Aim: To analyze the cardiovascular (CV) causes of disqualification from competitive sports in young (<35 years) and master (?35 years) athletes consecutively screened at our Sports Medicine Centre in a 10 years time interval and to collect follow-up data.
Methods: During the 2001-2010 period, 35627 athletes (young 91%, master 9%) were screened according to Italian Protocol (history, physical examination, 12-lead ECG, exercise stress testing). CV conditions were analyzed on the basis of the reasons for proceeding with further CV examinations. Athletes with CV diseases were treated according to specific guidelines.
Results: Overall, disqualified athletes were 99 (0.20%), 94 (95%) for a CV causes. They were referred for further examinations because of positive history for CV diseases (18%), heart murmurs or hypertension (9%), 12-lead ECG or stress test abnormalities (73%). Among young athletes 63 (0.19%) were disqualified for the following CV causes: rhythm and conduction abnormalities (21), bicuspid aortic valve (12), mitral valve prolapse (MVP) with ventricular arrhythmias (VA) (10), arrhythmogenic right ventricular cardiomyopathy (ARVC) (3), hypertrophic cardiomyopathy (HCM) (3), congenital coronary artery anomalies (3), myocarditis (2), dilated cardiomyopathy (1), coronary artery disease (CAD) (1), atrial septal defect (2), Kawasaki disease (1), left ventricular diverticulum (1), hypertension (2), pulmonary hypertension (1). During follow up (63±34 months) clinical course of young athletes with CV diseases was unremarkable. Among master athletes 31(1%) were disqualified for the following CV causes: MVP with VA (6), CAD (4), hypertension (3), HCM (2), ARVC (1), dilated cardiomyopathy (1), VA in myocardial fibrosis (2), and idiopathic VA (12). During follow-up (76±41 months) there were no deaths but two acute coronary syndromes.
Conclusions: CV disqualification rate was higher in master than young athletes (1% vs 0.19%). Clinical course of athletes with CV diseases was favorable, probably because they were disqualified from competition and appropriately treated. These data confirm the usefulness of pre-participation screening and the key role of 12-lead ECG and stress test for the identification of CV disease potentially at risk of sudden death.