Objective Preparticipation evaluation of veteran athletes should focus on accurate cardiovascular (CV) risk stratification and subclinical detection of coronary artery disease (CAD), which is the main cause of sudden cardiac death in this population. We aimed to investigate the effectiveness of current preparticipation methodology used to identify veteran athletes with high coronary atherosclerotic burden. Methods A total of 105 asymptomatic male athletes aged ≥40 years old, with low to moderate CV risk (Systematic Coronary Risk Estimation <5%) who trained ≥4 hours/week for at least 5 years, were studied. The screening protocol included clinical evaluation, ECG, transthoracic echocardiogram and exercise testing. Cardiac CT was performed to detect CAD, defined as a high atherosclerotic burden according to coronary artery calcium score and coronary CT angiography. Results The majority of the athletes (n=88) engaged in endurance sports, with a median volume of exercise of 66 (44; 103) metabolic equivalent task score/hour/week. Exercise testing was abnormal in 13 (12.4%) athletes, 6 (5.7%) with electrocardiographic criteria for myocardial ischaemia and 7 (6.7%) with exercise-induced ventricular arrhythmias. A high coronary atherosclerotic burden was present in 27 (25.7%) athletes, of whom 11 (40.7%) had CV risk factors and 6 had abnormal exercise tests, including 3 who were positive for myocardial ischaemia. Conclusions Conventional methodology used in preparticipation evaluation of veteran athletes, based on clinical CV risk factors and exercise testing, was poor at identifying significant subclinical CAD. The inclusion of more objective markers, particularly data derived from cardiac CT, is promising for more accurate CV risk stratification of these athletes.

中文翻译：

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退伍军人亚临床冠状动脉疾病：是否需要新的参与方法？

目的 退役运动员的参赛前评估应侧重于准确的心血管 (CV) 风险分层和亚临床检测冠状动脉疾病 (CAD)，这是该人群心脏性猝死的主要原因。我们旨在调查当前用于识别具有高冠状动脉粥样硬化负担的资深运动员的预参与方法的有效性。方法 对 105 名年龄≥40 岁、低至中度心血管风险（系统冠状动脉风险估计<5%）、每周训练≥4 小时且至少 5 年的无症状男性运动员进行研究。筛选方案包括临床评估、ECG、经胸超声心动图和运动测试。进行心脏 CT 以检测 CAD，根据冠状动脉钙化评分和冠状动脉 CT 血管造影，定义为高动脉粥样硬化负荷。结果 大多数运动员 (n=88) 从事耐力运动，运动量中位数为 66 (44; 103) 代谢等效任务分数/小时/周。13 名 (12.4%) 运动员的运动测试异常，6 名 (5.7%) 有心肌缺血的心电图标准，7 名 (6.7%) 有运动诱发的室性心律失常。27 名 (25.7%) 运动员存在高冠状动脉粥样硬化负担，其中 11 名 (40.7%) 有心血管危险因素，6 名运动试验异常，其中 3 名心肌缺血呈阳性。结论 基于临床 CV 风险因素和运动测试，用于退伍军人预赛评估的常规方法，在识别显着的亚临床 CAD 方面表现不佳。纳入更客观的标志物，尤其是来自心脏 CT 的数据，有望对这些运动员进行更准确的心血管风险分层。