Πρόληψη αιφνιδίου καρδιακού θανάτου στους αθλητές

Transcription

1 Πρόληψη αιφνιδίου καρδιακού θανάτου στους αθλητές Σωκράτης Παστρωμάς Επιμελητής Α Τμήμα Ηλεκτροφυσιολογίας & Βηματοδότησης Ερρίκος Ντυνάν Hospital Center

2 Pheidippides sudden cardiac death in the Atheneum in 490 B.C Clin. Cardiol. 35, 2, (2012)

3 European Heart Journal (2015) 36,

4 Detrimental effects of exercise European Heart Journal (2015) 36,

5 Cardiovascular and peripheral adaptation to exercise in athletes 5-6 fold increase in cardiac output European Heart Journal (2015) 36,

6 Athletes heart vs. cardiomyopathy European Heart Journal (2015) 36,

7 Definition Epidemiology Incidence in athletes 35 yrs old is 0.6 to 3.6 per 100,000 population per year 10-fold greater risk in males compared to females The risk of SCD is greater in athletes >35 yrs old Adolescent and young adults involved in sports activity have an estimated risk of SCD that is 2.8 times greater than that of their nonathletic counterparts JACC Cardiovasc Imaging. 2013;6: Card Electrophysiol Clin 5 (2013) 13 21

8 Circulation 2012;125:

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10 Circulation 2009;119:

11 Distribution of cardiovascular causes of sudden death in 1435 young competitive athletes. From the Minneapolis Heart Institute Foundation Registry, 1980 to 2005 Circulation. 2007;115:

12 Post mortem cardiac pathology findings % of cases: myocardial disease

13 ESC, IOC, FIFA, NBA endorse cardiovascular screening including ECG AHA recommends screening using a health questionnaire and a brief physical examination without ECG

14 Trends in Sudden Cardiovascular Death in Young Competitive Athletes After Implementation of a Preparticipation Screening Program in Veneto prescreening period early screening period late screening period RR of SCD 44% lower RR of SCD 79% lower The annual incidence of SCD in athletes decreased by 89%, from 3.6 per 100,000 person-years during the prescreening period to 0.4 per 100,000 person-years during the late screening period Mortality reduction was predominantly due to a lower incidence of sudden death from cardiomyopathies JAMA 2006;296:1596

15 >80% <5%

16 University athletes (n=508) underwent routine medical history/physical examination and ECG before athletic participation Application of the 2010 ESC criteria, compared with the 2005 criteria, reduced the number of participants with abnormal ECG findings from 83/508 (16.3%) to 49/508 (9.6%) Heart 2011;97:1573e1577

17 2015 ESC Guidelines for SCD (in athletes) European Heart Journal (2015) 36,

18 785 athletes (73% males, 46.8±7.3 years) were enrolled over a 13-month period. 14.3% required additional examinations: 5.1% because of abnormal ECG, 4.7% due to physical examination, 4.1% because of high cardiovascular risk and 1.6% due to medical history. A new cardiovascular abnormality was established in 2.8% of athletes Conclusions: Cardiovascular evaluation of middle-aged athletes detected a new cardiovascular abnormality in about 3% of participants and a high-cardiovascular risk profile in about 4% Br J Sports Med 2014;0:1 6.

19 Performed by physicians or nurse practitioners/physician-assistants formally trained in physical examination techniques to perform athletic screening evaluations Not routine use of ECG Circulation. 2007;115:

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21 15 papers, 47,137 athletes Journal of Electrocardiology 48 (2015)

22 21 athletes with resuscitated cardiac arrest or SCD vs. 365 healthy athletes ECG analyses: J-point elevation (J wave), slurred QRS complex, & ST-segment elevation QRS slurring or J wave in the absence of ST elevation in the inferior-lateral ECG leads was associated with increased risk of CA or SD, whereas the presence of ST-segment elevation did not appear to increase such risk Circ Arrhythm Electrophysiol. 2010;3:

23 Recommendations for competitive sports participation in athletes with potential causes of SCD J Am Coll Cardiol 2013;61:

24 372 athletes, age yrs, median time since implantation was 27 mo, median f-u 31 mo Most of them: HCM, ARVC, LQTS 13% at least 1 appropriate shock 11% at least 1 inappropriate shock Freedom from lead malfunction was 97% at 5 years (from implantation) and 90% at 10 years Circulation. 2013;127:

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