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Prof. Maurizio Galderisi ,
Sudden cardiac death (SCD) is uncommon but dramatic in athletes. Cardiomyopathies (mainly hypertrophic cardiomyopathy, HCM) are the main cause of SCD in young athletes, and coronary artery disease in the older athletes. Diagnosis is difficult in athletes. Exercise capacity is not enough to exclude cardiomyopathies, but cardiac imaging evaluation can be extremely useful.
Multi-modality imaging is very important to predict SCD in HCM. Main risk factors include maximal wall thickness ≥30 mm, low ejection fraction (EF) and Global Longitudinal Strain (GLS), diastolic septum E/e’ dysfunction, left ventricular output tract (LVOT) obstruction(also provoked by exercise), late gadolinium enhancement (scar, presence and extent) and inducible myocardial ischemia.
LVEF and aortic end systolic diameter are important but questionable. GLS (>-15%) can provide important additional information in patients with normal LVEF. The rate of progression of aortic jet velocity (which is incremental to the extent of valve calcification), left ventricular hypertrophy and inappropriate increase of left ventricular mass as well as myocardial fibrosis are predictive factors in aortic stenosis. GLS , low contractile reserve and myocardial fibrosis predict cardiac events also in mitral regurgitation.
CAD is the main cause of ischemic cardiomyopathy in patients older than 35 years. LVEF alone is often used in these patients to assess long-term outcomes and the risk of SCD and pump failure, and is used to select patients for device therapy (ICD and CRT). However, LVEF has shortcomings due to variability of measurements and risk prediction on an individual basis. Myocardial scar, GLS (>-14%) and mechanical dispersion, derived from GLS, have proven incremental prognostic value over LVEF alone for predicting severe arrhythmias and SCD.
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