Restricted accessResearch articleFirst published online 2017-1
Pre-participation cardiovascular evaluation for athletic participants to prevent sudden death: Position paper from the EHRA and the EACPR,branches of the ESC. Endorsed by APHRS,HRS,and SOLAECE
KimJHMalhotraRChiampasGd’HemecourtPTroyanosCCiancaJ, et al.. Cardiac arrest during long-distance running races. N Engl J Med2012; 366: 130–40.
2.
HarmonKGAsifIMMaleszewskiJJOwensDSPrutkinJMSalernoJC, et al.. Incidence, etiology, and comparative frequency of sudden cardiac death in NCAA athletes: a decade in review. Circulation2015; 132: 10–19.
3.
CorradoDBassoCPaveiAMichieliPSchiavonMThieneG. Trends in sudden cardiovascular death in young competitive athletes after implementation of a pre-participation screening program. JAMA2006; 296: 1593–601.
4.
MarijonETaffletMCelermajerDSDumasFPerierMCMustaficH, et al.. Sports-related sudden death in the general population. Circulation2011; 124: 672–81.
5.
CorradoDBassoCRizzoliGSchiavonMThieneG. Does sports activity enhance the risk of sudden death in adolescents and young adults?J Am Coll Cardiol2003; 42: 1959–63.
6.
DunnTPPickhamDAggarwalSSainiDKumarNWheelerMT, et al.. Limitations of current AHA guidelines and proposal of new guidelines for the pre-participation examination of athletes. Clin J Sport Med2015; 25: 472–7.
7.
PellicciaAFagardRBjornstadHHAnastassakisAArbustiniEAssanelliD, et al.. Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J2005; 26: 1422–45.
8.
BorjessonMUrhausenAKouidiEDugmoreDSharmaSHalleM, et al.. Cardiovascular evaluation of middle-aged/senior individuals engaged in leisure-time sport activities: position stand from the sections of exercise physiology and sports cardiology of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil2011; 18: 446–58.
9.
ElliottPMAnastasakisABorgerMABorggrefeMCecchiFCharronP, et al.. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J2014; 35: 2733–79.
10.
PrioriSGBlomstrom-LundqvistCMazzantiABlomNBorggrefeMCammJ, et al.. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Europace2015; 17: 1601–87.
11.
PrioriSGWildeAAHorieMChoYBehrERBerulC, et al.. Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes. Europace2013; 15: 1389–406.
12.
PellicciaACorradoDBjornstadHHPanhuyzen-GoedkoopNUrhausenACarreF, et al.. Recommendations for participation in competitive sport and leisuretime physical activity in individuals with cardiomyopathies, myocarditis and pericarditis. Eur J Cardiovasc Prev Rehabil2006; 13: 876–85.
13.
PerkJDe BackerGGohlkeHGrahamIReinerZVerschurenM, et al.. The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J2012; 33: 1635–701.
14.
HarmonKGDreznerJAWilsonMGSharmaS. Incidence of sudden cardiac death in athletes: a state-of-the-art review. Heart2014; 100: 1227–34.
15.
ToresdahlBGRaoALHarmonKGDreznerJA. Incidence of sudden cardiac arrest in high school student athletes on school campus. Heart Rhythm2014; 11: 1190–4.
16.
RisgaardBWinkelBGJabbariRGlingeCIngemann-HansenOThomsenJL, et al.. Sports-related sudden cardiac death in a competitive and a noncompetitive athlete population aged 12 to 49 years: data from an unselected nationwide study in Denmark. Heart Rhythm2014; 11: 1673–81.
17.
MaronBJHaasTSMurphyCJAhluwaliaARutten-RamosS. Incidence and causes of sudden death in U.S. college athletes. J Am Coll Cardiol2014; 63: 1636–43.
18.
CorradoDThieneGNavaARossiLPennelliN. Sudden death in young competitive athletes: clinicopathologic correlations in 22 cases. Am J Med1990; 89: 588–96.
19.
MaronBJDoererJJHaasTSTierneyDMMuellerFO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980–2006. Circulation2009; 119: 1085–92.
20.
EckartREShryEABurkeAPMcNearJAAppelDACastillo-RojasLM, et al.. Sudden death in young adults: an autopsy-based series of a population undergoing active surveillance. J Am Coll Cardiol2011; 58: 1254–61.
21.
HolstAGWinkelBGTheiladeJKristensenIBThomsenJLOttesenGL, et al.. Incidence and etiology of sports-related sudden cardiac death in Denmark—implications for pre-participation screening. Heart Rhythm2010; 7: 1365–71.
22.
SolbergEEBorjessonMSharmaSPapadakisMWilhelmMDreznerJA, et al.. Sudden cardiac arrest in sports—need for uniform registration: A Position Paper from the Sport Cardiology Section of the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Prev Cardiol2016; 23: 657–67.
23.
MaronBJShiraniJPoliacLMathengeRRobertsWCMuellerFO. Sudden death in young competitive athletes: clinical, demographic, and pathological profiles. JAMA1996; 276: 199–204.
24.
Suarez-MierMPAguileraB. Causes of sudden death during sports activities in Spain. Rev Esp Cardiol2002; 55: 347–58.
25.
WatkinsHThierfelderLHwangDSMcKennaWSeidmanJGSeidmanCE. Sporadic hypertrophic cardiomyopathy due to de novo myosin mutations. J Clin Invest1992; 90: 1666–71.
26.
SemsarianCInglesJMaronMSMaronBJ. New perspectives on the prevalence of hypertrophic cardiomyopathy. J Am Coll Cardiol2015; 65: 1249–54.
27.
MaronBJNiimuraHCaseySASoperMKWrightGBSeidmanJG, et al.. Development of left ventricular hypertrophy in adults in hypertrophic cardiomyopathy caused by cardiac myosin-binding protein C gene mutations. J Am Coll Cardiol2001; 38: 315–21.
28.
O’MahonyCJichiFPavlouMMonserratLAnastasakisARapezziC, et al.. A novel clinical risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy (HCM risk-SCD). Eur Heart J2014; 35: 2010–20.
29.
MaronBJPellicciaA. The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death. Circulation2006; 114: 1633–44.
30.
CaselliSMaronMSUrbano-MoralJAPandianNGMaronBJPellicciaA. Differentiating left ventricular hypertrophy in athletes from that in patients with hypertrophic cardiomyopathy. Am J Cardiol2014; 114: 1383–9.
31.
SheikhNPapadakisMSchnellFPanoulasVMalhotraAWilsonM, et al.. Clinical profile of athletes with hypertrophic cardiomyopathy. Circ Cardiovasc Imaging2015; 8: e003454–e003454.
32.
RyanMPClelandJGFrenchJAJoshiJChoudhuryLChojnowskaL, et al.. The standard electrocardiogram as a screening test for hypertrophic cardiomyopathy. Am J Cardiol1995; 76: 689–94.
33.
CharronPDubourgODesnosMBouhourJBIsnardRHagegeA, et al.. Diagnostic value of electrocardiography and echocardiography for familial hypertrophic cardiomyopathy in genotyped children. Eur Heart J1998; 19: 1377–82.
34.
PellicciaAMaronBJCulassoFDi PaoloFMSpataroABiffiA, et al.. Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation2000; 102: 278–84.
35.
PapadakisMCarreFKervioGRawlinsJPanoulasVFChandraN, et al.. The prevalence, distribution, and clinical outcomes of electrocardiographic repolarization patterns in male athletes of African/Afro-Caribbean origin. Eur Heart J2011; 32: 2304–13.
36.
SheikhNPapadakisMGhaniSZaidiAGatiSAdamiPE, et al.. Comparison of electrocardiographic criteria for the detection of cardiac abnormalities in elite black and white athletes. Circulation2014; 129: 1637–49.
37.
CorradoDBassoCThieneGMcKennaWJDaviesMJFontaliranF, et al.. Spectrum of clinicopathologic manifestations of arrhythmogenic right ventricular cardiomyopathy/dysplasia: a multicenter study. J Am Coll Cardiol1997; 30: 1512–20.
38.
CorradoDBassoCThieneG. Arrhythmogenic right ventricular cardiomyopathy: diagnosis, prognosis, and treatment. Heart2000; 83: 588–95.
39.
CorradoDThieneG. Arrhythmogenic right ventricular cardiomyopathy/dysplasia: clinical impact of molecular genetic studies. Circulation2006; 113: 1634–7.
40.
CorradoDBassoCPilichouKThieneG. Molecular biologyand clinical management of arrhythmogenic right ventricular cardiomyopathy/dysplasia. Heart2011; 97: 530–9.
41.
MiglioreFZorziASilvanoMBevilacquaMLeoniLMarraMP, et al.. Prognostic value of endocardial voltage mapping in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia. Circ Arrhythm Electrophysiol2013; 6: 167–76.
42.
JamesCABhonsaleATichnellCMurrayBRussellSDTandriH, et al.. Exercise increases age-related penetrance and arrhythmic risk in arrhythmogenic right ventricular dysplasia/cardiomyopathy-associated desmosomal mutation carriers. J Am Coll Cardiol2013; 62: 1290–7.
43.
SaberniakJHasselbergNEBorgquistRPlatonovPGSarvariSISmithHJ, et al.. Vigorous physical activity impairs myocardial function in patients with arrhythmo-genic right ventricular cardiomyopathy and in mutation positive family members. Eur J Heart Fail2014; 16: 1337–44.
44.
RuwaldACMarcusFEstesNA3rdLinkMMcNittSPolonskyB, et al.. Association of competitive and recreational sport participation with cardiac events in patients with arrhythmogenic right ventricular cardiomyopathy: results from the North American multidisciplinary study of arrhythmogenic right ventricular cardiomyopathy. Eur Heart J2015; 36: 1735–43.
45.
McKennaWJThieneGNavaAFontaliranFBlomstrom-LundqvistCFontaineG, et al.. Diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy. Task Force of the Working Group Myocardial and Pericardial Disease of the European Society of Cardiology and of the Scientific Council on Cardiomyopathies of the International Society and Federation of Cardiology. Br Heart J1994; 71: 215–8.
46.
MarcusFIMcKennaWJSherrillDBassoCBauceBBluemkeDA, et al.. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the Task Force Criteria. Eur Heart J2010; 31: 806–14.
47.
CorradoDBassoCThieneG. Arrhythmogenic right ventricular cardiomyopathy: an update. Heart2009; 95: 766–73.
48.
CorradoDSchmiedCBassoCBorjessonMSchiavonMPellicciaA, et al.. Risk of sports: do we need a pre-participation screening for competitive and leisure athletes?Eur Heart J2011; 32: 934–44.
49.
PlatonovPGCalkinsHHauerRNCorradoDSvendsenJHWichterT, et al.. High interobserver variability in the assessment of epsilon waves: implications for diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia. Heart Rhythm2016; 13: 208–16.
50.
MarraMPLeoniLBauceBCorbettiFZorziAMiglioreF, et al.. Imaging study of ventricular scar in arrhythmogenic right ventricular cardiomyopathy: comparison of 3D standard electroanatomical voltage mapping and contrast-enhanced cardiac magnetic resonance. Circ Arrhythm Electrophysiol2012; 5: 91–100.
51.
GomesJFinlayMAhmedAKCiaccioEJAsimakiASaffitzJE, et al.. Electrophysio-logical abnormalities precede overt structural changes in arrhythmogenic right ventricular cardiomyopathydue to mutations in desmoplakin-A combined murine and human study. Eur Heart J2012; 33: 1942–53.
52.
Te RijdtWPJongbloedJDde BoerRAThieneGBassoCvan den BergMP, et al.. Clinical utility gene card for: arrhythmogenic right ventricular cardiomyopathy (ARVC). Eur J Hum Genet2014; 22. doi:10.1038/ejhg.2013.124.
53.
AngeliniP. Coronary artery anomalies: an entity in search of an identity. Circulation2007; 115: 1296–305.
54.
BassoCMaronBJCorradoDThieneG. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol2000; 35: 1493–501.
55.
WymanRAChiuRYRahkoPS. The 5-minute screening echocardiogram for athletes. J Am Soc Echocardiogr2008; 21: 786–8.
56.
HissRGLambLE. Electrocardiographic findings in 122,043 individuals. Circulation1962; 25: 947–61.
57.
ArasDTufekciogluOErgunKOzekeOYildizATopalogluS, et al.. Clinical features of isolated ventricular noncompaction in adults long-term clinical course, echocardiographic properties, and predictors of left ventricular failure. J Card Fail2006; 12: 726–33.
58.
TowbinJALortsAJefferiesJL. Left ventricular non-compaction cardiomyopathy. Lancet2015; 386: 813–25.
59.
BresciaSTRossanoJWPignatelliRJefferiesJLPriceJFDeckerJA, et al.. Mortality and sudden death in pediatric left ventricular noncompaction in a tertiary referral center. Circulation2013; 127: 2202–8.
60.
CaselliSAttenhofer JostCHJenniRPellicciaA. Left ventricular noncompaction diagnosis and management relevant to pre-participation screening of athletes. Am J Cardiol2015; 116: 801–8.
61.
GatiSChandraNBennettRLReedMKervioGPanoulasVF, et al.. Increased left ventricular trabeculation in highly trained athletes: do we need more stringent criteria for the diagnosis of left ventricular non-compaction in athletes?Heart2013; 99: 401–8.
62.
PintoYMElliottPMArbustiniEAdlerYAnastasakisABohmM, et al.. Proposal for a revised definition of dilated cardiomyopathy, hypokinetic non-dilated cardiomyopathy, and its implications for clinical practice: a position statement of the ESC working group on myocardial and pericardial diseases. Eur Heart J2016; 37: 1850–8.
63.
MarijonEUy-EvanadoAReinierKTeodorescuCNarayananKJouvenX, et al.. Sudden cardiac arrest during sports activity in middle age. Circulation2015; 131: 1384–91.
64.
PellicciaACulassoFDi PaoloFMMaronBJ. Physiologic left ventricular cavity dilatation in elite athletes. Ann Intern Med1999; 130: 23–31.
LieveKVWildeAA. Inherited ion channel diseases: a brief review. Europace2015; 17(Suppl 2): ii1–6.
67.
SchwartzPJStramba-BadialeMCrottiLPedrazziniMBesanaABosiG, et al.. Prevalence of the congenital long-QT syndrome. Circulation2009; 120: 1761–7.
68.
NakanoYShimizuW. Genetics of long-QT syndrome. J Hum Genet2016; 61: 51–5.
69.
AckermanMJPrioriSGWillemsSBerulCBrugadaRCalkinsH, et al.. HRS/EHRA expert consensus statement on the state of genetic testing for the channelopathies and cardiomyopathies. Europace2011; 13: 1077–109.
70.
FukuyamaMWangQKatoKOhnoSDingWGToyodaF, et al.. Long QT syndrome type 8: novel CACNA1C mutations causing QT prolongation and variant phenotypes. Europace2014; 16: 1828–37.
71.
NguyenHLPieperGHWildersR. Andersen-Tawil syndrome: clinical and molecular aspects. Int J Cardiol2013; 170: 1–16.
72.
SplawskiITimothyKWSharpeLMDecherNKumarPBloiseR, et al.. Ca(V)1.2 calcium channel dysfunction causes a multisystem disorder including arrhythmia and autism. Cell2004; 119: 19–31.
73.
SchwartzPJPrioriSGSpazzoliniCMossAJVincentGMNapolitanoC, et al.. Genotype-phenotype correlation in the long-QT syndrome: gene-specific triggers for life-threatening arrhythmias. Circulation2001; 103: 89–95.
74.
SchwartzPJMossAJVincentGMCramptonRS. Diagnostic criteria for the long QT syndrome. An update. Circulation1993; 88: 782–4.
75.
VincentGMJaiswalDTimothyKW. Effects of exercise on heart rate, QT, QTc and QT/QS2 in the Romano-Ward inherited long QT syndrome. Am J Cardiol1991; 68: 498–503.
76.
SwanHViitasaloMPiippoKLaitinenPKontulaKToivonenL. Sinus node function and ventricular repolarization during exercise stress test in long QT syndrome patients with KvLQTl and HERG potassium channel defects. J Am Coll Cardiol1999; 34: 823–9.
77.
HornerJMHornerMMAckermanMJ. The diagnostic utility of recovery phase QTc during treadmill exercise stress testing in the evaluation of long QT syndrome. Heart Rhythm2011; 8: 1698–704.
78.
SchwartzPJCrottiL. QTc behavior during exercise and genetic testing for the long-QT syndrome. Circulation2011; 124: 2181–4.
79.
SyRWvan der WerfCChatthaISChockalingamPAdlerAHealeyJS, et al.. Derivation and validation of a simple exercise-based algorithm for prediction of genetic testing in relatives of LQTS probands. Circulation2011; 124: 2187–94.
80.
ViskinSPostemaPGBhuiyanZARossoRKalmanJMVohraJK, et al.. The response of the QT interval to the brief tachycardia provoked by standing: a bedside test for diagnosing long QT syndrome. J Am Coll Cardiol2010; 55: 1955–61.
81.
AdlerAvan der WerfCPostemaPGRossoRBhuiyanZAKalmanJM, et al.. The phenomenon of ‘QT stunning’: the abnormal QT prolongation provoked by standing persists even as the heart rate returns to normal in patients with long QT syndrome. Heart Rhythm2012; 9: 901–8.
82.
Stramba-BadialeMPrioriSGNapolitanoCLocatiEHVinolasXHaverkampW, et al.. Gene-specific differences in the circadian variation of ventricular repolarization in the long QT syndrome: a key to sudden death during sleep?Ital Heart J2000; 1: 323–8.
83.
PrioriSGSchwartzPJNapolitanoCBloiseRRonchettiEGrilloM, et al.. Risk stratification in the long-QT syndrome. N Engl J Med2003; 348: 1866–74.
84.
GuerrierKKwiatkowskiDCzosekRJSparDSAndersonJBKnilansTK. Short QT interval prevalence and clinical outcomes in a pediatric population. Circ Arrhythm Electrophysiol2015; 8: 1460–4.
85.
AnttonenOJunttilaMJRissanenHReunanenAViitasaloMHuikuriHV. Prevalence and prognostic significance of short QT interval in a middle-aged Finnish population. Circulation2007; 116: 714–20.
86.
DhutiaHMalhotraAParpiaSGabusVFinocchiaroGMellorG, et al.. The prevalence and significance of a short QT interval in 18 825 low-risk individuals including athletes. Br J Sports Med2016; 50: 124–9.
87.
PrioriSGNapolitanoCMemmiMColombiBDragoFGaspariniM, et al.. Clinical and molecular characterization of patients with catecholaminergic polymorphic ventricular tachycardia. Circulation2002; 106: 69–74.
88.
MarjamaaAHiippalaAArrheniusBLahtinenAMKontulaKToivonenL, et al.. Intravenous epinephrine infusion test in diagnosis of catecholaminergic polymorphic ventricular tachycardia. J Cardiovasc Electrophysiol2012; 23: 194–9.
89.
van der WerfCZwindermanAHWildeAA. Therapeutic approach for patients with catecholaminergic polymorphic ventricular tachycardia: state of the art and future developments. Europace2012; 14: 175–83.
90.
BrugadaPBrugadaJ. Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol1992; 20: 1391–6.
91.
CatalanoOAntonaciSMoroGMussidaMFrascaroliMBaldiM, et al.. Magnetic resonance investigations in Brugada syndrome reveal unexpectedly high rate of structural abnormalities. Eur Heart J2009; 30: 2241–8.
92.
Schulze-BahrEEckardtLBreithardtGSeidlKWichterTWolpertC, et al.. Sodium channel gene (SCN5A) mutations in 44 index patients with Brugada syndrome: different incidences in familial and sporadic disease. Hum Mutat2003; 21: 651–2.
93.
RudicBSchimpfRVeltmannCDoeschCTulumenESchoenbergSO, et al.. Brugada syndrome: clinical presentation and genotype-correlation with magnetic resonance imaging parameters. Europace2015. In press. doi:10.1093/europace/euv300.
MakimotoHNakagawaETakakiHYamadaYOkamuraHNodaT, et al.. Augmented ST-segment elevation during recovery from exercise predicts cardiac events in patients with Brugada syndrome. J Am Coll Cardiol2010; 56: 1576–84.
97.
ThompsonPDFranklinBABaladyGJBlairSNCorradoDEstesNAIII, et al.. Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology. Circulation2007; 115: 2358–68.
98.
GiriSThompsonPDKiernanFJCliveJFramDBMitchelJF, et al.. Clinical and angiographic characteristics of exertion-related acute myocardial infarction. JAMA1999; 282: 1731–6.
99.
FletcherGFAdesPAKligfieldPArenaRBaladyGJBittnerVA, et al.. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation2013; 128: 873–934.
100.
Guerri-GuttenbergRAGranaDRAmbrosioGMileiJ. Chagas cardiomyopathy: Europe is not spared!. Eur Heart J2008; 29: 2587–91.
DiasJC. The indeterminate form of human chronic Chagas’ disease A clinical epidemiological review. Rev Soc Bras Med Trop1989; 22: 147–56.
103.
NunesMCDonesWMorilloCAEncinaJJRibeiroAL. Council on Chagas Disease of the Interamerican Society of Cardiology Chagas disease: an overview of clinical and epidemiological aspects. J Am Coll Cardiol2013; 62: 767–76.
104.
SternickEBMartinelliMSampaioRGerkenLMTeixeiraRAScarpelliR, et al.. Sudden cardiac death in patients with chagas heart disease and preserved left ventricular function. J Cardiovasc Electrophysiol2006; 17: 113–6.
105.
de PaolaAAGomesJATerzianABMiyamotoMHMartinez FoEE. Ventricular tachycardia during exercise testing as a predictor of sudden death in patients with chronic chagasic cardiomyopathy and ventricular arrhythmias. Br Heart J1995; 74: 293–5.
106.
Martinelli FilhoMSosaENishiokaSScanavaccaMBellottiGPileggiF. Clinical and electrophysiologic features of syncope in chronic chagasic heart disease. J Cardiovasc Electrophysiol1994; 5: 563–70.
107.
ShivkumarKBoyleNGScanavaccaMSosaEEpicardial ablation of ventricular tachycardia in Chagas heart disease. In: ShivkumarKBoyleNG (eds). Cardiac Electrophysiology Clinics: Epicardial Interventions in Electrophysiology, Philadelphia: Saunders, 2010, pp. 55–67.
108.
MatosLDAzevedoLFBrumPCSosaEAMartinelliMNegraoCE. Longdistance runner with dilated cardiomyopathy and excellent performance. Arq Bras Cardiol2011; 96: e3–6.
109.
CruzFMSanz-RosaDRoche-MolinaMGarcia-PrietoJGarcia-RuizJMPizarroG, et al.. Exercise triggers ARVC phenotype in mice expressing a disease-causing mutated version of human plakophilin-2. J Am Coll Cardiol2015; 65: 1438–50.
110.
KirchhofPFabritzLZwienerMWittHSchafersMZellerhoffS, et al.. Age- and training-dependent development of arrhythmogenic right ventricular cardiomyopathy in heterozygous plakoglobin-deficient mice. Circulation2006; 114: 1799–806.
111.
KonhilasJPWatsonPAMaassABoucekDMHornTStaufferBL, et al.. Exercise can prevent and reverse the severity of hypertrophic cardiomyopathy. Circ Res2006; 98: 540–8.
112.
HeidbuchelHHoogsteenJFagardRVanheesLEctorHWillemsR, et al.. High prevalence of right ventricular involvement in endurance athletes with ventricular arrhythmias. Role of an electrophysiologic study in risk stratification. Eur Heart J2003; 24: 1473–80.
113.
La GercheARobberechtCKuiperiCNuyensDWillemsRde RavelT, et al.. Lower than expected desmosomal gene mutation prevalence in endurance athletes with complex ventricular arrhythmias of right ventricular origin. Heart2010; 96: 1268–74.
114.
BenitoBGay-JordiGSerrano-MollarAGuaschEShiYTardifJC, et al.. Cardiac arrhythmogenic remodeling in a rat model of long-term intensive exercise training. Circulation2011; 123: 13–22.
115.
SawantACBhonsaleATe RieleASTichnellCMurrayBRussellSD, et al.. Exercise has a disproportionate role in the pathogenesis of arrhythmogenic right ventricular dysplasia/cardiomyopathy in patients without desmosomal mutations. J Am Heart Assoc2014; 3: e001471–e001471.
116.
La GercheAHeidbuchelH. Can intensive exercise harm the heart? You can get too much of a good thing. Circulation2014; 130: 992–1002.
117.
HeidbuchelHPriorDLLa GercheA. Ventricular arrhythmias associated with long-term endurance sports: what is the evidence?Br J Sports Med2012; 46(Suppl 1): i44–50.
118.
AbergelEChatellierGHagegeAAOblakALinhartADucardonnetA, et al.. Serial left ventricular adaptations in world-class professional cyclists: implications for disease screening and follow-up. J Am Coll Cardiol2004; 44: 144–9.
119.
KielRJSmithFEChasonJKhatibRReyesMP. Coxsackievirus B3 myocarditis in C3H/HeJ mice: description of an inbred model and the effect of exercise on virulence. Eur J Epidemiol1989; 5: 348–50.
120.
SchnellFClaessenGLa GercheABogaertJLentzPAClausP, et al.. Subepicardial delayed gadolinium enhancement in asymptomatic athletes: let sleeping dogs lie?Br J Sports Med2016; 50: 111–7.
121.
CorradoDBassoCSchiavonMThieneG. Screening for hypertrophic cardiomyopathy in young athletes. N Engl J Med1998; 339: 364–9.
122.
HarmonKGZigmanMDreznerJA. The effectiveness of screening history, physical exam, and ECG to detect potentially lethal cardiac disorders in athletes: a systematic review/meta-analysis. J Electrocardiol2015; 48: 329–38.
123.
BrosnanMLa GercheAKalmanJLoWFallonKMaclsaacA, et al.. Comparison of frequency of significant electrocardiographic abnormalities in endurance versus nonendurance athletes. Am J Cardiol2014; 113: 1567–73.
124.
SenturkTXuHPuppalaKKrishnanBSakaguchiSChenLY, et al.. Cardiac pauses in competitive athletes: a systematic review examining the basis of current practice recommendations. Europace2015. In press. doi:10.1093/europace/euv373.
125.
BrosnanMLa GercheAKalmanJLoWFallonKMaclsaacA, et al.. The Seattle Criteria increase the specificity of preparticipation ECG screening among elite athletes. Br J Sports Med2014; 48: 1144–50.
126.
RowinEJMaronBJAppelbaumELinkMSGibsonCMLesserJR, et al.. Significance of false negative electrocardiograms in preparticipation screening of athletes for hypertrophic cardiomyopathy. Am J Cardiol2012; 110: 1027–32.
127.
DreznerJAFudgeJHarmonKGBergerSCampbellRMVetterVL. Warning symptoms and family history in children and young adults with sudden cardiac arrest. J Am Board Fam Med2012; 25: 408–15.
128.
MaronBJFriedmanRAKligfieldPLevineBDViskinSChaitmanBR, et al.. Assessment of the 12-lead ECG as a screening test for detection of cardiovascular disease in healthy general populations of young people (12–25 years of age): a scientific statement from the American Heart Association and the American College of Cardiology. Circulation2014; 130: 1303–34.
129.
CorradoDPellicciaAHeidbuchelHSharmaSLinkMBassoC, et al.. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J2010; 31: 243–59.
130.
DreznerJAAckermanMJAndersonJAshleyEAsplundCABaggishAL, et al.. Electrocardiographic interpretation in athletes: the ‘Seattle Criteria’. Br J Sports Med2013; 47: 122–4.
131.
PickhamDZarafsharSSaniDKumarNFroelicherV. Comparison of three ECG criteria for athlete pre-participation screening. J Electrocardiol2014; 47: 769–74.
132.
BergeHMGjesdalKAndersenTESolbergEESteineK. Prevalence of abnormal ECGs in male soccer players decreases with the Seattle criteria, but is still high. Scand J Med Sci Sports2015; 25: 501–8.
133.
CorradoDCaloreCZorziAMiglioreF. Improving the interpretation of the athlete’s electrocardiogram. Eur Heart J2013; 34: 3606–9.
134.
ViskinSRosovskiUSandsAJChenEKistlerPMKalmanJM, et al.. Inaccurate electrocardiographic interpretation of long QT: the majority of physicians cannot recognize a long QT when they see one. Heart Rhythm2005; 2: 569–74.
135.
BerteBDuytschaeverMElicesJKatariaVTimmersLVan HeuverswynF, et al.. Variability in interpretation of the electrocardiogram in young athletes: an unrecognized obstacle for electrocardiogram-based screening protocols. Europace2015; 17: 1435–40.
136.
MagalskiAMaronBJMainMLMcCoyMFlorezAReidKJ, et al.. Relation of race to electrocardiographic patterns in elite American football players. J Am Coll Cardiol2008; 51: 2250–5.
137.
GloverDWGloverDWMaronBJ. Evolution in the process of screening United States high school student-athletes for cardiovascular disease. Am J Cardiol2007; 100: 1709–12.
138.
HeidbuchelHPapadakisMPanhuyzen-GoedkoopNCarreFDugmoreDMellwigKP, et al.. Position paper: proposal for a core curriculum for a European Sports Cardiology qualification. Eur J Prev Cardiol2013; 20: 889–903.
139.
PapadakisMChandraNSharmaS. Controversies relating to preparticipation cardiovascular screening in young athletes: time for a realistic solution?Br J Sports Med2011; 45: 165–6.
140.
SolbergEEBjornstadTHAndersenTEEkebergO. Cardiovascular preparticipation screening does not distress professional football players. Eur J Prev Cardiol2012; 19: 571–7.
141.
AsifIMJohnsonSSchmiegJSmithTRaoALHarmonKG, et al.. The psychological impact of cardiovascular screening: the athlete’s perspective. Br J Sports Med2014; 48: 1162–6.
142.
SharmaSEstesNAIIIVetterVLCorradoD. Clinical decisions. Cardiac screening before participation in sports. N Engl J Med2013; 369: 2049–53.
143.
TasakiHHamasakiYIchimaruT. Mass screening for heart disease of school children in Saga city: 7-year follow up study. Jpn Circ J1987; 51: 1415–20.
144.
VetterVLDuganNGuoRMercer-RosaLGleasonMCohenM, et al.. A pilot study of the feasibility of heart screening for sudden cardiac arrest in healthy children. Am Heart J2011; 161: 1000–1006.e3.
145.
LahavDLeshnoMBrezisM. Is an exercise tolerance test indicated before beginning regular exercise? A decision analysis. J Gen Intern Med2009; 24: 934–8.
146.
GianrossiRDetranoRMulvihillDLehmannKDubachPColomboA, et al.. Exercise-induced ST depression in the diagnosis of coronary artery disease. A meta-analysis. Circulation1989; 80: 87–98.
147.
SchnellFRidingNO’HanlonRAxel LentzPDonalEKervioG, et al.. Recognition and significance of pathological T-wave inversions in athletes. Circulation2015; 131: 165–73.
148.
FeinsteinRAColvinEKimohM. Echocardiographic screening as part of a preparticipation examination. Clin J Sport Med1993; 3: 149–52.
149.
WeidenbenerEJKraussMDWallerBFTaliercioCP. Incorporation of screening echocardiography in the preparticipation exam. Clin J Sport Med1995; 5: 86–9.
150.
AndersonJBGrenierMEdwardsNMMadsenNLCzosekRJSparDS, et al.. Usefulness of combined history, physical examination, electrocardiogram, and limited echocardiogram in screening adolescent athletes for risk for sudden cardiac death. AmJCardiol2014; 114: 1763–7.
151.
RidingNRSharmaSSalahOKhalilNCarreFGeorgeKP, et al.. Systematic echocardiography is not efficacious when screening an ethnically diverse cohort of athletes in West Asia. Eur J Prev Cardiol2015; 22: 263–70.
152.
LewisJFMaronBJDiggsJASpencerJEMehrotraPPCurryCL. Preparticipation echocardiographic screening for cardiovascular disease in a large, predominantly black population of collegiate athletes. Am J Cardiol1989; 64: 1029–33.
153.
ZaidiAGhaniSSharmaROxboroughDPanoulasVFSheikhN, et al.. Physiological right ventricular adaptation in elite athletes of African and Afro-Caribbean origin. Circulation2013; 127: 1783–92.
154.
JellisCMartinJNarulaJMarwickTH. Assessment of nonischemic myocardial fibrosis. J Am Coll Cardiol2010; 56: 89–97.
155.
La GercheAClaessenGDymarkowskiSVoigtJUDe BuckFVanheesL, et al.. Exercise-induced right ventricular dysfunction is associated with ventricular arrhythmias in endurance athletes. Eur Heart J2015; 36: 1998–2010.
156.
La GercheABurnsATMooneyDJInderWJTaylorAJBogaertJ, et al.. Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes. Eur Heart J2012; 33: 998–1006.
157.
WilsonMO’HanlonRPrasadSDeighanAMacmillanPOxboroughD, et al.. Diverse patterns of myocardial fibrosis in lifelong, veteran endurance athletes. J Appl Physiol2011; 110: 1622–6.
158.
DavisJACecchinFJonesTKPortmanMA. Major coronary artery anomalies in a pediatric population: incidence and clinical importance. J Am Coll Cardiol2001; 37: 593–7.
159.
AlbertCMMittlemanMAChaeCULeeIMHennekensCHMansonJE. Triggering of sudden death from cardiac causes by vigorous exertion. N Engl J Med2000; 343: 1355–61.
160.
YeboahJMcClellandRLPolonskyTSBurkeGLSibleyCTO’LearyD, et al.. Comparison of novel risk markers for improvement in cardiovascular risk assessment in intermediate-risk individuals. JAMA2012; 308: 788–95.
161.
MohlenkampSLehmannNBreuckmannFBrocker-PreussMNassensteinKHalleM, et al.. Running: the risk of coronary events: prevalence and prognostic relevance of coronary atherosclerosis in marathon runners. Eur Heart J2008; 29: 1903–10.
162.
SchnohrPO’KeefeJHMarottJLLangePJensenGB. Dose of jogging and longterm mortality: the Copenhagen City Heart Study. J Am Coll Cardiol2015; 65: 411–9.
163.
MaronBJLevineBDWashingtonRLBaggishALKovacsRJMaronMS. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 2: preparticipation screening for cardiovascular disease in competitive athletes: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol2015; 66: 2356–61.
164.
DvorakJGrimmKSchmiedCJungeA. Development and implementation of a standardized precompetition medical assessment of international elite football players—2006 FIFA World Cup Germany. Clin J Sport Med2009; 19: 316–21.
165.
LjungqvistAJenourePEngebretsenLAlonsoJMBahrRCloughA, et al.. The International Olympic Committee (IOC) Consensus Statement on periodic health evaluation of elite athletes March 2009. Br J Sports Med2009; 43: 631–43.
166.
ViskinS. Antagonist: routine screening of all athletes prior to participation in competitive sports should be mandatory to prevent sudden cardiac death. Heart Rhythm2007; 4: 525–8.
167.
SteinvilAChundadzeTZeltserDRogowskiOHalkinAGalilyY, et al.. Mandatory electrocardiographic screening of athletes to reduce their risk for sudden death proven fact or wishful thinking?J Am Coll Cardiol2011; 57: 1291–6.
168.
SuissaS. Immortal time bias in pharmaco-epidemiology. Am J Epidemiol2008; 167: 492–9.
169.
RobertsWOMaronBJ. Evidence for decreasing occurrence of sudden cardiac death associated with the marathon. J Am Coll Cardiol2005; 46: 1373–4.
170.
MaronBJHaasTSDoererJJThompsonPDHodgesJS. Comparison of U.S. and Italian experiences with sudden cardiac deaths in young competitive athletes and implications for preparticipation screening strategies. Am J Cardiol2009; 104: 276–80.
171.
HalkinASteinvilARossoRAdlerARozovskiUViskinS. Preventing sudden death of athletes with electrocardiographic screening: what is the absolute benefit and how much will it cost?J Am Coll Cardiol2012; 60: 2271–6.
172.
FullerCM. Cost effectiveness analysis of screening of high school athletes for risk of sudden cardiac death. Med Sci Sports Exerc2000; 32: 887–90.
173.
MaronBJThompsonPDAckermanMJBaladyGBergerSCohenD, et al.. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation2007; 115: 1643–55.
174.
WheelerMTHeidenreichPAFroelicherVFHlatkyMAAshleyEA. Cost-effectiveness of preparticipation screening for prevention of sudden cardiac death in young athletes. Ann Intern Med2010; 152: 276–86.
175.
LeslieLKCohenJTNewburgerJWAlexanderMEWongJBSherwinED, et al.. Costs and benefits of targeted screening for causes of sudden cardiac death in children and adolescents. Circulation2012; 125: 2621–9.
176.
SchoenbaumMDenchevPVitielloBKaltmanJR. Economic evaluation of strategies to reduce sudden cardiac death in young athletes. Pediatrics2012; 130: e380–9.
177.
CorradoDBassoCThieneG. Pros and cons of screening for sudden cardiac death in sports. Heart2013; 99: 1365–73.
178.
AssanelliDLevaggiRCarreFSharmaSDeligiannisAMellwigKP, et al.. Cost-effectiveness of pre-participation screening of athletes with ECG in Europe and Algeria. Intern Emerg Med2015; 10: 143–50.
179.
Van CampSPBloorCMMuellerFOCantuRVOlsonHG. Nontraumatic sports death in high school and college athletes. Med Sci Sports Exerc1995; 27: 641–7.
180.
BohmPScharhagJMeyerT. Data from a nationwide registry on sports-related sudden cardiac deaths in Germany. Eur J Prev Cardiol2016; 23: 649–56.