Key result
Anomalous left circumflex artery shows benign anatomy and zero anomaly-related CV deaths in master athletes.
Why the study?
To describe clinical outcomes in master athletes with an anomalous origin of the left circumflex artery from the right sinus of Valsalva to establish clinical management and sports counseling.
Does the anomalous origin of the left circumflex artery from the right sinus of Valsalva correlate with high-risk anatomical features or adverse clinical outcomes in master athletes?
Observational (n=14)
No
Does the anomalous origin of the left circumflex artery from the right sinus of Valsalva correlate with high-risk anatomical features or adverse clinical outcomes in master athletes?
Anomalous origin of the left circumflex artery from the right sinus of Valsalva in master athletes is typically associated with low-risk anatomical features and follows a benign clinical course.
Supports low-risk profile in master athletes; hypothesis-generating and leaves open larger prospective studies before practice change.
BACKGROUND: Aim of the study was to collect and describe a case series of consecutive master athletes in whom an anomalous origin of left circumflex artery (LCx) from the right sinus of Valsalva (ALCx) was detected at a clinically indicated coronary computed tomography angiography CCTA) to establish a focused clinical management and counseling about sport activity in those subjects. METHODS: We analyzed a prospective registry of subjects referred to a clinically indicated CCTA. Information about the clinical status was obtained by previous clinical records and clinical evaluation at time of image acquisition; follow-up allowed to record symptoms, outcomes and downstream testing. RESULTS: The study population consisted in 14 subjects, of which one competitive athlete and 13 recreational master athletes. Mean age was of 67.2 ± 10.6 years (71% of male); follow-up lasted 6.4 ± 2.6 years. The major high-risk anatomy features (inter-arterial course, intramural segment, high take-off and slit-like ostium) were absent. None had abnormal ostial morphology and all had full retroaortic course; three subjects (21%) presented an acute take-off angle. Coronary artery disease (CAD) was present in 10 patients (71%). Major outcomes (cardiac hospitalization, death for all causes) recorded were not related to the anomalous LCx. Symptoms were most related to atherosclerotic CAD in different vessels whereas two subjects without CAD exhibited cardiac symptoms, without hospitalization. CONCLUSIONS: Our study suggests that the diagnosis of ALCx, being usually associated to low-risk anatomical characteristics, could be considered a benign finding, with scarce or no implications for physically active individuals neither for recreational athletes.
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Ratti et al. (2023) conducted an observational in Anomalous origin of left circumflex artery from the right sinus of Valsalva (n=14). Anomalous origin of left circumflex artery (ALCx) was evaluated on Presence of high-risk anatomy features at CCTA and major clinical outcomes (cardiac hospitalization, death). In 14 master athletes with anomalous origin of the left circumflex artery, high-risk anatomical features were absent and no anomaly-related cardiovascular deaths occurred over 6.4 years.
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