Sudden Cardiac and Noncardiac Death in Sports: Epidemiology, Causes, Pathogenesis, and Prevention

Giuseppe Lippi; Emmanuel J. Favaloro; Fabian Sanchis-Gomar

doi:10.1055/s-0038-1661334

Seminars in Thrombosis and Hemostasis, Inhaltsverzeichnis

Semin Thromb Hemost 2018; 44(08): 780-786
DOI: 10.1055/s-0038-1661334

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Sudden Cardiac and Noncardiac Death in Sports: Epidemiology, Causes, Pathogenesis, and Prevention

Giuseppe Lippi

¹Section of Clinical Biochemistry, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy

,

Emmanuel J. Favaloro^*

²Department of Clinical and Laboratory Haematology, Sydney Centres for Thrombosis and Haemostasis, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital, Westmead, New South Wales, Australia

,

Fabian Sanchis-Gomar^*

³Department of Physiology, Faculty of Medicine, Instituto de Investigación INCLIVA, Fundación Investigación Hospital Clínico, University of Valencia, Valencia, Spain

⁴Leon H. Charney Division of Cardiology, NYU School of Medicine, New York, New York

› Institutsangaben

Abstract

Although few doubts remain that physical exercise should be widely promoted for maintenance of health and fitness, the risk of adverse events such as sudden death (especially due to cardiac causes, i.e., sudden cardiac death [SCD]) during exercise remains tangible. The overall risk of sudden death in athletes is relatively low (i.e., usually comprised between 0.1 and 38/100,000 person-years), and globally comparable to that of the general population. However, up to 20% of all sudden death cases are still recorded while exercising. The most frequent underlying disorders encountered in SCD are hypertrophic cardiomyopathy and coronary artery disease (CAD), representing three quarters of all conditions. The risk related to CAD increases with aging (>35 years old), while that attributable to cardiomyopathies or fatal arrhythmias is especially frequent among young people (<35 years old). Taken together, these findings would lead to the conclusion that physical exercise may be seen as an acute trigger of myocardial ischemia or arrhythmias in some predisposed individuals. Nonetheless, the prevalence of coronary atherosclerosis seems to be higher in athletes than in sedentary subjects with comparable risk profile. On the contrary, coronary plaques in physically active subjects appear more stable, thereby attenuating the risk of rupture and subsequent myocardial ischemia. These findings, along with evidence of a considerable increase of peak coronary blood flow during exercise, make it very likely that an imbalance between oxygen demand and supply may be the most frequent cause of myocardial ischemia in athletes suffering SCD and/or cardiac arrest. Therefore, all subjects who wish to practice moderate- to high-intensity exercise are recommended to undergo preparticipation screening and annual follow-up.

Keywords

sudden death - cardiac arrest - sports - physical exercise - physical activity

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References
1 World Health Organization. Physical activity. Available at: http://www.who.int/topics/physical_activity/en/ . Accessed February 2, 2018
2 Allison L. Amateurism in Sport: An Analysis and a Defence. London, UK: Frank Cass & Co; 2001
3 Lippi G, Franchini M, Guidi GC. Doping in competition or doping in sport?. Br Med Bull 2008; 86: 95-107
4 Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. CMAJ 2006; 174 (06) 801-809
5 Lippi G, Schena F, Guidi GC. Health benefits of physical activity. CMAJ 2006; 175 (07) 776 , author reply 777
6 Sanchis-Gomar F, Santos-Lozano A, Garatachea N. , et al. My patient wants to perform strenuous endurance exercise. What's the right advice?. Int J Cardiol 2015; 197: 248-253
7 Müller-Riemenschneider F, Reinhold T, Nocon M, Willich SN. Long-term effectiveness of interventions promoting physical activity: a systematic review. Prev Med 2008; 47 (04) 354-368
8 European Commission. Special Eurobarometer 412 “Sport and Physical Activity”. 2014. DOI: 10.2766/73002
9 Montagnana M, Lippi G, Franchini M, Banfi G, Guidi GC. Sudden cardiac death in young athletes. Intern Med 2008; 47 (15) 1373-1378
10 Montagnana M, Lippi G, Franchini M, Targher G, Cesare Guidi G. Sudden cardiac death: prevalence, pathogenesis, and prevention. Ann Med 2008; 40 (05) 360-375
11 American Heart Association. Heart Attack or Sudden Cardiac Arrest: How Are They Different?. Available at: http://www.heart.org/HEARTORG/Conditions/More/CardiacArrest/About-Cardiac-Arrest_UCM_307905_Article.jsp#.WmtGTuHhDcs . Accessed February 2, 2018
12 Narayanan K, Bougouin W, Sharifzadehgan A. , et al. Sudden cardiac death during sports activities in the general population. Card Electrophysiol Clin 2017; 9 (04) 559-567
13 Asif IM, Harmon KG. Incidence and etiology of sudden cardiac death: new updates for athletic departments. Sports Health 2017; 9 (03) 268-279
14 Waite O, Smith A, Madge L, Spring H, Noret N. Sudden cardiac death in marathons: a systematic review. Phys Sportsmed 2016; 44 (01) 79-84
15 Maron BJ, Roberts WC, McAllister HA, Rosing DR, Epstein SE. Sudden death in young athletes. Circulation 1980; 62 (02) 218-229
16 Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006. Circulation 2009; 119 (08) 1085-1092
17 Maron BJ, Haas TS, Ahluwalia A, Murphy CJ, Garberich RF. Demographics and epidemiology of sudden deaths in young competitive athletes: from the United States National Registry. Am J Med 2016; 129 (11) 1170-1177
18 Basso C, Corrado D, Thiene G. Cardiovascular causes of sudden death in young individuals including athletes. Cardiol Rev 1999; 7 (03) 127-135
19 Harmon KG, Asif IM, Klossner D, Drezner JA. Incidence of sudden cardiac death in National Collegiate Athletic Association athletes. Circulation 2011; 123 (15) 1594-1600
20 Kim JH, Malhotra R, Chiampas G. , et al; Race Associated Cardiac Arrest Event Registry (RACER) Study Group. Cardiac arrest during long-distance running races. N Engl J Med 2012; 366 (02) 130-140
21 Marijon E, Uy-Evanado A, Reinier K. , et al. Sudden cardiac arrest during sports activity in middle age. Circulation 2015; 131 (16) 1384-1391
22 Chappex N, Schlaepfer J, Fellmann F, Bhuiyan ZA, Wilhelm M, Michaud K. Sudden cardiac death among general population and sport related population in forensic experience. J Forensic Leg Med 2015; 35: 62-68
23 Finocchiaro G, Papadakis M, Robertus JL. , et al. Etiology of sudden death in sports: insights from a United Kingdom Regional Registry. J Am Coll Cardiol 2016; 67 (18) 2108-2115
24 Risgaard B. Sudden cardiac death: a nationwide cohort study among the young. Dan Med J 2016; 63 (12) B5321
25 Sweeting J, Ingles J, Ball K, Semsarian C. Sudden deaths during the largest community running event in Australia: a 25-year review. Int J Cardiol 2016; 203: 1029-1031
26 Harris KM, Creswell LL, Haas TS. , et al. Death and Cardiac Arrest in U.S. Triathlon Participants, 1985 to 2016: a case series. Ann Intern Med 2017; 167 (08) 529-535
27 Landry CH, Allan KS, Connelly KA, Cunningham K, Morrison LJ, Dorian P. ; Rescu Investigators. Sudden cardiac arrest during participation in competitive sports. N Engl J Med 2017; 377 (20) 1943-1953
28 Coplan NL, Gleim GW, Nicholas JA. Exercise and sudden cardiac death. Am Heart J 1988; 115 (1 Pt 1): 207-212
29 Sheppard MN. Aetiology of sudden cardiac death in sport: a histopathologist's perspective. Br J Sports Med 2012; 46 (Suppl. 01) i15-i21
30 Lippi G, Franchini M, Targher G. Arterial thrombus formation in cardiovascular disease. Nat Rev Cardiol 2011; 8 (09) 502-512
31 Lippi G, Favaloro EJ. Venous and arterial thromboses: two sides of the same coin?. Semin Thromb Hemost 2018; 44 (03) 239-248
32 Cervellin G, Mattiuzzi C, Bovo C, Lippi G. Diagnostic algorithms for acute coronary syndrome-is one better than another?. Ann Transl Med 2016; 4 (10) 193
33 Lippi G, Cervellin G, Schena F. How much myocardium mass may be injured during endurance physical exercise?. Clin Chim Acta 2017; 470: 29-30
34 Duncker DJ, Bache RJ. Regulation of coronary blood flow during exercise. Physiol Rev 2008; 88 (03) 1009-1086
35 Lippi G, Sanchis-Gomar F, Cervellin G. Chest pain, dyspnea and other symptoms in patients with type 1 and 2 myocardial infarction. A literature review. Int J Cardiol 2016; 215: 20-22
36 Schömig A. Catecholamines in myocardial ischemia. Systemic and cardiac release. Circulation 1990; 82 (3, Suppl): II13-II22
37 Pelliccia F, Kaski JC, Crea F, Camici PG. Pathophysiology of Takotsubo syndrome. Circulation 2017; 135 (24) 2426-2441
38 Hung MJ, Hung MY, Cheng CW, Yang NI, Cherng WJ. Clinical characteristics of patients with exercise-induced ST-segment elevation without prior myocardial infarction. Circ J 2006; 70 (03) 254-261
39 Lippi G, Maffulli N. Biological influence of physical exercise on hemostasis. Semin Thromb Hemost 2009; 35 (03) 269-276
40 Bailey D, Aude YW, Gordon P, Burtt D. ST-segment elevation myocardial infarction, severe anemia and nonobstructive coronary disease: case report and brief comment. Conn Med 2003; 67 (01) 3-5
41 Merghani A, Maestrini V, Rosmini S. , et al. Prevalence of subclinical coronary artery disease in masters endurance athletes with a low atherosclerotic risk profile. Circulation 2017; 136 (02) 126-137
42 Aengevaeren VL, Mosterd A, Braber TL. , et al. Relationship between lifelong exercise volume and coronary atherosclerosis in athletes. Circulation 2017; 136 (02) 138-148
43 World Health Organization. Physical Activity and Adults. Available at: http://www.who.int/dietphysicalactivity/factsheet_adults/en/ . Accessed February 2, 2018
44 American Heart Association. Recommendations for Physical Activity in Adults. Available at: http://www.heart.org/HEARTORG/HealthyLiving/PhysicalActivity/FitnessBasics/American-Heart-Association-Recommendations-for-Physical-Activity-in-Adults_UCM_307976_Article.jsp#.WmytbXxG0dU . Accessed February 2, 2018
45 Emery MS, Kovacs RJ. Sudden cardiac death in athletes. JACC Heart Fail 2018; 6 (01) 30-40
46 Marijon E, Uy-Evanado A, Dumas F. , et al. Warning symptoms are associated with survival from sudden cardiac arrest. Ann Intern Med 2016; 164 (01) 23-29
47 Corrado D, Zorzi A. Sudden death in athletes. Int J Cardiol 2017; 237: 67-70
48 Borjesson M, Urhausen A, Kouidi E. , et al. Cardiovascular evaluation of middle-aged/ senior individuals engaged in leisure-time sport activities: position stand from the sections of exercise physiology and sports cardiology of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil 2011; 18 (03) 446-458
49 Chugh SS, Weiss JB. Sudden cardiac death in the older athlete. J Am Coll Cardiol 2015; 65 (05) 493-502