6124Aorta and sports. the silent threat

Abstract

Abstract Background Thoracic aorta is the less known component of the athlete's heart and current publications shown that may be larger in athletes. It is known that high static training and body collision sports could increase the risk of sudden death, especially in patients with aortic disease (AD). Large scale traditional screening detects underlying cardiovascular diseases which may cause sudden cardiac death (SCD), however AD might be subdiagnosed. OBJECTIVE To describe AD burden on preparticipation screening and to assess diagnostic precision of traditional screening for AD detection in trained athletes. Methods Different sports athletes were recruited to follow current European guidelines (clinical history and cardiac examination, including resting 12-lead ECG) for preparticipation screening program (PSP). Bidimensional transthoracic echocardiography (TTE) was performed in all patients to detect AD: bicuspid aortic valve (BAV), thoracic aorta dilatation by Z score (TAD) and BAV plus TAD (BAD). Athletes were excluded from competition following international criteria. Sensitivity (Sn) and specificity (Sp) were calculated with 95% Clopper-Pearson confidence intervals and results are expressed as percentajes. McNemar paired chi-square test for one sample of individuals was used to compare diagnostic precision (Sn, Sp) of PSP vs gold standard: complete assessment (for sport exclusion, SpE) or TTE (for AD or BAD detection). Significance was set at p<0.05 Results Included population (n=1123) was 22.3±6.2 y-o and 222 (19.8%) female. Five athletes (0.44% of total) were excluded from competition due to different causes. AD was found on 11 athletes (0.98%) and 4 of them had BAD (0.36%), a high risk condition with poor prognosis. Three patients with BAD were competitive cyclists and close follow up was indicated. The remaining patient with BAD was a rugby player and was excluded from competition (one out of 5 excluded patients, 20%). Diagnostic precision of PSP was better for SpE than for AD or BAD diagnosis. PSP tended to have less Sn for AD [36.4 (10.9–69.2)] and BAD [25 (0.6–80.6)] detection, than for SpE [80 (28.4–99.5); p=NS]. PSP had significant less Sp for AD [91.1 (89.3–92.7)] and BAD [90.9 (89–92.5)] diagnosis, than for SpE [97.2 (96.1–98.1); p<0.05]. Conclusions AD is subdiagnosed by current PSP and its burden may be overlooked. Despite BAD is less frequent, its finding is determinant in a significant proportion of cases to decide exclusion from competitive (high static or body collision) sports. Although PSP has good sensitivity to detect potential pathologies of SCD, AD cannot be ruled out only by normal ECG and clinical examination. Diagnostic precision of PSP for AD and BAD detection could be enhanced by TTE screening, new studies with a larger number of athletes may answer the question.