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Cited by 32Cardiovascular Effects of ExerciseCardiomyopathy and Myosin StudiesCardiac electrophysiology and arrhythmias

Reproducibility of ventricular arrhythmias at exercise testing for prediction of non-ischaemic left ventricular scar in athletes

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Brunetti, Giulia, Graziano, Francesca, Cavigli, Luna, Cipriani, Alberto, D’Ascenzi, Flavio, Bauce, Barbara, Pilichou, Kalliopi, Perazzolo Marra, Martina +2 more·2023·European Journal of Preventive Cardiology
DOI 10.1093/eurjpc/zwac224
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Abstract

AIMS: The non-ischaemic left ventricular scar (NILVS) is an emerging substrate of ventricular arrhythmias (VA) in the athlete. We tested the diagnostic value of VA reproducibility at repeated exercise testing (ET). METHODS AND RESULTS: We included consecutive athletes who underwent cardiac magnetic resonance (CMR) for evaluation of VA and two consecutive ET off-therapy within 12 months. Those with a positive family history of premature sudden death/cardiomyopathy, syncope/pre-syncope, ECG or echocardiography abnormalities, or low-risk VA (exercise-suppressed infundibular or fascicular VA) were excluded. The NILVS was defined as subepicardial/midmyocardial stria of late gadolinium enhancement involving >5% of the LV mass. Reproducibility was defined as the occurrence of VA with the same pattern and behaviour during repeated ET. Of 325 athletes who underwent CMR for evaluation of VA, 75 were included, and 30 showed NILVS involving three [2-4] LV segments. At first ET, athletes with NILVS showed a higher prevalence of exercise-induced VA (93% vs. 53%, P < 0.001), while other VA characteristics did not differ between groups. At repeated ET, reproducibility was observed in 97% of athletes with vs. 13% without NILVS (P < 0.001). The remaining 87% of athletes with normal CMR either did not show any VA at repeated ET (59%) or showed arrhythmias with different patterns, mostly infundibular. Reproducibility yielded a positive predictive value for NILVS of 83% and a negative predictive value of 98%. CONCLUSION: VA reproducibility at repeated ET predicted an underlying NILVS in athletes with VA and otherwise normal clinical work-up. This finding may improve risk stratification and appropriate CMR referral of athletes with apparently idiopathic VA.

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  • The same group investigated athletes presenting with exercise-induced ventricular arrhythmia and demonstrated that this pattern of myocardial fibrosis was associated with a 7-fold increased risk of recurrent ventricular arrhythmia during exercise testing.

    “The same group investigated athletes presenting with exercise-induced ventricular arrhythmia and demonstrated this pattern of myocardial fibrosis was associated with a 7-fold increased risk of recurrent ventricular arrhythmia during exercise testing.9”

    From Ventricular Arrhythmia and Cardiac Fibrosis in Endurance Experienced Athletes (VENTOUX) (2025) · cites this paper as [9]

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  1. [1]1. Di Gioia CRT, Giordano C, Cerbelli B, Pisano A, Perli E, De Dominicis E, Poscolieri B, Palmieri V, Ciallella C, Zeppilli P, d'Amati G. Nonischemic left ventricular scar and cardiac sudden death in the young. Hum Pathol 2016; 58 :78-89.
  2. [3]3. Małek ŁA, Bucciarelli-Ducci C. Myocardial fibrosis in athletes-current perspective. Clin Cardiol 2020; 43 :882-888.
  3. [4]4. Schnell F, Claessen G, La Gerche A, Bogaert J, Lentz P-A, Claus P, Mabo P, Carré F, Heidbuchel H. Subepicardial delayed gadolinium enhancement in asymptomatic ath­ letes: let sleeping dogs lie? Br J Sports Med 2016; 50 :111-117.
  4. [5]5. Zorzi A, Bettella N, Tatangelo M, Del Monte A, Vessella T, Poscolieri B, Crescenzi C, Pegorin D, D'Ascenzi F, Pescatore V, Giada F, Sarto P, Calò L, Schiavon M, Gregori D, Hadley DM, Drezner JA, Pelliccia A, Corrado D. Prevalence and clinical significance of isolated low QRS voltages in young athletes. Europace 2022; 24 : 1484-1495.
  5. [6]6. Corrado D, Drezner JA, D'Ascenzi F, Zorzi A. How to evaluate premature ventricu­ lar beats in the athlete: critical review and proposal of a diagnostic algorithm. Br J Sports Med 2020; 54 :1142-1148.
  6. [7]7. D'Ascenzi F, Zorzi A, Alvino F, Bonifazi M, Corrado D, Mondillo S. The prevalence and clinical significance of premature ventricular beats in the athlete. Scand J Med Sci Sport 2017; 27 :140-151.
  7. [8]8. Heidbuchel H, Arbelo E, D'Ascenzi F, Borjesson M, Boveda S, Castelletti S, Miljoen H, Mont L, Niebauer J, Papadakis M, Pelliccia A, Saenen J, Sanz de la Garza M, Schwartz PJ, Sharma S, Zeppenfeld K, Corrado D. Recommendations for participation in leisure-time physical activity and competitive sports of patients with arrhythmias and potentially arrhythmogenic conditions. Part 2: ventricular arrhythmias, channe­ lopathies, and implantable defibrillators. Europace 2021; 23 :147-148.
  8. [9]9. Zorzi A, Vessella T, De Lazzari M, Cipriani A, Menegon V, Sarto G, Spagnol R, Merlo L, Pegoraro C, Marra MP, Corrado D, Sarto P. Screening young athletes for diseases at risk of sudden cardiac death: role of stress testing for ventricular arrhythmias. Eur J Prev Cardiol 2020; 27 :311-320.
  9. [10]10. Cipriani A, Zorzi A, Sarto P, Donini M, Rigato I, Bariani R, De Lazzari M, Pilichou K, Thiene G, Iliceto S, Basso C, Corrado D, Perazzolo Marra M, Bauce B. Predictive va­ lue of exercise testing in athletes with ventricular ectopy evaluated by cardiac mag­ netic resonance. Heart Rhythm 2019; 16 :239-248.
  10. [11]11. Di Florio A, Fusi C, Anselmi F, Cavigli L, Focardi M, Cameli M, Felici A, Capitani M, Valente S, Bonifazi M, Zorzi A, Corrado D, Mondillo S, D'Ascenzi F. Clinical manage­ ment of young competitive athletes with premature ventricular beats: a prospective cohort study. Int J Cardiol 2021; 330 :59-64.
  11. [12]12. Crescenzi C, Zorzi A, Vessella T, Martino A, Panattoni G, Cipriani A, De Lazzari M, Perazzolo Marra M, Fusco A, Sciarra L, Sperandii F, Guerra E, Tranchita E, Fossati C, Pigozzi F, Sarto P, Calò L, Corrado D. Predictors of left ventricular scar using cardiac magnetic resonance in athletes with apparently idiopathic ventricular arrhythmias. J Am Heart Assoc 2021; 10 :e018206.
  12. [13]13. Pelliccia A, De Martino L, Borrazzo C, Serdoz A, Lemme E, Zorzi A, Corrado D. Clinical correlates and outcome of the patterns of premature ventricular beats in Olympic athletes: a long-term follow-up study. Eur J Prev Cardiol 2020; 28 :1038-1047.
  13. [14]14. Zorzi A, De Lazzari M, Mastella G, Niero A, Trovato D, Cipriani A, Peruzza F, Portolan L, Berton G, Sciacca F, Tollot S, Palermo C, Bellu R, D'ascenzi F, Muraru D, Badano LP, Iliceto S, Schiavon M, Perazzolo Marra P, Corrado D. Ventricular ar­ rhythmias in young competitive athletes: prevalence, determinants, and underlying substrate. J Am Heart Assoc 2018; 7 :e009171.
  14. [15]15. Biffi A, Delise P, Zeppilli P, Giada F, Pelliccia A, Penco M, Casasco M, Colonna P, D'Andrea A, D'Andrea L, Gazale G, Inama G, Spataro A, Villella A, Marino P, Pirelli S, Romano V, Cristiano A, Bettini R, Thiene G, Furlanello F, Corrado D. Italian Cardiological guidelines for sports eligibility in athletes with heart disease: part 2. J Cardiovasc Med 2013; 14 :500-515.
  15. [16]16. Delise P, Mos L, Sciarra L, Basso C, Biffi A, Cecchi F, Colivicchi F, Corrado D, D'Andrea A, Di Cesare E, Di Lenarda A, Gervasi S, Giada F, Guiducci V, Inama G, Leoni L, Palamà Z, Patrizi G, Pelliccia A, Penco M, Robles AG, Romano S, Romeo F, Sarto P, Sarubbi B, Sinagra G, Zeppilli P. Italian Cardiological Guidelines (COCIS) for Competitive Sport Eligibility in athletes with heart disease: update 2020. J Cardiovasc Med 2021; 22 :874-891.
  16. [17]17. Sharma S, Drezner JA, Baggish A, Papadakis M, Wilson MG, Prutkin JM, Gerche A La, Ackerman MJ, Borjesson M, Salerno JC, Asif IM, Owens DS, Chung EH, Emery MS, Froelicher VF, Heidbuchel H, Adamuz C, Asplund CA, Cohen G, Harmon KG, Marek JC, Molossi S, Niebauer J, Pelto HF, Perez MV, Riding NR, Saarel T, Schmied CM, Shipon DM, Stein R. International recommendations for electrocardiographic inter­ pretation in athletes. Eur Heart J 2018; 39 :1466-1480.
  17. [18]18. Pelliccia A, Caselli S, Sharma S, Basso C, Bax JJ, Corrado D, D'Andrea A, D'Ascenzi F, Paolo FM Di, Edvardsen T, Gati S, Galderisi M, Heidbuchel H, Nchimi A, Nieman K, Papadakis M, Pisicchio C, Schmied C, Popescu BA, Habib G, Grobbee D, Lancellotti P. European Association of Preventive Cardiology (EAPC) and European Association of Cardiovascular Imaging (EACVI) joint position statement: recommen­ dations for the indication and interpretation of cardiovascular imaging in the evalu­ ation of the athlete's heart. Eur Heart J 2018; 39 :1949-1969.
  18. [19]19. Schulz-Menger J, Bluemke DA, Bremerich J, Flamm SD, Fogel MA, Friedrich MG, Kim RJ, von Knobelsdorff-Brenkenhoff F, Kramer CM, Pennell DJ, Plein S, Nagel E. Standardized image interpretation and post-processing in cardiovascular magnetic resonance -2020 update: Society for Cardiovascular Magnetic Resonance (SCMR): Board of Trustees Task Force on Standardized Post-Processing. J Cardiovasc Magn Reson Off J Soc Cardiovasc Magn Reson 2020; 22 :19.
  19. [20]20. Greulich S, Seitz A, Herter D, Günther F, Probst S, Bekeredjian R, Gawaz M, Sechtem U, Mahrholdt H. Long-term risk of sudden cardiac death in hypertrophic cardiomy­ opathy: a cardiac magnetic resonance outcome study. Eur Heart J Cardiovasc Imaging 2021; 22 :732-741.
  20. [21]21. Chan RH, Maron BJ, Olivotto I, Pencina MJ, Assenza GE, Haas T, Lesser JR, Gruner C, Crean AM, Rakowski H, Udelson JE, Rowin E, Lombardi M, Cecchi F, Tomberli B, Spirito P, Formisano F, Biagini E, Rapezzi C, De Cecco CN, Autore C, Cook EF, Hong SN, Gibson CM, Manning WJ, Appelbaum E, Maron MS. Prognostic value of quantitative contrast-enhanced cardiovascular magnetic resonance for the evalu­ ation of sudden death risk in patients with hypertrophic cardiomyopathy. Circulation 2014; 130 :484-495.
  21. [22]22. Verdile L, Maron BJ, Pelliccia A, Spataro A, Santini M, Biffi A. Clinical significance of exercise-induced ventricular tachyarrhythmias in trained athletes without cardiovas­ cular abnormalities. Heart Rhythm 2015; 12 :78-85.
  22. [23]23. Kawakami H, Nerlekar N, Haugaa KH, Edvardsen T, Marwick TH. Prediction of ven­ tricular arrhythmias with left ventricular mechanical dispersion: a systematic review and meta-analysis. JACC Cardiovasc Imaging 2020; 13 :562-572.
  23. [24]24. Biffi A, Maron BJ, Verdile L, Fernando F, Spataro A, Marcello G, Ciardo R, Ammirati F, Colivicchi F, Pelliccia A. Impact of physical deconditioning on ventricular tachyar­ rhythmias in trained athletes. J Am Coll Cardiol 2004; 44 :1053-1058.
  24. [25]25. Biffi A, Maron BJ, Culasso F, Verdile L, Fernando F, Di Giacinto B, Di Paolo FM, Spataro A, Delise P, Pelliccia A. Patterns of ventricular tachyarrhythmias associated with train­ ing, deconditioning and retraining in elite athletes without cardiovascular abnormal­ ities. Am J Cardiol 2011; 107 :697-703.
  25. [26]26. Delise P, Lanari E, Sitta N, Centa M, Allocca G, Biffi A. Influence of training on the number and complexity of frequent VPBs in healthy athletes. J Cardiovasc Med 2011; 12 :157-161.
  26. [27]27. Sugawara J, Murakami H, Maeda S, Kuno S, Matsuda M. Change in post-exercise vagal reactivation with exercise training and detraining in young men. Eur J Appl Physiol 2001; 85 :259-263.

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Authors
Brunetti, G., Graziano, F., Cavigli, L., Cipriani, A., D’Ascenzi, F., Bauce, B., Pilichou, K., Perazzolo Marra, M., Corrado, D., & Zorzi, A.
Affiliations
  • University of Padua (IT)
  • University of Siena (IT)
  • Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova , Via Giustiniani 2, 35128 Padova , Italy
Corresponding author
Zorzi, Alessandro
ORCID
Venue
European Journal of Preventive Cardiology
Publisher
Oxford University Press (OUP)
Published
2022-09-27
Volume
30
Issue
2
Pages
107-116
ISSN
  • 2047-4873 (ISSN-L)
  • 2047-4881
DOI
10.1093/eurjpc/zwac224
OpenAlex
W4297254637
Cited by
32
References
1
Citations by year
2026: 10 · 2025: 7 · 2024: 7 · 2023: 8
FWCI
3.86
Type
journal article
Language
en
Open access
Licence
Locations
  • European Journal of Preventive Cardiology (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Use Siena air (University of Siena) (submittedVersion, cc-by-nc)
  • Padua Research Archive (University of Padova) (submittedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
Keywords
ventricular arrhythmias, exercise testing, athletes, late gadolinium enhancement, cardiac magnetic resonance, sudden cardiac death risk stratification, idiopathic ventricular arrhythmia
MeSH terms
Arrhythmias, Cardiac, Cicatrix, Contrast Media, Exercise Test, Gadolinium, Humans, Reproducibility of Results, Athletes

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