Asymptomatic Athlete Research Articles

Massive Restrictive Aortic Regurgitation Caused by Aortic Chordae Tendineae Strands: Unusual Links

Determination of the etiology of a valvular heart disease is one of the major steps of every echocardiogram. Sometimes very unusual and rare etiologies can be found. In this article we report a case of very rare cause of aortic regurgitation, caused by the presence of aortic chordae tendineae strands leading to aortic cusps restriction in young asymptomatic athlete. In this case, we discuss two major problems. The first is the challenging diagnosis of this chordae tendineae strands, the second is the evaluation of an asymptomatic severe aortic regurgitation in a competitive athlete with an enlarged left ventricle.

Large Ostium Primum Interatrial Septum Defect in Asymptomatic Adult Athlete with Mitral Valve Prolapse and New Onset of Atrial Fibrillation

A large spectrum of congenital cardiac malformations can be the consequence of deficient formation of the embryonic atrioventricular canal by the endocardial cushions [1]. Among them, together with bicuspid aortic valve and mitral valve prolapse (MVP) [2], atrial septal defects (ASD) are one of the most frequent congenital heart diseases in adulthood. Differently from patients with secundum defects, ostium primum ASD are rarely reported in adulthood because those patients often require medical attention in pediatric age due to severity of symptoms. In ostium primum defect, in addition to the septal defect, the atrioventricular valves are often abnormal, including a cleft in the anterior mitral leaflet [3]. MVP is found in 30%-35% of ASD patients with or without significant mitral regurgitation (MR)and seems to be secondary to an abnormal left ventricular geometry and dilatated right ventricle which leads to shortening of inter-papillary distance and redundant chordae tendineae [4]. Atrial fibrillation (AF) is the most common cause of hospital admission among all arrhythmias in general population and AF is also the most common arrhythmia in the athletic population [5].

Progression of Wolff-Parkinson-White pattern 12-lead electrocardiogram changes in an asymptomatic athlete.

Progression of Wolff-Parkinson-White pattern 12-lead electrocardiogram changes in an asymptomatic athlete.

Post-COVID-19 Cardiovascular Evaluation in National Collegiate Athletic Association Division I Athletes.

To evaluate the necessity of cardiac testing after a COVID-19 diagnosis as it relates to myocarditis in collegiate athletes. Cross-sectional retrospective case series. National Collegiate Athletic Association Division I University. One hundred sixty-five collegiate athletes diagnosed with COVID-19 by reverse transcriptase-polymerase chain reaction or immunoglobulin G antibody between August and December 2020 without exclusion. All participants underwent cardiac workup consisting of serum troponin, electrocardiogram, transthoracic echocardiogram, and cardiac magnetic resonance (CMR). All results were reviewed by team physicians and sports cardiologists. Prevalence of myocarditis and abnormality on cardiac testing after COVID-19 infection at a single institution. One (0.61% [95% CI, 0.02%-3.3%] asymptomatic athlete had CMR findings of an age-indeterminate myocardial injury with further cardiac testing being otherwise normal. No athlete had CMR abnormalities consistent with acute myocarditis by the modified Lake Louise Criteria. Occurrence of myocarditis was lower in this population compared with other studies. No student athlete was permanently disqualified from participation because of testing. A stratified, risk-based testing strategy with CMR may be more appropriate than a universal screening strategy.

Abstract 9912: A Case of Left Ventricle Non-Compaction in an Asymptomatic Athlete

Introduction: Left ventricle non-compaction (LVNC) is defined as a primary genetic cardiomyopathy by the American Heart Association and as an unclassified cardiomyopathy by the European Society of Cardiology. Phenotypically, it is characterized by prominent trabeculations and intertrabecular recesses in the ventricular cavity. The clinical manifestations of LVNC range from an asymptomatic state to progressive heart failure and life-threatening arrhythmias. The following case highlights an athletic patient with LVNC. Case Presentation: A 22-year-old male presented to the cardiology clinic for evaluation prior to enrolling in the police academy. At age 15, an echo revealed prominent trabeculations. The patient has been a competitive soccer player since high school. Upon presentation, he was asymptomatic with non-specific T wave changes noted on ECG, stress echocardiography revealed preserved functional capacity, prominent trabeculations, and EF 55%. No arrhythmias were noted. CMR revealed a hyper-trabeculated LV predominantly at the mid-ventricular and apical segments, moderate left and right ventricular enlargement with EF 55%. No LGE enhancement was noted. Discussion: LVNC is estimated to affect 8-12 patients per 1 million annually, but the actual number is likely higher as many individuals are asymptomatic. Although the cause of LVNC is unclear, it has been associated with mutations in sarcomere encoding genes including MYH7 and MYBPC3. It remains controversial whether LVNC is a distinct disorder since it has been reported in other cardiomyopathies and since it has been reported in pregnancy and trained athletes. The current diagnostic criteria for LVNC include a ratio of non-compacted to compacted myocardium >2.1:1 as demonstrated by echo or a ratio of >2.3:1 by CMR. However, it has been proposed that trabeculation formation represents a physiological adaptation to increased loading conditions seen in pregnancy and vigorously trained athletes. Therefore, it remains unclear whether the current diagnostic criteria apply to an athletic population. Furthermore, the prognostic implications of prominent trabeculations meeting accepted diagnostic criteria for LVNC remain uncertain.

Ultrasound feature variants of the adductor longus tendon in asymptomatic sportive subjects: Management implications

ObjectivesThe potential contribution of ultrasound (US) to diagnose adductor longus (AL) tendinopathy in athletic pubalgia requires clarification. We investigate US findings from AL tendons of asymptomatic participants to identify the range and prevalence of common US features not associated with groin pain. MethodsWe consecutively enrolled 45 volunteers physically active participants with no history of groin pain. US features of bilateral AL tendons were investigated and recorded by two experienced musculoskeletal radiologists (MSKR) in accordance with a defined ultrasound protocol. Two other MSKRs retrospectively and independently analyzed all US images. ResultsNinety AL tendons from 45 participants (4/45 women) were imaged (average age: 35 years ±14.6; dominant side: 37/45 (82.2%) right, 8/45 (17.8%) left). Abnormalities on US were found in all 45 (100%) AL tendons, including: abnormal echogenicity (98.9%/100% respectively according to reader), loss of fibrillar structure (92.2%/97.8%), irregularities of the superficial paratendon (23.3%/30%), calcifications (22.2%/25.5%), and cortical erosion (52%/55.5%), with excellent inter-observer assessment. No AL tears or hyperemia at color Doppler were detectable. ConclusionsAL tendon abnormalities were identified via US in 100% of our asymptomatic athletes. The significance of these US findings should be interpreted cautiously with respect to clinical presentation. On the other hand, there is a need for supplemental investigation into the clinical relevance of US AL tendon tears not present in the present asymptomatic athlete population.

Surveillance testing for SARS-COV-2 infection in an asymptomatic athlete population: a prospective cohort study with 123 362 tests and 23 463 paired RT-PCR/antigen samples

ObjectiveTo assess the diagnostic accuracy of antigen compared with reverse transcriptase (RT)-PCR testing in an asymptomatic athlete screening programme and to monitor infection in college athletes.MethodsQuidel Sofia-2 SARS-CoV-2 Antigen Tests...

Aortic dilation and tricuspid valve prolapse in an asymptomatic young athlete

Aortic dilation and tricuspid valve prolapse in an asymptomatic young athlete

Surveillance Testing for SARS-CoV-2 Infection in an Asymptomatic Athlete Population; The Experience of 123,362 Tests and 23,463 Paired RT-PCR/Antigen Samples

Background: This study assesses the diagnostic accuracy of antigen testing compared to RT-PCR in asymptomatic collegiate athletes and describes outcomes of a surveillance testing program.Methods: Quidel Sofia-2 SARS-CoV-2 Antigen Tests were performed daily prior to sport participation for high-risk of transmission (HROT) sports from September 29, 2020-February 28, 2021. Paired RT-PCR and antigen tests were performed at least once a week. Positive antigen tests were reflexed to RT-PCR.Findings: There were 1,931 athletes in 6 HROT sports. A total of 81,175 antigen and 42,187 RT-PCR tests were performed (including 23,463 paired antigen/RT-PCR surveillance tests). There were 346 athletes (17·9%) with a positive RT-PCR test during the study period. Of the positive RT-PCRs, 83 (4·4%) occurred on paired testing days. The clinical sensitivity of antigen tests varied with the frequency of RT-PCR testing and prevalence of COVID-19. With once-a-week PCR testing, the clinical sensitivity of antigen testing was 35·7% (95% CI: 17%, 60%) and specificity 99·8% (95% CI: 99·7%, 99·9%), after adjusting for school prevalence. Daily antigen testing was similar to PCR testing 2-3 times a week in identifying infection, however, antigen testing identified infection prior to the next scheduled PCR on 89 occasions. This resulted in a 234 days where potentially infectious athletes were isolated prior to when they would have been isolated with RT-PCR testing alone. Among athletes who had RT-PCR testing 4 times a week, daily antigen testing did not increase sensitivity. Two (14%) athletic-related outbreaks occurred but 86% of infections were community-acquired.Interpretation: Screening for asymptomatic SARS-CoV-2 can be successful using different strategies. Physical mitigation is important even with frequent screening.Funding Statement: This study was funded by Quidel Corporation. Declaration of Interests: Kimberly G. Harmon declares grants from American Medical Society for Sports Medicine for Outcomes Registry for Cardiac Outcomes in Athletes; grants from Pac-12 Conference as Research Development Director, she is also the President of the American Medical Society for Sports Medicine Foundation Board. All other authors have nothing to declare. Ethics Approval Statement: The study was considered exempt by the University of Washington Institutional Review Board. Data sharing agreements for data in the Pac 12 HAP were in place for all institutions.

Preliminary Feasibility Study to Measure the Immediate Changes of Bilateral Asymmetry After Lumbar Spinal Manipulative Therapy in Asymptomatic Athletes

ObjectiveThe purpose of this preliminary study was to assess the feasibility of a study to measure the immediate changes in bilateral asymmetry on physical performance tests before and after lumbar spinal manipulative therapy (SMT). MethodsThirteen asymptomatic athletes participated in this study. Each participant underwent a clinical and physical evaluation for inclusion according to eligibility criteria. Assessments were performed in all participants and included a physical test symmetry sequence (static standing position, squat, and countermovement jump) before and after lumbar SMT intervention. The immediate changes were quantitatively measured from before to after intervention by statistical calculations. ResultsAll recruited participants completed the study, and none of them reported complaints during participation. Statistically significant differences between before and after lumbar SMT were found only for static symmetry (respectively, mean = 14.4% and 3.7%), not for squatting or the countermovement jump. ConclusionAccording our sample characteristics, asymptomatic athlete participants, presented initially bilateral asymmetry values, such as described in the literature, and after lumbar SMT, these values decreased significantly in static posture. This preliminary study demonstrates the feasibility to measure the pre-to-post changes in symmetry after lumbar SMT intervention. The results showed a great decrease in bilateral asymmetry on static symmetry percentage, but none in dynamic tests, which deserves further investigation. Nevertheless, this preliminary study demonstrated the feasibility of measuring the immediate changes in symmetry produced by lumbar SMT, and of a larger study to measure whether lumbar SMT changes symmetry.

Differentiation of T-wave Inversion Changes with Borderline Left Ventricular Hypertrophy in an Asymptomatic Young Athlete – Case Report and Literature Review

This is a case of initially 15 years of age, white, male from junior football team. He was completely asymptomatic, with no previous medical history or family history of sudden cardiac death and cardiac diseases. He has been playing football for 8 years. On periodic preparticipation screening, he presented T-wave inversions (TWIs) in leads V4–V6 and II, III, and aVF, which were not observed before on yearly screenings. Subsequently, he underwent echocardiography, which showed mildly increased myocardial thickness (13 mm) without other abnormalities. He was then referred to for further testing, which is discussed in the context of the current literature. Finally, management is presented.

Place de l’épreuve d’effort chez le sportif

Is the stress test still part of the useful examinations in the detection of risk heart disease in sports subjects? Should we continue to use it as a surveillance examination in coronary sports patients? Meta-analysis, considering a ST subshift of more than 1mm as a criterion for positivity, underline the low prevalence of abnormal examinations and a significant rate of false-positives. But for the diagnosis of coronary artery disease, it is mainly the evolution of the ST segment to effort or recovery and the occurrence of stress arrhythmias that detect true positivity. When coronary risk is more important (presence of risk factors, resumption of sport, intense and prolonged efforts), it seems lawful to recommend such a review on a regular basis among men over 40 years of age with two risk factors but Also among veterans taking up sport after a period of prolonged inactivity. For the asymptomatic coronary athlete the stress test remains at the centre of the final decision for the resumption of a sport in competition irrespective of the method of revascularization. Of course the stress test, even inevitable, remains flawed in the detection of coronary artery disease in the asymptomatic athlete. However, it provides additional information on the condition of being maximal, and attaching importance to arrhythmias, the tensional profile and the maximum power developed in addition to the ST segment's only study.

Impact of molecular diagnostics in an asymptomatic amateur athlete found to be affected by hypertrophic cardiomyopathy

Impact of molecular diagnostics in an asymptomatic amateur athlete found to be affected by hypertrophic cardiomyopathy

Diagnostic dilemma of deep T-wave inversion for sports participation: Two contrasting case reports

Sudden cardiac death (SCD) is the leading cause of death in athletes. Among which, cardiomyopathy is the most common in young asymptomatic sportsperson. The electrocardiogram (ECG) is used as a primary screening and diagnostic tool for detecting underlying conditions associated with SCD. However, providing medical clearance for an asymptomatic athlete without any positive personal or family history is especially challenging when the athlete demonstrates abnormal ECG, particularly repolarization patterns, highly suggestive of an inherited cardiomyopathy, or ion channelopathy. This paper presents two such cases of contrasting diagnostic conundrum which may help sports physicians and cardiologists working with athletes.

Scapulohumeral rhythm in young tennis players

Intensive tennis practice, with its unilateral solicitation, leads to sport-specific adaptations particularly in shoulder range of motion and muscular strength at the dominant shoulder (Gillet et al., 2017). However, excessive or imbalance changes are known to increase the risk of shoulder injuries (Chorley et al., 2017). Shoulder injuries can be evaluated and prevented by monitoring the scapulohumeral rhythm (SHR). The SHR assess the contribution of the humerus and the scapula during the arm elevation. Commonly, a 2:1 ratio is observed and its alterations are related to shoulder injuries (Hosseinimehr et al., 2015). However, asymptomatic overhead adult athlete presents a lower SHR ratio in the dominant side compared with the nondominant one (Hosseinimehr et al., 2015). To our knowledge, the SHR in young competitive tennis players has not been characterized yet. A better description of the SHR in such a population may help to improve the shoulder injury prevention. This study aimed to describe the SHR of young competitive tennis players. We hypothesized that the SHR in the dominant side should be lower than the nondominant one.

Bradycardia and Prolonged Ventricular Pauses in Athletes

Cardiovascular modifications generated by high performance sports conform the athlete’s hear syndrome. These changes are manifested in the physical exam, electrocardiographic (at rest and with stress exercise) and echocardiographic studies and even in magnetic resonance imaging. (1, 2) Occasionally, the differentiation from diverse cardiac diseases is difficult and the decision to discharge or nor the athlete from sports activity can be complicated. (3) Although ending sports activities in a patient with certain cardiac diseases may protect him from a fatal event, unnecessary athlete disqualification is usually associated with psychosocial and economic problems which significantly alter quality of life. Severe sinus bradycardia (SB) and presence of prolonged ventricular pauses in Holter monitoring is one of the situations generating doubts in the conduct to follow in the asymptomatic athlete. When present, the athletes are occasionally discouraged to continue sports training, and even treatments, such as pacemaker implantation, may be suggested. The purpose of this presentation is to pose different cases with comments on the adopted decision. Four cases of asymptomatic high-performance athletes with prolonged ventricular pauses on Holter monitoring will be presented. Athletes had no structural heart disease (normal Doppler echocardiography and magnetic resonance imaging with and without gadolinium) and with adequate chronotropic response to exercise. A brief review and discussion will follow this presentation.

PREVALENCE OF ACETABULAR LABRAL TEARS IN ASYMPTOMATIC YOUNG ATHLETES

BackgroundYouth sport injuries are on the rise. These injuries at an early age may prevent young people from continuing with sports or eventually limit their ability to participate in physical...

Clinical importance of follow-up scans to detect cardiomyopathies with delayed phenotypic expression

A 13-year-old asymptomatic athlete underwent cardiovascular magnetic resonance (CMR) because of inferolateral-negative T-waves at electrocardiography ( Panel 1 ). He had neither family history of cardiac disease or sudden death, nor major arrhythmias at cycle ergometry and 24-h Holter monitoring, but only rare supraventricular and ventricular ectopic beats. His CMR showed only a bizarre shape of the …

A case of asymptomatic patient with right ventricular dilatation

Sinus venous defect is an uncommon type of atrial septal defect (ASD), often associated with anomalous pulmonary vein drainage and left to right shunting. If undetected, it leads to right atrial and ventricular volume overload. The current case describes an asymptomatic athlete with missed large sinus venosus defect since birth, and the different types of cardiac imaging modalities that lead to the detection of the defect and guiding the appropriate surgical intervention.

Endocardial Electrophysiological Study in an Asymptomatic Competitive Athlete With Ventricular Preexitation due to Conduction via Fasciculoventricular Accessory Pathway

We present a clinical case of a rare form of the WPW phenomenon due to anterograde conduction over fasciculoventricular accessory pathway in 20-year-old competitive athlete. The patient had no history of palpitations or syncope. ECG revealed shortening of PQ interval (112 ms) and wide QRS complex due to conduction via accessory pathway. To address the question of participation in competitive activity and the need for ablation the patient underwent endocardial electrophysiological study in the course of which we verified conduction via fasciculoventricular accessory pathway. The result of the study was used in determination of strategy of further management.