Role of coronary CT angiography (CCTA) in the prepartecipation screening (PPS) of apparently healthy master athletes

Pre-participation screening (PPS) of athletes aged over 35 years (master athletes, MA) is a major concern in Sports Cardiology. In this population, exercise-related sudden cardiac death (SCD) is rare but primarily due to coronary atherosclerosis (cATS)[1] often resulting from acute plaque rupture/erosion or complication of severe stenosis in most cases, making mandatory the need for early detection of apparently healthy competitive mature athletes. Despite its excellent negative predictive value [2], the possible role of Coronary CT Angiography (CCTA) in this context has yet to be clearly defined [3].

To evaluate the contribute of CCTA for the sport suitability and clinical management of MA assessed in course of PPS with risk factors, symptoms and/or positive/equivocal stress-test ECG.

We retrospectively enrolled MA who underwent CCTA in our hospital in the last 12 years, analyzing symptoms, stress-test ECG, cardiovascular risk profiles (SCORE) and CCTA findings.

The study population included 167 MA (143 males, 24 females, mean age 53±10 and 54±9 years, respectively). Among the whole enrolled population, 153 (91.6%) MA underwent CCTA for equivocal/positive stresstest ECG with/without symptoms, 13 (7.8%) just for clinical symptoms, 1 (0.6%) for the family history. The CCTA showed the presence of cATS in 69 MA (41.3%), congenital coronary anomalies (anomalous origin or deep myocardial bridge) in 8 (4.8%), both in 7 (4.2%). A negative CCTA was observed in 83 MA (49.7%). The risk-SCORE (age, hypertension, hypercholesterolemia, smoking) was a good indicator for the presence of moderate/severe cATS on CCTA. However, mild/moderate cATS was present in 17.2% of MA clinically stratified at a low risk-SCORE.

While invasive angiography is more indicated in MA with positive stress-test ECG if symptomatic and/or with high/very high risk-SCORE, in our experience CCTA may be helpful in the PPS of MA (males/postmenopausal females) with an abnormal stress-test ECG and/or clinical symptoms engaged in competitive sports with a high cardiovascular involvement. Age, gender, presence of symptoms and clinical risk-SCORE assessment may help sports physicians and cardiologists to decide whether to request a CCTA or not.

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