Identifying Coronary Artery Disease in Asymptomatic Middle-Aged Sportsmen: The Additional Value of Pulse Wave Velocity.

Thijs L Braber,Niek H J Prakken,Willem P Th M Mali,Birgitta K Velthuis,Pieter A F M Doevendans,Michiel L Bots,Arend Mosterd

doi:10.1371/journal.pone.0131895

Abstract

BackgroundCardiovascular screening may benefit middle-aged sportsmen, as coronary artery disease (CAD) is the main cause of exercise-related sudden cardiac death. Arterial stiffness, as measured by pulse wave velocity (PWV), may help identify sportsmen with subclinical CAD. We examined the additional value of PWV measurements to traditional CAD risk factors for identifying CAD.MethodsFrom the Measuring Athlete’s Risk of Cardiovascular events (MARC) cohort of asymptomatic, middle-aged sportsmen who underwent low-dose Cardiac CT (CCT) after routine sports medical examination (SME), 193 consecutive sportsmen (aged 55±6.6 years) were included with additional PWV measurements before CCT. Sensitivity, specificity and predictive values of PWV values (>8.3 and >7.5m/s) assessed by Arteriograph were used to identify CAD (coronary artery calcium scoring ≥100 Agatston Units or coronary CT angiography luminal stenosis ≥50%) and to assess the additional diagnostic value of PWV to established cardiovascular risk factors.ResultsForty-seven sportsmen (24%) had CAD on CCT. They were older (58.9 vs. 53.8 years, p<0.001), had more hypertension (17 vs. 4%, p=0.003), higher cholesterol levels (5.7 vs. 5.4mmol/l) p=0.048), and more often were (ever) smokers (55 vs. 34%, p=0.008). Mean PWV was higher in those with CAD (8.9 vs. 8.0 m/s, p=0.017). For PWV >8.3m/s respectively >7.5m/s sensitivity to detect CAD on CT was 43% and 74%, specificity 69% and 45%, positive predictive value 31% and 30%, and negative predictive value 79% and 84%. Adding PWV to traditional risk factor models did not change the area under the curve (from 0.78 (95% CI = 0.709-0.848)) to AUC 0.78 (95% CI 0.710-0.848, p = 0.99)) for prediction of CAD on CCT.ConclusionsLimited additional value was found for PWV on top of established risk factors to identify CAD. PWV might still have a role to identify CAD in middle-aged sportsmen if risk factors such as cholesterol are unknown.

Highlights

Regular physical activity is key in the prevention of cardiovascular disease, but vigorous exercise is associated with a higher cardiovascular event risk, in those with known or unknown cardiac disease [1]
We examined the additional value of pulse wave velocity (PWV) measurements to traditional coronary artery disease (CAD) risk factors for identifying CAD
Adding PWV to traditional risk factor models did not change the area under the curve

Summary

Introduction

Regular physical activity is key in the prevention of cardiovascular disease, but vigorous exercise is associated with a higher cardiovascular event risk, in those with known or unknown cardiac disease [1]. During the six years of follow up, cardiovascular events occurred in 8 participants, 7 of whom had a CACS higher than 100 Agatston units their mean FRS placed them in a low-risk category [5] It seems that the conventional cardiovascular risk stratification underestimates the coronary artery calcium burden in this presumably healthy cohort and that an increased awareness of a potentially higher than anticipated coronary risk is warranted [5]. These facts indicate that early identification of subclinical CAD should be an important goal in the pre-participation sports evaluation of middle-aged persons. We examined the additional value of PWV measurements to traditional CAD risk factors for identifying CAD

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Conclusion