Prevalence of atherosclerotic coronary artery disease in master athletes with exercise-induced ventricular arrhythmias: implications for pre-participation screening

Abstract Background The leading cause of sudden cardiac death in master athletes (≥35 years) is coronary atherosclerotic disease (CAD). During pre-participation screening (PPS), the primary indication for investigating CAD in this population is ST-segment depression at exercise test (ET); a second most debated indication is represented by high-risk premature ventricular beats (PVBs), which are considered another potential marker of ischemic heart disease. However, the prevalence of coronary artery disease in master athletes with PVBs is still unknown. Purpose The aim of this study was to evaluate the prevalence of CAD in master athletes who underwent coronary computed tomography (CCT) due to high-risk PVBs during PPS (emerging indication), and to compare this population to age-, gender- and risk factors-matched group of athletes who underwent CCT due to ST segment depression during ET (traditional indication). Methods We retrospectively enrolled master athletes with no baseline ECG abnormalities and no previous history of heart disease who underwent CCT due to non-common PVBs during PPS. We compared them with a control group of athletes with ST-segment depression during PPS. The entity of the disease was assessed using the CAD-RADs scoring system (0= no plaque, 1=minimal stenosis 1-24%, 2=mild stenosis 25-49%, 3= moderate stenosis 50-69%, 4A= severe stenosis 70-99%, 4B= severe stenosis 70-99% left main stem 50% or 3 vessels ≥70%, 5= total occlusion). Results The population resulted to be composed by 70 Caucasian athletes, median age 53 (44-59 years, 88% male), 73% practiced endurance sports. Thirty-five of them underwent CCT for ST-segment depression and 35 for high-risk PVBs. A CAD-RADs of 0 was detected in 63% of athletes, 1-2 in 25.6%, 3 in 5.7%, and 4A-4B in 5.7%. A CAD was found in 37% of athletes investigated for PVB at ET and the same prevalence was found among subjects with ST-depression (p=0.8). Between athletes with moderate-severe CAD, 75% had one or more cardiovascular risk factors, while 25% had no risk factors. Conclusions The prevalence of CAD in master athletes resulted to be equivalent in case of PVBs and ST-segment depression and, in the majority of cases, was a mild disease. Despite a coronary artery stenosis 50% was detected just on 12% of athletes who underwent CCT for these indications, however in both groups (PVB and ST-segment depression) the severity of CAD increased with the rise of cardiovascular risk factors. Therefore, the systematic execution of CCT among master athletes with non-common PVBs does not seem justified, but the indication should be reserved for selected cases with cardiovascular risk factors.