Occult coronary artery disease in middle-aged sportsmen with a low cardiovascular risk score: The Measuring Athlete's Risk of Cardiovascular Events (MARC) study.

Autor:	Braber TL; Department of Radiology, University Medical Center Utrecht, The Netherlands Department of Cardiology, University Medical Center Utrecht, The Netherlands Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands t.l.braber@umcutrecht.nl., Mosterd A; Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands., Prakken NH; Department of Radiology, University Medical Center Groningen, The Netherlands., Rienks R; Department of Cardiology, University Medical Center Utrecht, The Netherlands., Nathoe HM; Department of Cardiology, University Medical Center Utrecht, The Netherlands., Mali WP; Department of Radiology, University Medical Center Utrecht, The Netherlands., Doevendans PA; Department of Cardiology, University Medical Center Utrecht, The Netherlands., Backx FJ; Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, The Netherlands., Bots ML; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands., Grobbee DE; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands., Velthuis BK; Department of Radiology, University Medical Center Utrecht, The Netherlands.
Jazyk:	angličtina
Zdroj:	European journal of preventive cardiology [Eur J Prev Cardiol] 2016 Oct; Vol. 23 (15), pp. 1677-84. Date of Electronic Publication: 2016 May 24.
DOI:	10.1177/2047487316651825
Abstrakt:	Background: Most exercise-related cardiac arrests in men aged ≥45 years are due to coronary artery disease (CAD). The current sports medical evaluation (SME) of middle-aged sportsmen includes medical history, physical examination and resting and exercise electrocardiography (ECG). We investigated the added value of low-dose cardiac computed tomography (CCT) - both non-contrast CT for coronary artery calcium scoring (CACS) and contrast-enhanced coronary CT angiography (CCTA) - in order to detect occult CAD in asymptomatic recreational sportsmen aged ≥45 years without known cardiovascular disease. Methods: Following a normal SME (with resting and bicycle exercise ECG), 318 asymptomatic sportsmen underwent CCT and 300 (94%) had a low European Society of Cardiology Systematic Coronary Risk Evaluation (SCORE) risk. Occult CAD was defined as a CACS ≥100 Agatston units (AU) or obstructive (≥50%) luminal stenosis on CCTA. The number needed to screen (NNS) in order to prevent one cardiovascular event within 5 years with statin treatment was estimated. Results: Fifty-two (16.4%, 95% confidence interval (CI): 12.7-20.8%) of 318 participants had a CACS ≥100 AU. The CCTA identified an additional eight participants with luminal narrowing ≥50% (and a CACS <100 AU). Taken together, CCT identified CAD in 60 (18.9%, 95% CI: 14.9-23.5%) of 318 participants. The 5-year estimated NNS was 183 (95% CI: 144-236) for CACS and 159 (95% CI: 128-201) for CACS combined with CCTA. Conclusions: Coronary CT detects occult CAD in almost one in five asymptomatic sportsmen aged ≥45 years after a normal SME that included resting and bicycle exercise ECG. CACS reveals most of the relevant CAD with limited additional value of contrast-enhanced CCTA. The NNS in order to prevent one cardiovascular event compares favourably to that of other screening tests. (© The European Society of Cardiology 2016.)
Databáze:	MEDLINE
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