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Predictive Value of Exercise Testing in Athletes with Ventricular Ectopy Evaluated by Cardiac Magnetic Resonance.

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Predictive Value of Exercise Testing in Athletes with Ventricular Ectopy Evaluated by Cardiac Magnetic Resonance.

Heart Rhythm. 2018 Aug 29;:

Authors: Cipriani A, Zorzi A, Sarto P, Donini M, Rigato I, Bariani R, De Lazzari M, Pilichou K, Thiene G, Iliceto S, Basso C, Corrado D, Marra MP, Bauce B

Abstract
BACKGROUND: Exercise-induced ventricular arrhythmias (EIVA) in young athletes raise the suspect of an underlying heart disease at risk of sudden death.
OBJECTIVE: We aimed to assess the prevalence and determinants of abnormal cardiac magnetic resonance (CMR) findings in athletes referred for EIVA versus non-EIVA with negative or inconclusive echocardiography.
METHODS: we performed CMR in a consecutive series of athletes aged 15-50 year-old referred for frequent (>500/day) or repetitive premature ventricular beats. Clinical and CMR findings were compared between athletes with EIVA versus non-EIVA and predictors of abnormal CMR were assessed.
RESULTS: we included 36 athletes with EIVA (75% men, median age 25 year-old) and 24 with non-EIVA (75% men, median age 17 year-old). CMR revealed cardiac abnormalities in 20 (56%) athletes with EIVA and in 5 (21%) with non-EIVA (p=0.004). In particular, left ventricular late gadolinium enhancement was identified in 17 (47%) athletes with EIVA and in 3 (13%) with non-EIVA (p=0.006), mostly with a non-ischemic pattern. Predictors of abnormal CMR were T-wave inversion on ECG (OR 5.2, 95%CI 1.0-27.1, p=0.05), complex ventricular arrhythmias on 24-hour ambulatory ECG monitoring (OR 4.5, 95%CI 1.1-18.7, p=0.04) and complex EIVA with a right-bundle-branch-block or polymorphic morphology on exercise testing (OR 5.3, CI 1.4-19.4, p=0.01).
CONCLUSION: pathological myocardial substrates on CMR were observed significantly more often in athletes with EIVA compared to those with non-EIVA. Repolarization abnormalities on baseline ECG and complex EIVA with a right-bundle-branch-block or polymorphic morphology identified the subgroup of athletes with the highest probability of CMR abnormalities.

PMID: 30172028 [PubMed – as supplied by publisher]

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