63 fold increase in hs-cTnT concentrations. Peak hs-cTnT concentrations occurred at 180 minutes post-exercise (13.9 [9.4-17.0] ng/L versus 12.1 [10.0-21.5] ng/L versus 13.8 [9.1-19.9] ng/L, for group I, II and III, respectively) and the incidence of hs-cTnT concentrations above the URL (n=9 (45%) vs n=7 (35.0%) vs n=9 (47.4%)) was comparable across groups (p=0.92 and p=0.71, respectively). Patterns of time-dependent changes in hs-cTnT concentrations did not differ across groups (p=.49). Conclusion Exercise-induced elevations in hs-cTnT concentrations did not differ among middle-aged and older athletes with different degrees of coronary atherosclerosis. Our findings suggest that hs-cTnT sampled before, during or within 180 minutes following an exhaustive endurance cycling exercise test is not suitable to detect occult coronary atherosclerosis in athletes.