Alessandro Zorzi , MD * , Martina Perazzolo Marra , MD, PhD * , Ilaria Rigato , MD, PhD, Manuel De Lazzari , MD, Angela Susana , MD, Alice Niero , MD, Kalliopi Pilichou , BS, PhD, Federico Migliore , MD, PhD, Stefania Rizzo , MD, PhD, Benedetta Giorgi , MD, Giorgio De Conti , MD, Patrizio Sarto , MD, Luis Serratosa , MD, Giampiero Patrizi , MD, Elia De Maria , MD, Antonio Pelliccia , MD, Cristina Basso , MD, PhD, Maurizio Schiavon , MD, Barbara Bauce , MD, PhD, Sabino Iliceto , MD, Gaetano Thiene , MD, Domenico Corrado , MD, PhD
19 July 2016
The clinical profile and arrhythmic outcome of competitive athletes with isolated nonischemic left ventricular (LV) scar as evidenced by contrast-enhanced cardiac magnetic resonance remain to be elucidated.
We compared 35 athletes (80% men, age: 14–48 years) with ventricular arrhythmias and isolated LV subepicardial/midmyocardial late gadolinium enhancement (LGE) on contrast-enhanced cardiac magnetic resonance (group A) with 38 athletes with ventricular arrhythmias and no LGE (group B) and 40 healthy control athletes (group C). A stria LGE pattern with subepicardial/midmyocardial distribution, mostly involving the lateral LV wall, was found in 27 (77%) of group A versus 0 controls (group C; P<0.001), whereas a spotty pattern of LGE localized at the junction of the right ventricle to the septum was respectively observed in 11 (31%) versus 10 (25%; P=0.52). All athletes with stria pattern showed ventricular arrhythmias with a predominant right bundle branch block morphology, 13 of 27 (48%) showed ECG repolarization abnormalities, and 5 of 27 (19%) showed echocardiographic hypokinesis of the lateral LV wall. The majority of athletes with no or spotty LGE pattern had ventricular arrhythmias with a predominant left bundle branch block morphology and no ECG or echocardiographic abnormalities. During a follow-up of 38±25 months, 6 of 27 (22%) athletes with stria pattern experienced malignant arrhythmic events such as appropriate implantable cardiac defibrillator shock (n=4), sustained ventricular tachycardia (n=1), or sudden death (n=1), compared with none of athletes with no or LGE spotty pattern and controls.