The role of cardiac computed tomography in pre‐participation screening of mature athletes

Abstract

The overwhelming majority of sports-related sudden cardiac deaths in mature athletes is attributed to coronary artery disease (CAD). Coronary plaques of mature athletes appear to be more calcified compared to sedentary individuals and thus may be more stable and less likely to be associated with an acute coronary event. Cardiac computed tomography (CT), including unenhanced CT for coronary artery calcium scoring (CACS) and contrast-enhanced coronary CT angiography, is characterized by very high negative predictive value to rule out CAD. Cardiac CT has been shown to have additional diagnostic value for detection of CAD in athletes over and above exercise electrocardiogram. Moreover, measurement of CACS possibly enables a more precise cardiovascular risk stratification of mature athletes. The main advantage of cardiac CT is its noninvasive nature. Although cardiac CT appears to increase the overall cost of cardiac examinations, this additional cost is much lower than the cost of unnecessary invasive coronary angiographies that would be performed in case of false positive results of exercise electrocardiograms. Radiation exposure may not be a major concern for the application of this modality to pre-participation screening of athletes, since recent technical advancements have resulted in low radiation dose of cardiac CT. Highlights. Coronary computed tomography angiography can be used in pre-participation screening of mature athletes to increase the negative predictive value for excluding coronary artery disease. . The identification of coronary artery calcium score = 0 in an athlete can improve risk stratification, since this athlete can be reasonably managed as an individual with low cardiovascular risk.

Physiological Changes in QRS Fragmentation in Athletes and Nonathletes without Cardiac Disease

“…Exclusion criteria included presence of any cardiac disease and use of performance-enhancing drugs (on the basis of history taking and physical examination for the detection of signs suggestive of concealed use of performance enhancing drugs) [17]. The diagnosis of coronary artery disease in individuals older than 35 years was excluded through exercise testing or cardiac computed tomography [18].…”

Athlete's Heart: A Cardiovascular Step-By-Step Multimodality Approach

“…Therefore, depending on the local availability and expertise, CCT may be considered in athletes with symptoms suggestive of CAD and in older, asymptomatic athletes with risk factors for CV disease or equivocal exercise stress test. Indeed, it has been recently theorized the use of CCT in the screening process of mature athletes increases the negative predictive value for excluding coronary artery disease [ 137 ]. Moreover, CCT should be considered when a precise definition of proximal coronary anatomy or characterization of great vessel morphology is indicated [ 136 ].…”

Posicionamiento mexicano para el tamizaje y la evaluación cardiovascular preparticipación deportiva

“…Las placas ateromatosas de los deportistas de alto rendimiento suelen estar más calcificadas que en sujetos sedentarios y se consideran «placas estables». El alto valor predictivo negativo de la TCC convierte a esta técnica en un método ideal para descartar EAC en deportistas con probabilidad preprueba intermedia a alta, obtenida mediante escalas clínicas de riesgo CV tradicionales 78 . Dado que la placa ateromatosa del deportista de alto rendimiento tiende a estar más calcificada, la determinación del índice de calcio coronario (TCC sin contraste) puede ser útil en la evaluación inicial de este grupo de deportistas.…”