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Abstract Background Pre-participation screening (PPS) of athletes aged over 35 years (master athletes, MA) is a major concern in Sports Cardiology. In this population, exercise-related sudden cardiac death (SCD) is rare but primarily due to coronary atherosclerosis (cATS)1 often resulting from acute plaque rupture/erosion or complication of severe stenosis in most cases, making mandatory the need for early detection of apparently healthy competitive mature athletes. Despite its excellent negative predictive value 2, the possible role of Coronary CT Angiography (CCTA) in this context has yet to be clearly defined 3. Purpose To evaluate the contribute of CCTA for the sport suitability and clinical management of MA assessed in course of PPS with risk factors, symptoms and/or positive/equivocal stress-test ECG. Methods We retrospectively enrolled MA who underwent CCTA in our hospital in the last 12 years, analyzing symptoms, stress-test ECG, cardiovascular risk profiles (SCORE) and CCTA findings. Results The study population included 167 MA (143 males, 24 females, mean age 53±10 and 54±9 years, respectively). Among the whole enrolled population, 153 (91.6%) MA underwent CCTA for equivocal/positive stresstest ECG with/without symptoms, 13 (7.8%) just for clinical symptoms, 1 (0.6%) for the family history. The CCTA showed the presence of cATS in 69 MA (41.3%), congenital coronary anomalies (anomalous origin or deep myocardial bridge) in 8 (4.8%), both in 7 (4.2%). A negative CCTA was observed in 83 MA (49.7%). The risk-SCORE (age, hypertension, hypercholesterolemia, smoking) was a good indicator for the presence of moderate/severe cATS on CCTA. However, mild/moderate cATS was present in 17.2% of MA clinically stratified at a low risk-SCORE. Conclusion While invasive angiography is more indicated in MA with positive stress-test ECG if symptomatic and/or with high/very high risk-SCORE, in our experience CCTA may be helpful in the PPS of MA (males/postmenopausal females) with an abnormal stress-test ECG and/or clinical symptoms engaged in competitive sports with a high cardiovascular involvement. Age, gender, presence of symptoms and clinical risk-SCORE assessment may help sports physicians and cardiologists to decide whether to request a CCTA or not.Flow-Charts CCTA
Moliterno et al. (Thu,) studied this question.