P4444Athlete's heart or structural heart disease? - First Hungarian Structural Heart Disease and Aborted Sudden Cardiac Death Magnetic Resonance Registry in Athletes

Abstract

Sudden cardiac death (SCD) is the most common cause of death in athletes occurring usually during intensive training. Cardiac magnetic resonance (CMR) has a crucial role in the detection of structural myocardial abnormalities. Our aim was to investigate the etiology of SCD and to estimate the prevalence of myocardial structural heart diseases among Hungarian competitive athletes using CMR. During a 6-year period (between January 2011 and January 2017) we performed CMR scans on 154 athletes (135 males, age: 28.7±12.5 y) with suspected structural myocardial disease. Ten athletes were investigated after aborted SCD. CMR confirmed the diagnosis of structural myocardial disease in 40 athletes (26.0%) (38 male, age: 27±18 y): hypertrophic cardiomyopathy (HCM) in 9 cases (22.5%), arrhythmogenic right ventricular cardiomyopathy (ARVC) in 8 cases (20.0%), noncompaction (NCCMP) and dilated cardiomyopathy (DCM) in 2-2 cases (5.0-5.0%) (Figure). Subendocardial late gadolinium enhancement (LGE), reflecting myocardial scar/fibrosis, was typical of previous myocardial infarction (post AMI) in 2 cases. Nonischaemic LGE pattern was found in 15 cases (37.5%): patchy subepi-midmyocardial LGE suggesting previous myocarditis in 8 athletes, and with aspecific pattern in 7 athletes. Athletes with nonischaemic LGE had normal laboratory parameters without wall motion abnormalities, in their cases systemic diseases were ruled out. One athlete was diagnosed with Fabry-disease (2.5%), one with coronary artery abnormality (anomalous origin of the left main coronary artery from the right sinus of Valsalva) (2.5%). Regarding the 10 aborted SCD cases, CMR findings were the following: ARVC (n=3), aspecific LGE pattern (n=2), and no structural myocardium abnormality (n=5). In the last group two athletes were diagnosed with long QT-syndrome, one with Wolff-Parkinson-Whitesyndrome and one with Brugada-syndrome. In our national CMR registry the most common structural alteration was nonischaemic fibrosis, the most common cardiomyopathy was HCM, and the leading cause of SCD in Hungarian competitive athletes was ARVC. The national registers are highly important for a better understanding the etiology and the geographical differences of SCD in athletes.