Sudden cardiac death in athletes and the value of cardiovascular magnetic resonance

Abstract

Sudden cardiac death (SCD) is the nontraumatic death, due to loss of heart function that occurs suddenly and unexpectedly within 6 hours of a previously normal state of health. It is related to intense competitive sports promoting ventricular tachycardia (VT)/ventricular fibrillation (VF) in the presence of underlying abnormal substrate. A serial evaluation of cardiac physiologic changes taking place during training will allow the better understanding of athlete's heart and will facilitate its discrimination from other grey-zone cardiomyopathies. According to the ESC recommendations, a pre-participation evaluation should include medical history, physical examination as well as a 12-lead electrocardiogram (ECG). Additional tests, such as echocardiography, 24-hours Holter monitoring, stress testing and cardiovascular magnetic resonance (CMR) should be requested upon positive findings at the initial evaluation. Cardiovascular magnetic resonance can be of great value in the differential diagnosis between various cardiomyopathies including hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), left ventricle noncompaction cardiomyopathy (LVNC) and athlete's heart. This is due to its great versatility that can provide reliable and reproducible anatomical, functional and tissue characterization information, which are operator and acoustic window independent.

MicroRNAs as Biomarkers of Systemic Changes in Response to Endurance Exercise—A Comprehensive Review

“…Intensive exercise in adolescent and young athletes may be rarely associated with the risk of sudden cardiac death (SCD). The combination of LV hypertrophy, enlargement, and/or low ejection fraction can overlap with inherited cardiomyopathies, which are the most common causes of SCD in young sportsmen [ 6 ]. For this reason, the differential diagnosis between athlete’s heart and disease using conventional methods remains challenging and new biomarkers are needed to distinguish physiology from pathology.…”

Cardiac Magnetic Resonance Imaging for Nonischemic Cardiac Disease in Out-of-Hospital Cardiac Arrest Survivors Treated with Targeted Temperature Management: A Multicenter Retrospective Analysis

“…Moreover, among 110 OHCA survivors with inconclusive coronary angiogram, Baritussio et al, found that CMR imaging provided a clinical impact in 76 patients (70%) and contributed to the diagnosis in 27 patients (25%) [23]. Additionally, Mavrogeni et al, reported that CMR can be of great value in evaluation of arrhythmogenesis in sudden cardiac death of healthy athletes especially by its ability to differentiate non-ischemic cardiomyopathy with athlete's heart [10]. However, another study with 36 cardiac arrest survivors found only minor findings in CMR imaging and other study that evaluated the cause in 43 cardiac arrest survivors reported that >50% of the patients who underwent CMR imaging had normal or non-diagnostic findings [4].…”

“…CMR imaging also provides crucial information for risk stratification of sudden cardiac death in non-ischemic cardiomyopathy with late gadolinium enhancement sequence [8,9]. Additionally, CMR can be of great value in evaluation of arrhythmogenesis in sudden cardiac death [10]. Knowledge from investigations using CMR imaging for the etiology of sudden cardiac death is limited and inconsistent.…”

Mixed phenotype cardiomyopathy, associated with DSP genetic variant: a case report and literature review.

“…И АКМП, и НКМП могут проявляться в виде симптомов и/или документации ФП, нарушения проводимости, тахиаритмий из ПЖ и/или ЛЖ [28]. Нарушения процессов реполяризации, регистрируемые у пациентов с НМЛЖ и у пациентов АКМП, также предрасполагают к возникновению злокачественных желудочковых тахиаритмий и ВСС [27,29]. Наиболее характерными нарушениями реполяризации при НМЛЖ являются ранняя реполяризация, которая встречается с частотой ~40%, и синдром уд линенного QT (у 50% больных) [30][31][32].…”