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Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/20617

Title: Subepicardial delayed gadolinium enhancement in asymptomatic athletes: let sleeping dogs lie?
Authors: Schnell, Frédéric
Claessen, Guido
La Gerche, André
Bogaert, Jan
Lentz, Pierre-Axel
Claus, Piet
Mabo, Philippe
Carré, Francois
Heidbuchel, Hein
Issue Date: 2016
Publisher: BMJ PUBLISHING GROUP
Citation: BRITISH JOURNAL OF SPORTS MEDICINE, 50 (2), p. 111-117
Abstract: Background Subepicardial delayed gadolinium enhancement (DGE) patches without underlying cardiomyopathy is poorly understood. It is often reported as the result of prior silent myocarditis. Its prognostic relevance in asymptomatic athletes is unknown; therefore, medical clearance for competitive sports participation is debated. This case series aims to relate this pattern of DGE in athletes to outcome. Methods We report on seven young asymptomatic athletes with isolated subepicardial DGE detected during workup of abnormalities on their regular screening examination, that is, pathological T-wave inversions on ECG (n=4) or ventricular arrhythmias on exercise test (n=3). All underwent a comprehensive initial investigation in order to assess left ventricular (LV) function at rest and exercise (exercise cardiac MRI and/or exercise echocardiography) and occurrence of arrhythmias (exercise test, 24 h-ECG Holter, electrophysiological study). All underwent a careful follow-up with biannual evaluation. Results All athletes had extensive subepicardial DGE (12.0 +/- 4.8% of LV mass), predominantly in the lateral wall. Three athletes had non-sustained ventricular arrhythmias, whereas two of them had LV ejection fraction <50% at rest with no contractile reserve at exercise. During a follow-up of 3.0 +/- 1.5 years in the four remaining athletes, two had symptomatic ventricular tachycardia and one demonstrated progressive LV dysfunction. Hence, six of seven athletes had to be excluded from competitive sports participation. Conclusions Isolated large areas of subepicardial DGE in an asymptomatic athlete are not benign and require a careful evaluation at exercise and a strict follow-up. These findings question whether extreme exercise during silent myocarditis may facilitate fibrosis generation and adverse remodelling.
Notes: [Schnell, Frederic; Carre, Francois] Univ Hosp Pontchaillou, Dept Sport Med, Rennes, France. [Schnell, Frederic; Claessen, Guido; La Gerche, Andre] Univ Leuven, Univ Hosp Gasthuisberg, Dept Cardiol, Leuven, Belgium. [La Gerche, Andre] Baker IDI Heart & Diabet Inst, Melbourne, Australia. [Bogaert, Jan] Univ Leuven, Univ Hosp Gasthuisberg, Dept Radiol, Leuven, Belgium. [Lentz, Pierre-Axel] Univ Hosp Pontchaillou, Dept Radiol, Rennes, France. [Claus, Piet] Univ Leuven, Dept Cardiovasc Imaging & Dynam, Leuven, Belgium. [Mabo, Philippe] Univ Hosp Pontchaillou, Dept Cardiol, Rennes, France. [Heidbuchel, Hein] Hasselt Univ & Heart Ctr, Jessa Hosp, Hasselt, Belgium.
URI: http://hdl.handle.net/1942/20617
DOI: 10.1136/bjsports-2014-094546
ISI #: 000367609600011
ISSN: 0306-3674
Category: A1
Type: Journal Contribution
Validation: ecoom, 2017
Appears in Collections: Research publications

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