P659Athlete's heart or structural heart disease: data of the hungarian magnetic resonance registry of structural heart disease and aborted sudden cardiac death in athletes

Abstract

Background/Introduction: 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. Purpose: 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. Methods: During a 7-year period (between January 2011 and January 2018) we performed CMR scans on 200 athletes (175 males, age: 28.4±12.4) with suspected structural myocardial disease prospectively. Twelve athletes were investigated after aborted sudden cardiac death. Results: CMR confirmed the diagnosis of structural myocardial disease in 55 athletes (27.5%) (52 male, age: 27±18 y 29.1±9.4 y): hypertrophic cardiomyopathy (HCM) in 11 cases (20%), arrhythmogenic right ventricular cardiomyopathy (ARVC) in 8 cases (18.2%), noncompaction (NCCMP) and dilated cardiomyopathy (DCM) in 5-5 cases (9.1-9.1%). Subendocardial late gadolinium enhancement (LGE), reflecting myocardial scar, was typical of previous myocardial infarction (post AMI) in 3 cases (5.5%). Acute myocarditis was found in 2 cases (3.6%). Nonischaemic LGE pattern was found in 18 cases (32.7%): patchy subepi-midmyocardial LGE suggesting previous myocarditis in 8 athletes, and with aspecific pattern in 10 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 (1.8%), one with coronary artery abnormality (anomalous origin of the left main coronary artery from the right sinus of Valsalva) (1.8%), one athlete showed pheochromocytoma-related Tako-Tsubo cardiomyopathy. Eleven athletes with confirmed structural heart disease were investigated after sustained ventricular tachycardy, seven athletes after aborted SCD: ARVC (n=3), aspecific LGE pattern (n=3), and pheochromocytoma-related Tako-Tsubo cardiomyopathy (n=1). Conclusions: 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.