Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 5: Valvular Heart Disease : A Scientific Statement From the American Heart Association and American College of Cardiology
- ACC/AHA Scientific Statements;
- cardiovascular abnormalities;
- valvular heart disease
A search of the literature identifies no prospective clinical trials examining the management of athletes or very physically active, asymptomatic people with abnormal cardiac valves. There are also few clinical trials on nonathletes with aortic or mitral valve disease. Consequently, recommendations for athletic participation in people with these conditions are based on cohort analyses of nonathletic subjects and consensus opinion.
The 2014 American Heart Association/American College of Cardiology “Guideline for the Management of Patients With Valvular Heart Disease” (1) defines stages of valve disease that are useful for subgrouping patients with aortic and mitral valve disease. In stage A are asymptomatic people at risk for developing clinically important valve stenosis or regurgitation, such as patients with bicuspid aortic valves or mitral valve prolapse without obstruction or regurgitation. Patients in stage A may have physical findings consistent with the underlying valve pathology, such as a mitral valve click or an aortic ejection sound, but do not have the pathognomonic findings of valvular malfunction. Stage B includes asymptomatic patients with mild to moderate valvular heart disease with normal left ventricular (LV) systolic function. Stage C designates asymptomatic patients with severe valvular heart disease with evidence of preserved systolic function (stage C1) or LV dysfunction (C2), and stage D designates patients with symptomatic severe valvular heart disease with or without LV dysfunction. Eligibility for competitive sports is a pertinent issue for people with valvular heart disease in stages A, B, and C, whereas symptomatic patients in stage D are not candidates for competition and under most circumstances should be referred for valve replacement or repair. Athletic competition is also a relevant issue in asymptomatic patients who have undergone successful valve surgery.
Autor / Fonte:Robert O Bonow, Rick A Nishimura, Paul D Thompson, James E Udelson Journal of the American College of Cardiology 2015 October 27