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Eur J Prev Cardiol. 2016 Oct;23(15):1677-84. doi: 10.1177/2047487316651825. Epub 2016 May 24.

Occult coronary artery disease in middle-aged sportsmen with a low cardiovascular risk score: The Measuring Athlete's Risk of Cardiovascular Events (MARC) study.

Author information

1
Department of Radiology, University Medical Center Utrecht, The Netherlands Department of Cardiology, University Medical Center Utrecht, The Netherlands Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands t.l.braber@umcutrecht.nl.
2
Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands.
3
Department of Radiology, University Medical Center Groningen, The Netherlands.
4
Department of Cardiology, University Medical Center Utrecht, The Netherlands.
5
Department of Radiology, University Medical Center Utrecht, The Netherlands.
6
Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, The Netherlands.
7
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.

Abstract

BACKGROUND:

Most exercise-related cardiac arrests in men aged ≥45 years are due to coronary artery disease (CAD). The current sports medical evaluation (SME) of middle-aged sportsmen includes medical history, physical examination and resting and exercise electrocardiography (ECG). We investigated the added value of low-dose cardiac computed tomography (CCT) - both non-contrast CT for coronary artery calcium scoring (CACS) and contrast-enhanced coronary CT angiography (CCTA) - in order to detect occult CAD in asymptomatic recreational sportsmen aged ≥45 years without known cardiovascular disease.

METHODS:

Following a normal SME (with resting and bicycle exercise ECG), 318 asymptomatic sportsmen underwent CCT and 300 (94%) had a low European Society of Cardiology Systematic Coronary Risk Evaluation (SCORE) risk. Occult CAD was defined as a CACS ≥100 Agatston units (AU) or obstructive (≥50%) luminal stenosis on CCTA. The number needed to screen (NNS) in order to prevent one cardiovascular event within 5 years with statin treatment was estimated.

RESULTS:

Fifty-two (16.4%, 95% confidence interval (CI): 12.7-20.8%) of 318 participants had a CACS ≥100 AU. The CCTA identified an additional eight participants with luminal narrowing ≥50% (and a CACS <100 AU). Taken together, CCT identified CAD in 60 (18.9%, 95% CI: 14.9-23.5%) of 318 participants. The 5-year estimated NNS was 183 (95% CI: 144-236) for CACS and 159 (95% CI: 128-201) for CACS combined with CCTA.

CONCLUSIONS:

Coronary CT detects occult CAD in almost one in five asymptomatic sportsmen aged ≥45 years after a normal SME that included resting and bicycle exercise ECG. CACS reveals most of the relevant CAD with limited additional value of contrast-enhanced CCTA. The NNS in order to prevent one cardiovascular event compares favourably to that of other screening tests.

KEYWORDS:

Athletes; coronary artery calcium score; coronary artery disease; coronary computed tomography angiography; exercise electrocardiography; screening

PMID:
27222386
DOI:
10.1177/2047487316651825
[Indexed for MEDLINE]

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