Vai ai contenuti. | Spostati sulla navigazione | Spostati sulla ricerca | Vai al menu | Contatti | Accessibilità

| Crea un account

Pescatore, Valentina (2013) Cause cardiovascolari di non idoneità all'attività sportiva agonistica. Studio e follow-up di atleti non idonei nel decennio 2001-2010 presso la Medicina dello Sport di Noale (VE). [Tesi di dottorato]

Full text disponibile come:

[img]
Anteprima
Documento PDF
3132Kb

Abstract (inglese)

Objective. The main goal of pre-participation screening is to identify the cohort of athletes affected by cardiovascular diseases at risk of sudden death during sports. The aim of this work is to analyze the cardiovascular causes of disqualification from competitive sports in athletes (young and master athletes) consecutively screened at the Centre for Sport Medicine in Noale (VE) between 2001 and 2010, and to collect the long term follow-up data about these athletes.
Methods. During the 2001-2010 period, 35627 athletes were screened (aged ≤ 35 years 91% and Master athletes 9%, 29% female). The athletes ultimately disqualified were 99 (2‰), 94 (95%) because of cardiovascular causes and 5 (5%) non-cardiovascular causes. Cardiovascular conditions causing disqualification were distinctly analyzed in athletes ≤35 years of age and Master, and on the basis of the reasons for proceeding to further examinations, i.e. 2nd level examination (echocardiography, 24-h Holter monitoring, exercise testing, cardiac magnetic resonance-CMR-, computed tomography, myocardial perfusion scintigraphy) and 3rd level (coronary angiography, endomyocardial biopsy, electrophysiological study). A sub-study was carried out on athletes with the suspicion of left circumflex coronary artery origin from the right aortic sinus by echocardiography, running behind the aorta, in order to better clarify the current guidelines regarding sports eligibility.
Results. A) Young athletes, aged ≤ 35 years, eventually disqualified from participation in competitive sport were 63 (1.9‰). They were referred for further examination because of personal history of cardiovascular diseases in 15 (24%), heart murmurs or systemic hypertension at physical examination in 5 (8%), changes on the 12-lead electrocardiogram or submaximal exercise test (arrhythmias or myocardial ischemia) in 39 (62%); reasons remained unknown in 4 (6%). Cardiovascular causes of disqualification were: bicuspid aortic valve with dilatation of ascending aorta or valve incompetence/stenosis (12), mitral valve prolapse with polymorphic ventricular arrhythmias (10), arrhythmogenic right ventricular cardiomyopathy (3), hypertrophic cardiomyopathy (3), congenital coronary artery diseases (3), previous myocarditis (2), dilated cardiomyopathy (1), atherosclerotic coronary artery disease (1), atrial septal defect (1), previous surgical repair of atrial septal defect (1), coronary artery aneurysms post- Kawasaki disease (1), left ventricular diverticulum (1), systemic hypertension (2) pulmonary hypertension (1). Finally rhythm and conduction abnormalities included junctional or supraventricular arrhythmias (3), 3rd-degree atrioventricular block (1), long QT syndrome (1), atrial fibrillation (1), and idiopathic ventricular arrhythmias (15). In a mean follow up of 63±34 months, the clinical course was unremarkable. Altogether the cardiac disease at risk of sudden death in the young (hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, congenital coronary artery anomalies) were identified in 8 athletes and they were all referred for further examination because of positive 12-lead ECG or ventricular arrhythmias. In 3 athletes the cardiovascular disease was not confirmed by additional tests (false-positive results).
B) Master athletes disqualified from participation in competitive sport were 31 (1%). They were referred for further examination because of personal history of valve disease 1 (3%), systemic hypertension at physical examination 3 (10%), ECG abnormalities in 2 (7%), positive finding in maximal stress test (arrhythmias or myocardial ischemia) in 23 (74%). In 2 (6%) athletes data are not available. Cardiovascular causes of disqualification in Master athletes were: mitral valve prolapse with ventricular arrhythmias (5), atherosclerotic coronary artery disease (4), systemic hypertension con multiorgan damage (3), hypertrophic cardiomyopathy (2), arrhythmogenic right ventricular cardiomyopathy (1), dilated cardiomyopathy (1), ventricular arrhythmias in myocardial fibrosis of unknown etiology (2), mitral valve prolapse with moderate incompetence (1) and finally idiopathic ventricular arrhythmias (12). In a mean follow-up of 76±41 months there were no deaths or other major events. The most common structural cardiovascular disease was coronary artery atherosclerosis with 4 athletes identified because of myocardial ischemia during stress test e 2 athletes with ventricular arrhythmias and ischemic heart disease onset during follow-up.
A total of 27 athletes (15 young and 12 Master athletes) were eventually considered affected by idiopathic ventricular arrhythmias. Among the 25 with available clinical and instrumental data, CMR was performed in 11 (42%), with contrast enhancement in 6 (23%).
C) Among 11 athletes with suspicion of anomalous origin of the left circumflex coronary artery from the right aortic sinus, only 1 showed abnormalities at basal ECG (ST-T changes in inferior and lateral leads). The diagnosis of anomalous coronary course behind the aorta was confirmed in 9 athletes (82%), while in 2 athletes there were normal coronaries. In one athlete with ST abnormalities on effort, inducible ischemia at stress CMR with signs of late enhancement, angiography demonstrated an anomalous origin of the right coronary artery from the left aortic sinus running behind the aorta. This patient was disqualified from sport participation. Among the remaining 10 athletes, all with negative stress test, no clinical events occurred during a mean follow-up of 24 months, despite they continued to participate in sport activities.
Conclusions. The rate of disqualification at pre-participation screening because of cardiovascular diseases is higher in Master than young athletes (1% vs. 1,9‰), with a greater incidence of ischemic cardiovascular disease in the former. The athletes with ischemic heart disease had known cardiovascular risk factors. Our data confirm the absence of symptoms and signs in Master athletes with atherosclerotic coronary disease and the importance to carefully investigate athletes with known cardiovascular risk factors during pre-participation screening, and to refer athletes for further clinical and instrumental investigations even if the exercise test is ambiguous. It is important to thoroughly examine risk factors also in young people <35 years due the rare but not exceptional possibility of coronary artery disease at this age. Our data confirm the usefulness of pre-participation screening and the key role of 12-led ECG and stress test for the identification of cardiovascular disease at risk of sudden death during sport. Cardiovascular disease and cardiomyopathies have shown good prognosis. A systematic follow-up of athletes disqualified from competition has been carried out and drug or interventional therapies have seen undertaken when deemed necessary. Cardiac magnetic resonance findings, mostly useless or ambiguous in the first years of the observational period, revealed to be of utmost value in the identification of cardiomyopathies in the recent years mainly thanks to the late-enhancement technique introduction.
Our preliminary data show a good diagnostic value of echocardiography in detection of coronary anomalies with a retro-aortic course. In the absence of signs of myocardial ischemia, the prognosis during short-term follow-up of athletes with left circumflex coronary artery origin from the right aortic sinus seems excellent.

Abstract (italiano)

Presupposti e Scopo. L’obiettivo principale dello screening pre-agonistico è identificare gli atleti affetti da malattie cardiovascolari occulte che predispongono alla morte improvvisa durante sforzo fisico. Lo scopo del mio lavoro di tesi è stato considerare le cause di non idoneità all’attività sportiva agonistica di atleti giovani e atleti Master (>35 anni), valutati presso la Medicina dello Sport di Noale (VE) nel decennio 2001-2010 e analizzare il follow-up di tali atleti.
Materiale e metodi. Nell’intervallo di tempo considerato il numero totale di visite di idoneità agonistica è stato di 35627, di cui il 91% ≤35 anni e il 9% Master; il 29% erano donne. Gli atleti dichiarati non idonei sono stati 99 (2‰), di cui 94 (95%) per cause cardiovascolari e 5 (5%) per cause non cardiovascolari. Di questi è disponibile un follow-up medio complessivo di 68±37 mesi. Le cause cardiovascolari di non idoneità sono state valutate per gruppi di età, ≤35 anni vs. Master, e quindi analizzate in base al motivo di richiesta degli accertamenti non invasivi di 2° livello (ecocardiogramma, test da sforzo massimale, risonanza magnetica nucleare, tomografia assiale computerizzata, scintigrafia) ed invasivi di 3° livello (coronarografia, biopsia, studio elettrofisiologico). Un sotto-studio ha focalizzato l’attenzione sul riscontro di origine anomala della coronaria circonflessa da destra, con lo scopo di raccogliere dati di follow-up atti a perfezionare le linee guida, che al momento non discriminano tra anomalie coronariche a maggiore o minore rischio di morte improvvisa, negando l’idoneità agonistica in tutti i casi.
Risultati. A) I giovani atleti dichiarati non idonei per cause cardiovascolari sono stati 63 (1,9‰). In essi l’indicazione ad esami di 2° livello è stata la storia pregressa di cardiopatia o sintomi riferiti alla raccolta anamnestica in 15 (24%), il riscontro di soffio cardiaco o ipertensione arteriosa all’esame obiettivo in 5 (8%), alterazioni dell’ECG di base o da sforzo (tachiaritmie sopraventricolari, ventricolari o segni di ischemia inducibile) in 39 (62%), non nota in 4 (6%). Le cause di non idoneità negli atleti giovani <35 anni sono state: bicuspidia con ectasia aortica (12), prolasso mitralico con aritmie ventricolari complesse (10), sospetta cardiomiopatia aritmogena (3), cardiomiopatia ipertrofica (3), anomalie congenite delle coronarie (3), probabile pregressa miocardite (2), cardiopatia dilatativa (1), coronaropatia aterosclerotica (1), aneurisma del setto interatriale con difetto interatriale con pervietà del forame ovale (1), esiti di correzione di difetto interatriale (1), aneurismi coronarici da pregressa malattia di Kawasaki (1), diverticolo miocardico (1), ipertensione arteriosa (2), sospetta ipertensione polmonare (1); infine disturbi del ritmo erano identificati nei rimanenti casi, consistenti in tachicardia parossistica giunzionale o sopraventricolare (3), blocco atrio ventricolare avanzato (1), sindrome del QT lungo (1), fibrillazione atriale (1), e aritmie ventricolari in cuore apparentemente sano (15). Infine una non idoneità per sospetta ipertensione polmonare è stata successivamente revocata. In un follow-up medio di 63±34 mesi non si sono registrati eventi di rilievo in termini di mortalità e morbilità. In totale le malattie cardiovascolari considerate a rischio di morte improvvisa nell’atleta (cardiomiopatia ipertrofica, cardiomiopatia aritmogena del ventricolo destro e anomalia congenita delle coronarie) sono state identificate in 8 atleti e le indicazioni per lo studio consistevano in alterazioni della ripolarizzazione all’ECG di base o aritmie ventricolari all’ECG da sforzo. In 3 casi, indagini successive, hanno portato a non confermare la diagnosi iniziale sospettata.
B) Gli atleti Master dichiarati non idonei per cause cardiovascolari sono 31 (1%). In essi, l’indicazione ad esami di 2° livello è stata l’anamnesi positiva per valvulopatia in 1 (3%), ipertensione arteriosa all’esame obiettivo in 3 (10%), anomalie dell’ECG di base in 2 (7%), anomalie al test da sforzo massimale (ischemia inducibile e aritmie ventricolari) in 23 (74%), non nota in 2 atleti (6%). Le cause di non idoneità sono state: prolasso mitralico con aritmie ventricolari complesse (5), coronaropatia aterosclerotica (4), ipertensione arteriosa con danno d’organo (3), cardiomiopatia ipertrofica (2), cardiomiopatia aritmogena del ventricolo destro (1), cardiomiopatia dilatativa (1), aritmie ventricolari in quadro di fibrosi miocardica di incerta eziologia (2), prolasso mitralico con moderata insufficienza (1) ed infine aritmie ventricolari in cuore apparentemente sano (12). In un follow-up medio di 76±41 mesi non si sono registrati decessi. La patologia strutturale più rappresentata è la cardiopatia ischemica con i 4 casi identificati per il riscontro di ischemia inducibile e altri 2 casi insorti nel follow-up di atleti fermati per aritmie ventricolari complesse. Per il resto non si sono registrati eventi significativi in termini di mortalità e morbilità.
Un totale di 27 soggetti (15 nel sottogruppo atleti giovani e 12 in quello atleti Master) è stato considerato affetto da aritmie ventricolari in cuore apparentemente sano. Nei 25 in cui era disponibile la cartella clinica, la coronarografia non era mai stata eseguita mentre la risonanza magnetica cardiaca era stata eseguita in 11 (42%), con gadolinio in 6 (23%).
C) Degli 11 soggetti con sospetto ecocardiografico di origine anomala della arteria coronaria circonflessa da destra uno solo presentava alterazioni al tracciato ECG di base (anomalie della ripolarizzazione a sede infero-laterale). La diagnosi di origine anomala della coronaria circonflessa con decorso retro-aortico è stata confermata in 9 su 11 (82%), mentre in due soggetti non è stata riscontrata alcuna anomalia al successivo esame (RMN cardiaca in 7 casi e angio TAC in 3 casi). In un ultimo atleta con sottoslivellamento del tratto ST da sforzo, la RMN cardiaca ha mostrato segni di late-enhancement e la RMN con stress farmacologico ha evidenziato segni di ischemia inducibile; le successive coronarografia e angio TAC hanno confutato la diagnosi iniziale individuando un’anomalia di origine della coronaria destra da sinistra e l’atleta è stato dichiarato non idoneo. Tutti gli altri 10 atleti, i quali avevano test ergometrico negativo, hanno ricevuto l’idoneità allo sport e in un follow-up medio di 24 mesi non hanno riportato eventi clinici significativi (uno solo non idoneo l’anno seguente per aritmie ventricolari ripetitive).
Conclusioni. La percentuale di non idoneità per malattie cardiovascolari è maggiore negli atleti Master rispetto a quelli giovani (1% vs. 1,9‰) e rispecchia la maggior incidenza di aterosclerosi coronarica nel primo gruppo. Tutti i soggetti con cardiopatia ischemica presentavano ≥ 2 fattori di rischio cardiovascolare. I nostri dati confermano la paucisintomaticità degli atleti Master portatori di cardiopatia ischemica su base aterosclerotica e la necessità di indagare in modo approfondito i fattori di rischio cardiovascolare durante la visita di idoneità e, in presenza di uno o più di questi, procedere con ulteriori accertamenti clinico strumentali di fronte ad un test da sforzo dubbio per ischemia inducibile. La possibilità, se pur eccezionale, di coronaropatia anche in età giovanile ci induce ad approfondire la presenza di fattori di rischio coronarico anche in atleti con età inferiore a 35 anni. I dati raccolti confermano l’utilità dello screening pre-agonistico ed in particolare dell’ECG di base e da sforzo nell’individuare soggetti portatori di cardiomiopatia. Le cardiomiopatie e, in generale, le patologie cardiovascolari identificate allo screening pre-agonistico hanno mostrato una buona prognosi, nessun evento maggiore si è verificato in termini di mortalità e morbilità in un follow-up a medio termine. E’ stato impostato un follow-up sistematico di tali atleti e, una volta allontanati i soggetti a rischio dall’attività sportiva, sono state messe in atto, dove necessario, le terapie più idonee. La risonanza magnetica cardiaca è risultata prevalentemente negativa quando eseguita nei primi anni dell’intervallo temporale considerato e positiva, anche se raramente diagnostica, negli ultimi anni. Infine, i nostri dati mostrano come l’ecocardiogramma abbia un buon valore diagnostico per l’individuazione delle anomalie coronariche con decorso retro-aortico e il follow-up a breve termine di questi atleti sembri favorevole, una volta esclusi segni di ischemia inducibile.

Statistiche Download - Aggiungi a RefWorks
Tipo di EPrint:Tesi di dottorato
Relatore:Basso, Cristina
Correlatore:Noventa, Donatella
Dottorato (corsi e scuole):Ciclo 24 > Scuole 24 > SCIENZE MEDICHE, CLINICHE E SPERIMENTALI > SCIENZE CARDIOVASCOLARI
Data di deposito della tesi:04 Febbraio 2013
Anno di Pubblicazione:04 Febbraio 2013
Parole chiave (italiano / inglese):screening pre-agonistico; pre-participation screening
Settori scientifico-disciplinari MIUR:Area 06 - Scienze mediche > MED/50 Scienze tecniche mediche applicate
Struttura di riferimento:Dipartimenti > Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari
Codice ID:5594
Depositato il:22 Ott 2013 11:58
Simple Metadata
Full Metadata
EndNote Format

Bibliografia

I riferimenti della bibliografia possono essere cercati con Cerca la citazione di AIRE, copiando il titolo dell'articolo (o del libro) e la rivista (se presente) nei campi appositi di "Cerca la Citazione di AIRE".
Le url contenute in alcuni riferimenti sono raggiungibili cliccando sul link alla fine della citazione (Vai!) e tramite Google (Ricerca con Google). Il risultato dipende dalla formattazione della citazione.

• Albert CM, Mittelman MA, Chae CU, Lee IM, Hennekens CH, Manson JE . Triggering of sudden death from cardiac causes by vigorous exertion. N Eng J Med 2000; 343:1355-61 Cerca con Google

• Atkins DL, Everson-Stewart S, Sears GK, Daya M, Osmond MH, Warden CR, Berg RA; Resuscitation Outcomes Consortium Investigators. Epidemiology and outcomes from out-of-hospital cardiac arrest in children: the Resuscitation Outcomes Consortium Epistry—Cardiac Arrest. Circulation 2009;119:1484–91. Cerca con Google

• Basso C, Boschello M, Perrone C, Mecenero A, Cera A, Bicego D, Thiene G, De Dominicis E. An echocardiographic survey of primary school children for bicuspid aortic valve. Am J Cardiol 2004;93:661–3. Cerca con Google

• Basso C, Calabrese F, Corrado D, Thiene G. Postmortem diagnosis in sudden cardiac death victims: macroscopic, microscopic and molecular findings. Cardiovasc Res 2001;50:290–300. Cerca con Google

• Basso C, Carturan E, Pilichou K, Rizzo S, Corrado D, Thiene G. Sudden cardiac death with normal heart: molecular autopsy. Cardiovasc Pathol 2010;19:321-5 Cerca con Google

• Basso C, Corrado D, Marcus FI, Nava A, Thiene G. Arrhythmogenic right ventricular cardiomyopathy. Lancet 2009;373:1289–300. Cerca con Google

• Basso C, Frescura C, Corrado D, Muriago M, Angelini A, Daliento L, Thiene G Congenital heart disease and sudden death in the young. Hum Pathol 1995;26:1065–72. Cerca con Google

• Basso C, Maron BJ, Corrado D, Thiene G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol 2000;35:1493–501. Cerca con Google

• Basso C, Ronco F, Marcus F, Abudureheman A, Rizzo S, Frigo AC, Bauce B, Maddalena F, Nava A, Corrado D, Grigoletto F, Thiene G. Quantitative assessment of endomyocardial biopsy in arrhythmogenic right ventricular cardiomyopathy/dysplasia: an in vitro validation of diagnostic criteria. Eur Heart J 2008;29:2760–71. Cerca con Google

• Basso C, Thiene G, Corrado D, Angelini A, Nava A, Valente M. Arrhythmogenic right ventricular cardiomyopathy: dysplasia, dystrophy, or myocarditis? Circulation 1996;94:983–91. Cerca con Google

• Basso C, Thiene G, Corrado D, Buja G, Melacini P, Nava A. Hypertrophic cardiomyopathy: pathologic evidence of ischemic damage in young sudden death victims. Hum Pathol 2000;31:988–98. Cerca con Google

• Bessem B, Groot FP, Nieuwland W. The Lausanne recommendations: a Dutch experience. Br J Sports Med. 2009; 43:708-15 Cerca con Google

• Borjesson M, Urhausen A, Kouidi E, Dugmore D, Sharma S, Halle M, Heidbüchel H, Björnstad HH, Gielen S, Mezzani A, Corrado D, Pelliccia A, Vanhees L. Cardiovascular evaluation of middle-aged/senior individuals engaged in leisure –time sport activities: position stand from the sections of exercise physiology and sports cardiology of the European Association of Cardiovascular Prevention and Rehabilitation . Eur J Cardiovasc Prev Rehabil 2011;18:446-58 Cerca con Google

• Bos JM, Poley RN, Ny M, Tester Dj, Xu X, Vatta M, Towbin JA, Gersh BJ, Ommen SR, Ackerman MJ. Genotype-phenotype relationships involving hypertrophic cardiomyopathy-associated mutations in titin, muscle LIM protein, and telethonin. Mol Genet Metab 2006;88:78-85 Cerca con Google

• Brugada P, Brugada J. Right bundle branch block, persistent ST segment elevation and suddencardiac death: a distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol 1992;20:1391–6 Cerca con Google

• Calabrese F, Rigo E, Milanesi O, Boffa GM, Angelini A, Valente M, Thiene G. Molecular diagnosis of myocarditis and dilated cardiomyopathy in children: clinicopathologic features and prognostic implications. Diagn Mol Pathol 2002;11:212–21. Cerca con Google

• Calabrese F, Thiene G. Myocarditis and inflammatory cardiomyopathy: microbiological and molecular biological aspects. Cardiovasc Res 2003;60:11–25. Cerca con Google

• Charron P, Komajda M. Molecular genetics in hypertrophic cardiomyopathy: towards individualized management of the disease. Expert Rev Mol Diagn 2006;6:65-78 Cerca con Google

• Chugh SS, Reinier K, Balaji S, Uy-Evanado A, Vickers C, Mariani R, Gunson K, Jui J. Population-based analysis of sudden death in children: the Oregon Sudden Unexpected Death Study. Hearth Rhythm 2009;6:1618-22 Cerca con Google

• COCIS 2009: Comitato organizzativo cardiologico per l’idoneità allo sport (ANCE, ANMCO, FMSI, SIC, SIC SPORT). Protocolli cardiologici per il giudizio di idoneità allo sport agonistico -Edizione del Ventennale, Casa Editrice Scientifica Internazionale, Roma 2009. Cerca con Google

• Corrado D, Basso C, Leoni L, Tokajuk B, Bauce B, Frigo G, Tarantini G, Napodano M, Turrini P, Ramondo A, Daliento L, Nava A, Buja G, Iliceto S, Thiene G. Three-dimensional electroanatomic voltage mapping increases accuracy of diagnosing arrhythmogenic right ventricular cardiomyopathy/dysplasia. Circulation 2005;111:3042–50. Cerca con Google

• Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA. 2006;296:1593-1601 Cerca con Google

• Corrado D, Basso C, Poletti A, Angelini A, Valente M, Thiene G. Sudden death in the young: is coronary thrombosis the major precipitating factor? Circulation 1994;90:2315–23. Cerca con Google

• Corrado D, Basso C, Rizzoli G, Schiavon M, Thiene G. Does sports activity enhance the risk of sudden death in adolescents and young adults? J Am Coll Cardiol. 2003; 42:1959-1963 Cerca con Google

• Corrado D, Basso C, Schiavon M, Thiene G. Screening for hypertrophic cardiomyopathy in young athletes. New Engl J Med 1998; 339:364-369 Cerca con Google

• Corrado D, Basso C, Schiavon M, Pelliccia A, Thiene G. Pre-participation screening of young competitive athletes for prevention of sudden cardiac death. J Am Coll Cardiol 2008;52:1981-9. Cerca con Google

• Corrado D, Basso C, Thiene G. Assay Sudden death in young athletes. Lancet. 2005; S47-S48 Cerca con Google

• Corrado D, Basso C, Thiene G. Comparison of United States and Italian experiences with sudden cardiac deaths in young competitive athletes: are the athletic populations comparable? Am J Cardiol 2010;105:421-2 Cerca con Google

• Corrado D, Basso C, Thiene G. Sudden cardiac death in young people with apparently normal heart. Cardiovasc Res 2001;50: 399–408. Cerca con Google

• Corrado D, McKenna WJ. Appropriate interpretation of the athlete‘s electrocardiogram saves lives as well as money. Eur Heart J 2007;28: 1920–2. Cerca con Google

• Corrado D, Migliore F, Basso C, Thiene G. Exercise and the risk of sudden cardiac death. Herz 2006;31:553-8 Cerca con Google

• Corrado D, Pelliccia A, Bjornstad HH, Vanhees L, Biffi A, Borjesson M, Panhuyzen-Goedkoop N, Deligiannis A, Solberg E, Dugmore D, Mellwig KP, Assanelli D, Delise P, van-Buuren F, Anastasakis A, Heidbuchel H, Hoffmann E, Fagard R, Priori SG, Basso C, Arbustini E, Blomstrom-Lundqvist C, McKenna WJ, Thiene G. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J 2005 ;26:516-24. Cerca con Google

• Corrado D, Pelliccia A, Heidbuchel H, Sharma S, Link M, Basso C, Biffi A, Buja G, Delise P, Gussac I, Anastasakis A, Borjesson M, Bjørnstad HH, Carrè F, Deligiannis A, Dugmore D, Fagard R, Hoogsteen J, Mellwig KP, Panhuyzen-Goedkoop N, Solberg E, Vanhees L, Drezner J, Estes NA 3rd, Iliceto S, Maron BJ, Peidro R, Schwartz PJ, Stein R, Thiene G, Zeppilli P, McKenna WJ; On behalf of the Sections of Sports Cardiology of the European Association of Cardiovascular Prevention and Rehabilitation; and the Working Group of Myocardial and Pericardial Disease of the European Society of Cardiology. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J. 2010;312:243-59 Cerca con Google

• Corrado D, Pennelli T, Piovesana PG, Thiene G. Anomalous origin of the left circumflex coronary artery from the right aortic sinus of Valsalva and sudden death. Cardiovasc Pathol 1994;3:269–71. Cerca con Google

• Corrado D, Schmied C, Basso C, Borjesson M, Schiavon M, Pelliccia A, Vanhees L, Thiene G. Risk of sports: do we need a pre-partecipation screening for competitive and leisure athletes? Eur Heart J 2011; 32:934-44 Cerca con Google

• Corrado D, Thiene G, Buja GF, Pantaleoni A, Maiolino P. The relationship between growth of atherosclerotic plaques, variant angina and sudden death. Int J Cardiol 1990;26:361–7. Cerca con Google

• Corrado D, Thiene G, Cocco P, Frescura C. Non-atherosclerotic coronary artery disease and sudden death in the young. Br Heart J 1992;68:601–7. Cerca con Google

• Corrado D, Thiene G, Pennelli N. Sudden death as the first manifestation of coronary artery disease in young people (less than or equal to 35 years). Eur Heart J. 1988; 9:139-44 Cerca con Google

• Crotti L, Celano G, Degradi F, Schwartz PJ Congenital Long QT syndrome. Orphanet J Rare Dis 2008;3:18 Cerca con Google

• Daviglus ML, Liao Y, Greenland P, Dyer AR, Liu K, Xie X, Huang CF, Prineas RJ, Stamler J. Association of non specific minor ST-T abnormalities with cardiovascular mortality : the Chicago Western Electric study. JAMA 1999; 281:530-6 Cerca con Google

• De Bacquer D, De Backer G, Kornitzer M, MynyK, Doyen Z, Blackburn H. Prognostic value of ischemic electrocardiographic findings for cardiovascular mortality in men and woman. J Am Coll Cardiol 1998;32:680-5 Cerca con Google

• Eckart RE, Scoville SL, Campbell CL, Shry EA, Stajduhar KC, Potter RN, Pearse LA, Virmani R. Sudden death in young adults: a 25-year review of autopsies in military recruits. Ann Intern Med 2004;141:829–34. Cerca con Google

• Ekker Solberg E, Embra BI, Borjesson M, Herlitz J, Corrado D. Commotio cordis-under-recognized in Europe? A case report and review. Eur J Cardiovasc Prev Rehabil. 2011;18:378-83 Cerca con Google

• Foote CB, Michaud GF. The Athlete’s electrocardiogram: distinguishing normal from abnormal. In: Estes NAM, Salem DN, Wang PJ (eds), Sudden Cardiac Death in the Athlete. Armonk, NY: Futura Publishing; 1998. p.101–113. Cerca con Google

• Frescura C, Basso C, Thiene G, Corrado D, Pennelli T, Angelini A, Daliento L. Anomalous origin of coronary arteries and risk of sudden death: a study based on an autopsy population of congenital heart disease. Hum Pathol 1998;29:689–95. Cerca con Google

• Fuller CW, Ojelade EO, Taylor A. preparticipation medical evaluation in professional sport in the UK: theory or practice? Br J Sports Med. 2007; 41:890-6 Cerca con Google

• Geier C, Perrot A, Ozcelik C, Binner P, Counsell D, Hoffmann K, Pilz B, Martiniak Y, Gehmlich K, van der Ven PF, Furst DO, Vornwald A, von Hodenberg E, Nurnberg P, Scheffold T, Dietz R, Osterziel KJ. Mutations in the human muscle LIM protein gene in families with hypertrophic cardiomyopathy. Circulation 2003;107:1390-1395. Cerca con Google

• Gori F, Basso C, Thiene G. Myocardial infarction in a patient with hypertrophic cardiomyopathy. N Engl J Med 2000;342:593–4. Cerca con Google

• Harmon KG, Asif IM, Klossner D, Drezner JA. Incidence of sudden cardiac death in natiomal collegiate athletic association athletes. Circulation 2011;123:1594-600 Cerca con Google

• Huikuri HV, Castellanos A, Myerburg RJ. Sudden death due to cardiac arrhythmias. N Engl J Med 2001;345:1473–82. Cerca con Google

• IOC Medical Commission, International Olympic Committee. Sudden Cardiovascular Death in Sport: Lausanne Recommendations: Preparticipation Cardiovascular Screening. December 10, 2004. Available at: http://www.olympic.org/Documents/Reports/EN enreport826.pdf Vai! Cerca con Google

• Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M. Cardiorespiratory fitness as quantitative predictor of all-cause mortality and cardiovascular events in healty men and woman . A meta-analysis JAMA 2009;301:2024-35 Cerca con Google

• Lipton MJ, Barry WH, Obrez I, Silverman JF, Wexler L. Isolated single coronary artery: diagnosis, angiographic classification, and clinical significance. Radiology. 1979;130:39-47 Cerca con Google

• M.Hernelahti Heinonen OJ, Karjalainen J, Nylander E, Börjesson M. Sudden cardiac death in young athlete: time for a Nordic approach in screening? Scand J Med Sci Sports 2008:18:132-139 Cerca con Google

• Marcus FI, McKenna WJ, Sherrill D, Basso C, Bauce B, Bluemke DA, Calkins H, Corrado D, Cox MG, Daubert JP, Fontaine G, Gear K, Hauer R, Nava A, Picard MH, Protonotarios N, Saffitz JE, Sanborn DM, Steinberg JS, Tandri H, Thiene G, Towbin JA, Tsatsopoulou A, Wichter T, Zareba W. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the task force criteria. Eur Heart J 2010 31,806-814 Cerca con Google

• Maron BJ. Hypertrophic Cardiomyopathy and Other Causes of Sudden Death in Young Competitive Athletes, with Consideration for Prepartecipation Screening and Criteria for Disqualification . Cardiol Clin 2007; 25:399-414 Cerca con Google

• Maron BJ, Araújo CG, Thompson PD, Fletcher GF, de Luna AB, Fleg JL, Pelliccia A, Balady GJ, Furlanello F, Van Camp SP, Elosua R, Chaitman BR, Bazzarre TL; World Heart Federation; International Federation of Sports Medicine; American Heart Association Committee on Exercise, Cardiac Rehabilitation, and Prevention. Recommendations for preparticipation screening and the assessment of cardiovascular disease in masters athletes: an advisory for healthcare professionals from the working groups of the World Heart Federation, the International Federation of Sports Medicine, and the American Heart Association Committee on Exercise, Cardiac Rehabilitation, and Prevention. Circulation. 2001 16;103:327-34 Cerca con Google

• Maron BJ, Chaitman BR, Ackerman MJ, Bayés de Luna A, Corrado D, Crosson JE, Deal BJ, Driscoll DJ, Estes NA 3rd, Araújo CG, Liang DH, Mitten MJ, Myerburg RJ, Pelliccia A, Thompson PD, Towbin JA, Van Camp SP; Working Groups of the American Heart Association Committee on Exercise, Cardiac Rehabilitation, and Prevention; Councils on Clinical Cardiology and Cardiovascular Disease in the Young. Recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular diseases. Circulation. 2004 8;109:2807-16. Cerca con Google

• Maron BJ, Doerer JJ, Haas TS, Tierney DM, Muller FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006. Circulation 2009; 119:1085-92. Cerca con Google

• Maron BJ, Gardin JM, Flack JM, Gidding SS, Kurosaki TT, Bild DE. Prevalence of hypertrophic cardiomyopathy in a general population of young adults. Echocardiographic analysis of 4111 subject in the CARDIA Study. Coronary Artery Risk Development in (Young) Adults. Circulation 1995; 92:785-9 Cerca con Google

• Maron BJ, Gohman TE , Kyle SB, Estes NA, Link MS. Clinical profile and spectrum of commotion cordis. JAMA 2002; 287:1142-6 Cerca con Google

• Maron BJ, Haas TS, Doerer JJ, Thompson PD, James HS. Comparison of U.S. and Italian experiences with sudden cardiac deaths in young competitive athletes and implications for preparticipation screening strategies. Am J Cardiol 2009;104:276 –280 Cerca con Google

• Maron BJ, Shirani J, Poliac LC, Mathenge R, Roberts WC, Mueller FO. Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles. JAMA 1996;276:199–204 Cerca con Google

• Maron BJ, Thompson PD, Ackerman MJ, Balady G, Berger S, Cohen D, Dimeff R,Douglas PS, Glover DW, Hutter AM Jr, Krauss MD, Maron MS, Mitten MJ, Roberts WO, Puffer JC. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation 2007;115:1643-455 Cerca con Google

• Maron BJ, Zipes DP. 36th Bethesda Conference: eligibility recommendations for competitive athletes with cardiovascular abnormalities. J Am Coll Cardiol 2005;45:2– 64. Cerca con Google

• Martini B, Nava A, Thiene G, Buja GF, Canciani B, Scognamiglio R, Daliento L, Dalla Volta S. Ventricular fibrillation without apparent heart disease: description of six cases. Am Heart J 1989;118:1203–9. Cerca con Google

• McKenna WJ, Thiene G, Nava A, Fontaliron F, Blomstrom-Lundquist G, Fontaine G, Camerini F, on behalf of the Task Force of the working group myocardial and pericardial disease of the European Society of Cardiology and of the Scientific Council on Cardiomyopathies of the International Society and Federationof Cardiology. Diagnosis of arrhythmogenic right ventricular dysplasia cardiomyopathy. Br Heart J 1994;71:215–218 Cerca con Google

• Melacini P, Corbetti F, Calore C, Pescatore V, Smaniotto G, Pavei A, Bobbo F, Cacciavillani L, Iliceto S, Cardiovascular magnetic resonance signs of ischemia in hypertrophic cardiomyopathy. Int J Cardiol 2008;128:364-373 Cerca con Google

• Minamisawa S, Sato Y, Tatsuguchi Y, Fujino T, Imamura S, Uetsuka Y, Nakazawa M, Matsuoka R. Mutation of the phospholamban promoter associated with hypertrophic cardiomyopathy. Biochem Biophys Res Commun 2003;304:1-4 Cerca con Google

• Mitchell J, Haskell WL, Raven PB. Classification of sports. J Am Coll Cardiol 1994;24:864–866. Cerca con Google

• Myerburg RJ, Vetter VL. Electrocardiograms should be included in preparticipation screening of athletes. Circulation 2007;116:2616 –26. Cerca con Google

• Nava A, Thiene G, Canciani B, Scognamiglio R, Daliento L, Buja G, Martini B, Stritoni P, Fasoli G. Familial occurrence of right ventricular dysplasia: a study involving nine families. J Am Coll Cardiol 1988,12:1222-1228. Cerca con Google

• Nava A, Bauce B, Basso C, Muriago M, Rampazzo A, Villanova C, Daliento L, Buja G, Corrado D, Danieli GA, Thiene G. Clinical profile and long-term follow-up of 37 families with arrhythmogenic right ventricular cardiomyopathy. J Am Coll Cardiol. 2000;36:2226-33. Cerca con Google

• Norman MW, McKenna WJ. Arrhythmogenic in right ventricular cardiomyopathy/dysplasia: perspectives on disease. Z Cardiol 1999,88:550-554 Cerca con Google

• Olivotto I, Cecchi F, Gistri R, Lorenzoni R, Chiriatti G, Girolami F, Torricelli F, Camici PG. Relevance of coronary microvascular flow impairment to long-term remodeling and systolic dysfunction in hypertrophic cardiomyopathy. J Am Coll Cardiol 2006;47:1043-48. Cerca con Google

• Pelliccia A, Fagard R, Bjørnstad HH, Anastassakis A, Arbustini E, Assanelli D, Biffi A, Borjesson M, Carrè F, Corrado D, Delise P, Dorwarth U, Hirth A, Heidbuchel H, Hoffmann E, Mellwig KP, Panhuyzen-Goedkoop N, Pisani A, Solberg EE, van-Buuren F, Vanhees L, Blomstrom-Lundqvist C, Deligiannis A, Dugmore D, Glikson M, Hoff PI, Hoffmann A, Hoffmann E, Horstkotte D, Nordrehaug JE, Oudhof J, McKenna WJ, Penco M, Priori S, Reybrouck T, Senden J, Spataro A, Thiene G Recommendations for competitive sports participation in athletes with cardiovascular disease. A consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology, and the Working Group of Myocardial and Pericardial diseases of the European Society of Cardiology. Eur Heart J 2005;26:1422– 45. Cerca con Google

• Pennel D, Casolo G. Right ventricular arrhythmia: emergence of magnetic resonance as an investigative tool Eur Heart J 1997,18:1843-1845 Cerca con Google

• Pilichou K, Nava A, Basso C, Beffagna G, Bauce B, Lorenzon A, Frigo G, Vettori A, Valente M, Towbin J, Thiene G, Danieli GA, Rampazzo A. Mutations in desmoglein-2 gene are associated with arrhythmogenic right ventricular cardiomyopathy. Circulation 2006;113:1171–9. Cerca con Google

• Priori S, Napolitano C, Tiso N, Memmi M, Vignati G, Bloise R, Sorrentino V, Danieli GA. Mutations in the cardiac ryanodine receptor gene (hRyR2) underlie catecholaminergic polymorphic ventricular tachycardia. Circulation 2001;103:196–200. Cerca con Google

• Protonotarios N, Tsatsopoulou A. Naxos disease and Carvajal syndrome: cardiocutaneous disorders that highlight the pathogenesis and broaden the spectrum of arrhythmogenic right ventricular cardiomyopathy. Cardiovasc Pathol 2004;13:185–94. Cerca con Google

• Rampazzo A, Nava A, Malacrida S, Beffagna G, Bauce B, Rossi V, Zimbello R, Simionati B, Basso C, Thiene G, Towbin JA, Danieli GA. Mutation in human desmoplakin domain binding to plakoglobin causes a dominant form of arrhythmogenic right ventricular cardiomyopathy. Am J Hum Genet 2002;71:1200–12. Cerca con Google

• Sarto P, Merlo L, Noventa D, Basso C, Pelliccia A, Maron BJ. Electrocardiographic Changes Associated With Training and Discontinuation of Training in an Athlete with Hypertrophic Cardiomyopathy. Am J Cardiol 2004;93:518–519. Cerca con Google

• Sassen B, Cornelissen VA, Kiers H, Wittink, Kok G, Vanhees L. Physical fitness matters more than physical activity in controlling cardiovascular disease risk factors . Eur J Cardiovasc Prev Rehabil 2009 ;16:677-83 Cerca con Google

• Seto CK, Pendleton ME. “Preparticipation cardiovascular screening in young athlete: current guidelines and dilemmas”. Curr Sports Med Rep.2009;8:59-64 Cerca con Google

• Tandri H, Bomma C, Calkins H, Bluemke DA. Magnetic resonance and computed tomography imaging of Arrhythmogenic right ventricular dysplasia J Magn Reson Imaging 2004, 19:848-858 Cerca con Google

• Thiene G, Basso C, Corrado D. Cardiovascular causes of sudden death. In: Silver MD, Gotlieb AI, Schoen FJ, editors. Cardiovascular pathology. 3rd ed. Philadelphia: Churchill Livingstone, 2001.p. 326–74. Cerca con Google

• Thiene G, Basso C. Arrhythmogenic right ventricular cardiomyopathy. An update. Cardiovasc Pathol 2001;10:109–11 Cerca con Google

• Thiene G, Carturan E, Corrado D, Basso C. Prevention of sudden cardiac death in the young and in atheletes:dream or reality? Cardiovasc Path 2010;19:207-217 Cerca con Google

• Thiene G, Corrado D, Rigato I, Basso C. Why and how to support screening strategies to prevent sudden death in athletes. Cell Tissue Res. 2012;348:315-8 Cerca con Google

• Thiene G, Nava A, Corrado D, Rossi L, Pennelli N. Right ventricular cardiomyopathy and sudden death in young people. N Engl J Med 1988;318:129–33. Cerca con Google

• Thompson PD, Franklin BA, Balady GJ, Blair SN, Corrado D, Estes NA 3rd, Fulton JE, Gordon NF, Haskell WL, Link MS, Maron BJ, Mittleman MA, Pelliccia A, Wenger NK, Willich SN, Costa F; American Heart Association Council on Nutrition, Physical Activity, and Metabolism; American Heart Association Council on Clinical Cardiology; American College of Sports Medicine. Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology. Circulation 2007;115:2358-68. Cerca con Google

• Tiso N, Stephan DA, Nava A, Bagattin A, Devaney JM, Stanchi F, Larderet G, Brahmbhatt B, Brown K, Bauce B, Muriago M, Basso C, Thiene G, Danieli GA, Rampazzo A. Identification of mutations in the cardiac ryanodine receptor gene in families affected with arrhythmogenic right ventricular cardiomyopathy type 2 (ARVD2). Hum Mol Gen 2001;10:189–94. Cerca con Google

• Van Camp SP, Bloor CM, Mueller FO, Cantu RC, Olson HG. Non-traumatic sports death in high school and college athletes. Med Sci Sports Exerc. 1995;27:641-647 Cerca con Google

• Van Der Wall EE, Kayser HW, Bootsma MM, de Roos A, Schalij MJ. Arrhythmogenic right ventricular dysplasia: MRI findings. Herz 2000, 25:356-364 Cerca con Google

• Van Driest SL, Ommen SR, Tajik AJ, Gersh BJ, Ackerman MJ. Yield of genetic testing in hypertrophic cardiomyopathy. Majo Clin Proc 2005;80:739-744 Cerca con Google

• Varnava AM, Elliott PM, Mahon N, Davies MJ, McKenna WJ. Relation between myocyte disarray and outcome in hypertrophic cardiomyopathy. Am J Cardiol 2001; 88: 275-279 Cerca con Google

• Varnava AM, Elliott PM, Sharma S, McKenna WJ, Davies MJ. Hypertrophic cardiomyopathy: the interrelation of disarray, fibrosis, and small vessell, disease. Heart 2000; 84: 476-482 Cerca con Google

Download statistics

Solo per lo Staff dell Archivio: Modifica questo record