Subepicardial delayed XXXX enhancement in asymptomatic athletes: let sleeping dogs lie?

@entity296 @entity1165 @entity943 @entity82 @entity14782 @entity2287 @entity2401 @entity1002
BACKGROUND: Subepicardial delayed @entity2287 enhancement (DGE) patches without underlying @entity296 is poorly understood. It is often reported as the result of prior silent @entity2401 . Its prognostic relevance in asymptomatic athletes is unknown; therefore, medical clearance for competitive sports participation is debated. This case series aims to relate this pattern of DGE in athletes to outcome. METHODS: We report on seven young asymptomatic athletes with isolated @entity14782 detected during workup of abnormalities on their regular screening examination, that is, pathological T-wave inversions on ECG (n=4) or @entity943 on exercise test (n=3). All underwent a comprehensive initial investigation in order to assess left ventricular (LV) function at rest and exercise (exercise cardiac MRI and/or exercise echocardiography) and occurrence of @entity943 (exercise test, 24   h-ECG Holter, electrophysiological study). All underwent a careful follow-up with biannual evaluation. RESULTS: All athletes had extensive @entity14782 (12.0  4.8% of LV mass), predominantly in the lateral wall. Three athletes had non-sustained @entity943 , whereas two of them had LV ejection fraction <50% at rest with no contractile reserve at exercise. During a follow-up of 3.0  1.5   years in the four remaining athletes, two had symptomatic @entity1165 and one demonstrated progressive @entity1002 . Hence, six of seven athletes had to be excluded from competitive sports participation. CONCLUSIONS: Isolated large areas of @entity14782 in an asymptomatic athlete are not benign and require a careful evaluation at exercise and a strict follow-up. These findings question whether extreme exercise during silent @entity2401 may facilitate @entity82 generation and adverse remodelling.
