Prominent left ventricular trabeculations in competitive athletes: A proposal for risk stratification and management

Abstract

Background

Recently, an unexpectedly large prevalence of Left Ventricular Non Compaction (LVNC) has been reported in athletes, raising the question of the appropriateness of current diagnostic criteria. We sought to describe prevalence and clinical characteristics of athletes with suspected LVNC in a large cohort of Olympic athletes.

Methods

Over 29 months, 2501 consecutive athletes underwent a cardiac evaluation including physical examination, ECG, exercise test and echocardiography. Additional investigations (Cardiac Magnetic Resonance and/or genetic testing) were selectively performed in athletes with abnormal ECGs, ventricular arrhythmias, borderline LV dysfunction or positive family history.

Results

Of the 2501 athletes, 36 (1.4%) showed prominent trabeculations suggestive for LVNC. Of these, 3 (0.1%) were considered to be affected by LVNC, based on presence of LV dysfunction (ejection fraction < 50%) and/or positive family history and genetic testing; these athletes were cautiously restricted from competitions and entered a clinical follow-up program. The remaining 33 athletes, in the absence of LV impairment or familial cardiac diseases, were considered normal (n = 24) or unlikely affected (n = 9), regardless of the extent of the trabeculations.

Conclusions

In a large athlete population, a marked LV trabecular pattern was seen in 1.4%. Only a small subset of these athletes (0.1%) showed familial, clinical and morphologic changes supporting the diagnosis of LVNC. In the vast majority of the athletes, the increased trabeculations were not associated with LV dysfunction and/or positive family history, likely representing a morphologic LV variant, deprived of clinical significance.

Keywords

  • Athletes
  • Left ventricular non-compaction
  • Trabeculations
  • Cardiomyopathy

The authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

Corresponding author at: Institute of Sport Medicine and Science, Largo Piero Gabrielli, 1, 00197 Rome, Italy.

Autor / Fonte:Stefano Caselli, Diana Ferreira, Eyad Kanawati, Fernando Di Paolo, Cataldo Pisicchio, Christine Attenhofer Jost, Antonio Spataro, Rolf Jenni, Antonio Pelliccia International Journal of Cardiology 2016 August 17, 223: 590-595
Link: http://www.sciencedirect.com/science/article/pii/S0167527316319787