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THE JOURNAL OF SPORTS MEDICINE AND PHYSICAL FITNESS

A Journal on Applied Physiology, Biomechanics, Preventive Medicine,
Sports Medicine and Traumatology, Sports Psychology


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The Journal of Sports Medicine and Physical Fitness 2017 Nov 17

DOI: 10.23736/S0022-4707.17.07961-0

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Clinical significance of ST depression at exercise stress testing in competitive athletes: usefulness of coronary CT during screening

Fabio SPERANDII 1, Emanuele GUERRA 2, Eliana TRANCHITA 3 , Carlo MINGANTI 3, Chiara LANZILLO 1, Antonia NIGRO 3, Federico QUARANTA 3, Attilio PARISI 3, Mauro DI ROMA 1, Luciano MARESCA 1, Federica FAGNANI 3, Leonardo CALÒ 1

1 Department of Cardiology, Policlinico Casilino, Rome, Italy; 2 National Health Service, Unit of Sports Medicine, Department of Public Health, AUSL Modena, Modena, Italy; 3 Division of Healt Sciences, Department of Movement, Human and Health Sciences, University of Rome, Rome, Italy


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BACKGROUND: Congenital coronary anomalies (CCAs) and coronary artery disease (CAD) arouse intense scientific and clinical interest in sports medicine and sports cardiology medical communities because of their potential to trigger sudden cardiac death (SCD) in athletes. Exercise stress testing represent the first instrumental assessment to evaluate electrocardiographic changes during effort. Coronary computed tomography angiography (CCTA) is an advanced accurate noninvasive imaging modality for excluding CAD and abnormalities of origin and course of coronary vessels. The aim of this study is to investigate with CCTA the clinical significance of ST depression suggestive for myocardial ischemia during exercise stress testing in athletes and to determine the prevalence of CAD and/or CCAs.
METHODS: 65 consecutive athletes showing electrocardiographic findings positive or equivocal for myocardial ischemia on exercise stress testing during pre-participation screening were investigated with CCTA.
RESULTS: Among 65 athletes investigated, 36 showed Myocardial Bridge (MB), 1 showed an anomalous coronary origin and 7 showed CAD. Among 36 athletes with MB, 4 were associated with mild coronary artery stenosis. Three athletes with CAD needed percutaneous transluminal coronary angioplasty or coronary artery bypass surgery.
CONCLUSIONS: In competitive athletes even with excellent workload capacities, in absence of cardiomyopathy, the presence of ischaemic electrocardiographic abnormalities could be mainly determined by a coronary congenital or acquired pathology. In this population CCTA is an useful imaging modality of choice for the risk stratification and for the diagnostic process, to allow eligible athletes to compete and to follow up subjects requiring medical surveillance.


KEY WORDS: Athletes - Myocardial bridge - Congenital coronary anomalies - Coronary artery disease

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Publication History

Article first published online: November 17, 2017
Manuscript accepted: November 8, 2017
Manuscript revised: October 18, 2017
Manuscript received: July 17, 2017

Cite this article as

Sperandii F, Guerra E, Tranchita E, Minganti C, Lanzillo C, Nigro A, et al. Clinical significance of ST depression at exercise stress testing in competitive athletes: usefulness of coronary CT during screening. J Sports Med Phys Fitness 2017 Nov 17. DOI: 10.23736/S0022-4707.17.07961-0

Corresponding author e-mail

e.tranchita@studenti.uniroma4.it