Conventional screening poorly identified subclinical CAD, as cardiac CT revealed high atherosclerotic burden in 25.7% of veteran athletes, of whom only 6 had abnormal exercise tests.
Cross-Sectional (n=105)
Does the inclusion of cardiac CT improve the detection of subclinical coronary artery disease compared to conventional preparticipation screening in asymptomatic veteran athletes?
Conventional preparticipation screening based on clinical risk factors and exercise testing is poor at identifying significant subclinical CAD in veteran athletes, suggesting a potential role for cardiac CT.
Objective Preparticipation evaluation of veteran athletes should focus on accurate cardiovascular (CV) risk stratification and subclinical detection of coronary artery disease (CAD), which is the main cause of sudden cardiac death in this population. We aimed to investigate the effectiveness of current preparticipation methodology used to identify veteran athletes with high coronary atherosclerotic burden. Methods A total of 105 asymptomatic male athletes aged ≥40 years old, with low to moderate CV risk (Systematic Coronary Risk Estimation <5%) who trained ≥4 hours/week for at least 5 years, were studied. The screening protocol included clinical evaluation, ECG, transthoracic echocardiogram and exercise testing. Cardiac CT was performed to detect CAD, defined as a high atherosclerotic burden according to coronary artery calcium score and coronary CT angiography. Results The majority of the athletes (n=88) engaged in endurance sports, with a median volume of exercise of 66 (44; 103) metabolic equivalent task score/hour/week. Exercise testing was abnormal in 13 (12.4%) athletes, 6 (5.7%) with electrocardiographic criteria for myocardial ischaemia and 7 (6.7%) with exercise-induced ventricular arrhythmias. A high coronary atherosclerotic burden was present in 27 (25.7%) athletes, of whom 11 (40.7%) had CV risk factors and 6 had abnormal exercise tests, including 3 who were positive for myocardial ischaemia. Conclusions Conventional methodology used in preparticipation evaluation of veteran athletes, based on clinical CV risk factors and exercise testing, was poor at identifying significant subclinical CAD. The inclusion of more objective markers, particularly data derived from cardiac CT, is promising for more accurate CV risk stratification of these athletes.
Dores et al. (Fri,) conducted a cross-sectional in Subclinical coronary artery disease (n=105). Cardiac CT vs. Conventional preparticipation evaluation was evaluated on High coronary atherosclerotic burden. Conventional screening poorly identified subclinical CAD, as cardiac CT revealed high atherosclerotic burden in 25.7% of veteran athletes, of whom only 6 had abnormal exercise tests.
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