Abstracts
S11
Differentiating physiology from pathology in elite athletes Thursday, 14 May 2015, 16:30–18:00 82 Sub-epicardial gadolinium enhancement in asymptomatic athletes: let sleeping dogs lie?
F Schnell1, G Claessen2, A La Gerche3, J Bogaerts4, PA Lentz5, P Claus6, PH Mabo7, F Carre1, H Heidbuchel8 1 Inserm U1099, Rennes, France, 2Gasthuisberg University Hospital, Department of Cardiology, Leuven, Belgium, 3St Vincent’s Hospital, Department of Medicine, Melbourne, Australia, 4 Gasthuisberg University Hospital, Department of Radiology, Leuven, Belgium, 5Hospital Pontchaillou of Rennes, Department of Radiology, Rennes, France, 6University of Leuven, Department of Cardiovascular Imaging and Dynamics, Leuven, Belgium, 7University Hospital of Rennes - Hospital Pontchaillou, Department of Cardiology and Vascular Disease, Rennes, France, 8 Heart Centre Hasselt, Hasselt, Belgium
exercise during silent myocarditis may facilitate fibrosis generation and/or promote adverse remodeling. LGE pattern in the 7 athletes
Topic: Sports cardiology Purpose: The prognostic relevance of sub-epicardial late gadolinium enhancement (LGE) patches without underlying cardiomyopathy, and likely the result of prior silent myocarditis, in asymptomatic athletes is unknown. Therefore, management is challenging and medical clearance for competitive sports participation is debated. This case series aims to relate this pattern of LGE in athletes to outcome. Methods: We report on 7 young asymptomatic athletes (26.14.9 years of age) with isolated sub-epicardial LGE. All underwent a comprehensive initial investigation in order to assess LV function at rest and exercise (exercise CMR and/or exercise echocardiography) and occurrence of arrhythmias (exercise test, 24h-ECG Holter, electrophysiological study). All underwent a careful follow-up with biannual evaluation. Results: The athletes were referred because of abnormalities on their regular screening examination, i.e. T wave inversions on ECG (n=4) or ventricular arrhythmias on exercise test (n=3). All athletes had extensive sub-epicardial LGE (12.04.8% of LV myocardial volume), predominantly in the lateral wall. Three athletes had nonsustained ventricular arrhythmias, two of them had subnormal LV function at rest and no contractile reserve at exercise. These 3 athletes stopped sports. During a follow-up of 3.01.5 years in the 4 remaining athletes, two had symptomatic VT and one showed deterioration of LV function. Hence, 6 out of 7 athletes had to be excluded from competitive sports participation. Conclusions: Sub-epicardial LGE in an asymptomatic athlete is not benign and should require a careful evaluation at exercise and a strict follow-up. The findings question whether extreme
Downloaded from cpr.sagepub.com by guest on June 4, 2016
S11
Differentiating physiology from pathology in elite athletes Thursday, 14 May 2015, 16:30–18:00 82 Sub-epicardial gadolinium enhancement in asymptomatic athletes: let sleeping dogs lie?
F Schnell1, G Claessen2, A La Gerche3, J Bogaerts4, PA Lentz5, P Claus6, PH Mabo7, F Carre1, H Heidbuchel8 1 Inserm U1099, Rennes, France, 2Gasthuisberg University Hospital, Department of Cardiology, Leuven, Belgium, 3St Vincent’s Hospital, Department of Medicine, Melbourne, Australia, 4 Gasthuisberg University Hospital, Department of Radiology, Leuven, Belgium, 5Hospital Pontchaillou of Rennes, Department of Radiology, Rennes, France, 6University of Leuven, Department of Cardiovascular Imaging and Dynamics, Leuven, Belgium, 7University Hospital of Rennes - Hospital Pontchaillou, Department of Cardiology and Vascular Disease, Rennes, France, 8 Heart Centre Hasselt, Hasselt, Belgium
exercise during silent myocarditis may facilitate fibrosis generation and/or promote adverse remodeling. LGE pattern in the 7 athletes
Topic: Sports cardiology Purpose: The prognostic relevance of sub-epicardial late gadolinium enhancement (LGE) patches without underlying cardiomyopathy, and likely the result of prior silent myocarditis, in asymptomatic athletes is unknown. Therefore, management is challenging and medical clearance for competitive sports participation is debated. This case series aims to relate this pattern of LGE in athletes to outcome. Methods: We report on 7 young asymptomatic athletes (26.14.9 years of age) with isolated sub-epicardial LGE. All underwent a comprehensive initial investigation in order to assess LV function at rest and exercise (exercise CMR and/or exercise echocardiography) and occurrence of arrhythmias (exercise test, 24h-ECG Holter, electrophysiological study). All underwent a careful follow-up with biannual evaluation. Results: The athletes were referred because of abnormalities on their regular screening examination, i.e. T wave inversions on ECG (n=4) or ventricular arrhythmias on exercise test (n=3). All athletes had extensive sub-epicardial LGE (12.04.8% of LV myocardial volume), predominantly in the lateral wall. Three athletes had nonsustained ventricular arrhythmias, two of them had subnormal LV function at rest and no contractile reserve at exercise. These 3 athletes stopped sports. During a follow-up of 3.01.5 years in the 4 remaining athletes, two had symptomatic VT and one showed deterioration of LV function. Hence, 6 out of 7 athletes had to be excluded from competitive sports participation. Conclusions: Sub-epicardial LGE in an asymptomatic athlete is not benign and should require a careful evaluation at exercise and a strict follow-up. The findings question whether extreme
Downloaded from cpr.sagepub.com by guest on June 4, 2016
