Cardiovascular Screening Of Adult Individuals Engaged In Sport Activities According To The Current European Guidelines

Abstract

The risk of acute cardiac events can seriously increase during exercise, particularly when performed at high intensity and by subjects carrying cardiovascular pathologies and risk factors. The incidence of these events may be expected to rise, as more and older individuals take part in organized sports. Specific European guidelines for cardiovascular screening were recently created (Borjesson et al., 2011), but their efficacy has not been proven. PURPOSE: To compare the results originating from the application of the European guidelines for master athletes (EACPR), recommending an individual approach with data resulting from the systematic application of a maximal exercise test. METHODS: So fare we evaluated 320 subjects (age > 35 y.o.; mean age 54±10.5), 277 of them performing high intensity activities (>6METs). The European screening protocol includes: questionnaire, clinical evaluation, basal ECG and maximal exercise testing, administered depending on a specific flow chart, including the use of cardiovascular risk charts. RESULTS: Data demonstrated a prevalence of cardiovascular risk factors (dyslipidemia, diabetes, hypertension) similar to what reported in the Italian population of the same age, except for smoking habits and overweight percentages that were significantly lower. The systematic use of a maximal exercise test allowed the new discovery of 22 subjects with coronary artery diseases (vs 10 by applying the EACPR guidelines), 22 with hypertension (vs 9), 14 with repetitive or complex exercise-related arrhythmias (vs 6), 6 with congenital anomaly of a coronary artery (vs 3), and 2 with a myocarditis (vs 1). CONCLUSIONS: This is the first study evaluating the effectiveness of the recent EACPR guidelines for cardiovascular screening in adult subjects, by comparing them with a full evaluation including a maximal exercise test. Our data suggest the greater diagnostic value of the latter approach, despite the need for a larger number of instrumental evaluations. Most of the clinical conditions not detected by applying the EACPR suggestions are generally considered at potential risk of exercise-related cardiovascular events and/or of a clinical progression of the disease, implicating worse cardiovascular risk and prognosis. These preliminary data suggest the need for a cautious application of current European guidelines, particularly in subjects carrying cardiovascular risk factors.