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Dr. Claudio Araujo
Prof. William J. McKenna
Those working in Sports Cardiology are often faced with elite athletes presenting uncommon structural, functional and eletrocardographic features. While it is sometimes possible to make evidence-based decisions, unfortunately, this is not always true.Therefore, it is a mixture of scarce data and personal experience/feelings that determines the medical advice for an individual complicated case. Four cardiologists who combined outstanding scientific contributions with solid clinical practice adressed several diagnostic dilemmas in sports cardiology during this Clinical Seminar. Dr. Gati (GB) initiated the session by presenting and discussing the potential relevance of her recent findings in left ventricular trabeculation in athletes. Particularly interesting were her preliminary thoughts regarding mechanisms using pregnancy as a model. Dr. Pelliccia (IT) detailed the interpretation and conseqences of T-wave inversion presenting in multiple leads of resting ECG in athletes. Mixing clinical cases, extracts from some of his several publications and personal judgements, he ended with a very practical take-home message for the clinical cardiologists in the audience. In sequence, Dr. Carre (FR) discussed different issues regarding measurement and clinical interpretation of a long-QT interval in the sports context. One of the various relevant issues brought up by the speaker was that Bazett correction for QT duration could be somewhat innapropriate for athletes showing extreme bradycardia. Finally, Dr. Niebauer (AT) presented physiopathological aspects of cardiopulmonary exercise testing, pointing out its potential role, as he emphasized still underutilized, for solving some relevant diagnostic dilemmas in Sports Cardiology. A considerable and participative audience significantly collaborated for the sucess of this Clinical Seminar.
Cardiovascular evaluation of recreational athletes has increased over the past decade, in part driven by a trickle of deaths in high profile elite athletes. The cardiovascular changes associated with different forms and amounts of exercise may overlap with disease manifestations of the inherited cardiomyopathies and arrhythmias. Though many of the structural and electrocardiographic changes have been recognised for decades, recent improvements in imaging and greater experience of elite athletes has revealed racial differences,( e.g. increased T wave inversion in subjects of African-American origin), and previously unrecognised structural changes, (e.g. hypertrabeculation), which may relate to the altered loading conditions to which highly trained individuals subject themselves. When the electrocardiographic and structural changes overlap with disease phenotypes, then more detailed assessment with emphasis on familial evaluation is warranted to determine whether changes,( e.g. T wave inversion), represent incomplete expression of one of the inherited cardiomyopathies, or an extreme physiological response in a highly trained individual. Increased experience of the ECG in athletes reveals longer QT intervals and greater T wave morphological changes than was previously recognised, and strongly supports the recently published revised Schwartz criteria for diagnosis of LQT. Cardiopulmonary exercise testing provides reproducible measures of exercise capacity that can facilitate identification of the underlying cause of exercise limitation in an athlete, which may aid diagnosis of a cardiac condition, as well as assess peak and maximum VO2.
Diagnostic dilemmas in sports cardiology
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