Dr. Lluis Mont,
There has been an interesting session devoted to sudden death in athletes.The session started with a presentation from Christina Basso (Padua, Italy) that reviewed the state of the art regarding pathology of hearts in victims of SD during sports. It is important to remember that previously unknown coronary artery disease, even without acute thrombosis is a frequent finding at necropsy, and together with abnormal coronary arteries, are conditions that often go undetected even after careful evaluation. On the other hand, she underlined the difficulties of the “grey zone” findings, for example in establishing a diagnosis of hypertrophic cardiomyopathy as opposed to athlete’s heart, or right ventricular abnormal vs normal fibro-fatty infiltration. A more homogenous necropsy practice may allow better diagnosis and classification.Peter Van Tinteleen (Groningen, NL) pointed out that a number of genetic arrhythmic deaths go undetected, unless careful genetic evaluation of the family members is undertaken. Sometimes mutations only represent a predisposition that does not fully develop unless endurance training takes place, like in some patients with arrhythmogenic right ventricular dysplasia (ARVD), in whom it has been shown that exercise worsens the prognosis.Hein Heidbuchel (Leuven, Belgium) discussed the proposed entity “exercise induced ARVD”. Some authors argue that a genetic mutation should be present. However, there have been many studies showing the higher vulnerability of the right ventricle to pressure and volume overload, due to the limited adaptation of the pulmonary circulation, resulting in increased wall stress at the right ventricle. It seems that long and intense endurance training per se, may create ARVD in certain individuals, creating a risk for ventricular arrhythmias and sudden death.Finally, Larissa Fabritz (Birmingham, UK) further discussed her work in mice models of ARVD. She has shown in several studies that exercise on top of desmosomal or plakoglobin mutations worsen the evolution, inducing more severe disease, as compared to sedentary animals.
Sudden death in athletes
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