Dr Peter Goethals: Sport en plotse dood - Screening elektrocardiogram (BHC Symposium 2012)
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Transcript of Dr Peter Goethals: Sport en plotse dood - Screening elektrocardiogram (BHC Symposium 2012)
SPORT en plotse dood
Screening elektrocardiogram
P. GOETHALS BHC symposium 2012
voor jonge (≤35j) competitiesporters
Date of download: 12/3/2012
Copyright © The American College of Cardiology. All rights reserved.
From: Does sports activity enhance the risk of sudden death in adolescents and young adults? J Am Coll Cardiol. 2003;42(11):1959-1963. doi:10.1016/j.jacc.2003.03.002
Incidence and relative risk (RR) of sudden death (SD) among athletes (solid columns) and non-athletes (open columns) from cardiovascular and non-cardiovascular causes. Athletes had a 2.8 RR of cardiovascular SD (confidence interval [CI] 1.9 to 3.7; p < 0.001), as compared with a 1.7 RR of non-cardiovascular SD (CI 0.3 to 5.7; p = 0.39).
Figure Legend:
Distribution of cardiovascular causes of sudden death in 1435 young competitive athletes. From the Minneapolis Heart Institute Foundation Registry, 1980 to 2005
Maron BJ. Circ 2007;115:1643-1655
?
Cardiale remodelling: ras, man/vrouw, type sport
Cardiomyopathie
Maron B. N Engl J Med 2003;349:1064-1075
Grijze zone: atletenhart of cardiomyopathie?
Pre-participation screening? • Doelgroep? Alle sporters (nationaal screeningsprogramma) of
alleen competitiesporters? • Wanneer? • Frequentie? • Protocol ?(anamnese, KO, ECG) • Wie heeft expertise? • Wie betaalt? • Vals negatief ECG resultaat? Marfan syndroom- abnormale
oorsprong kroonslagader- myocarditis… • Een afwijkend ECG, wat nu? • ‘Cost effective’? Lage incidentie 1/50.000 maar veel gewonnen
levensjaren! Ann Intern Med 2010; 152: 276-286
0
0,5
1
1,5
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2,5
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4,5
1979-1980
1981-1982
1983-1984
1985-1986
1987-1988
1989-1990
1991-1992
1993-1994
1995-1996
1997-1998
1999-2000
2001-2002
2003-2004
Years
Sudd
en d
eath
per
100
000
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on-y
ears
Annual Incidence Rates of Sudden Cardiovascular Death in Screened Competitive Athletes and
Unscreened Nonathletes Aged 12 to 35 Years in the Veneto Region of Italy
(1979-2004)
Athletes Nonathletes
P for trend <0.001
Corrado et al JAMA 2006;296:1593-1601
GROEP 1 (frequente-trainingsgebonden ECG veranderingen) Eur Heart J 2010; 31: 243-259
Isolated QRS voltage criteria LVH Sinus bradycardie AV blok gr I ORBTB Vroege repolarisatie
1005 elite atleten: 402 (40%) abnormaal ECG 240 atleten (24%) lone QRS LVH
Pelliccia et al Circulation 2000;102: 278-284
GROEP 1 (frequente- trainingsgebonden ECG veranderingen) Eur Heart J 2010; 31: 243-259
Isolated QRS voltage criteria LVH Sinus bradycardie AV blok gr I ORBTB Vroege repolarisatie
Opsporen van cardiomyopathie door ECG
HCM sens. 95%
ARVC sens.80%
Inversie T golf ST segment depressie Pathologische Q LA hypertrofie QRS as afwijking/LAH/LPH RVH Pre excitatie VLBTB/VRBTB Lang of kort QT interval Brugada like vroege repolarisatie
GROEP 2 (zeldzame-niet trainingsgebonden ECG veranderingen) Eur Heart J 2010; 31: 243-259
Prof Sharma
St George’s
University of London 20/10/2012
Screening aanbevolen ESC, IOC, vele Europese sportfederaties
BHC vous remercie de votre attention
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