Atherosclerotic coronary artery disease prevalence in master athletes exhibiting exercise-induced ventricular arrhythmias: relevance for preparticipation screening

Abstract Background Coronary atherosclerotic disease (CAD) is the leading cause of sudden cardiac death among master athletes (≥35 years). During pre-participation screening (PPS), the primary indication for investigating CAD in these population is ST-segment depression (STD) at exercise test (ET). Additionally, a developing indication involves the identification of high-risk premature ventricular beats (PVBs). Nevertheless, the prevalence of CAD among master athletes displaying PVBs remains uncertain. Objective The aim of this study was to evaluate the prevalence of CAD in master athletes who underwent coronary computed tomography (CCT) due to high-risk PVBs during PPS (emerging indication), and to compare this population to age-, gender- and risk factors-matched group of athletes who underwent CCT due to STD during ET (traditional indication). Methods We retrospectively enrolled master athletes with no baseline ECG abnormalities and no previous history of heart disease who underwent CCT because of a positive ET during PPS, for PVBs or STD. The entity of the disease was assessed using the CAD-RADs scoring system. Results The population resulted to be composed by 130 Caucasian athletes, median age 54 (46.5-60.5 years, 84% male), 74% practiced endurance sports. Eighty-two (63%) of them underwent CCT for STD and 48 (37%) for high-risk PVBs. A CAD-RADs of 0 was detected in 64.3% of athletes, 1-2 in 22.2%, 3 in 6.3%, and 4A-4B in 7.1%. A significant CAD was found in 10.4% of athletes investigated for PVBs at ET, and 14.6% in subjects with STD (p=0.5). Among athletes with moderate-severe CAD, 82.4% had one or more cardiovascular risk factors, while 17.6% had no risk factors (Figure 1). Conclusions The prevalence of CAD in master athletes is equivalent in case of PVBs and STD. The severity of CAD increases with an increasing number of cardiovascular risk factors. Therefore, in these cases the number of risk factors is an important variable to consider in the prescription of CCT.Figure 1