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Author Block:
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Giuseppe Inama,
MD, Claudio Pedrinazzi, Ornella Durin,
Massimiliano Nanetti and Giorgio Donato. Department
of Cardiology - Ospedale Maggiore, Crema, Italy
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Introduction:
Aim of our study is to evaluate the role of TWA to stratify the risk of
sudden cardiac death in athletes (Ath) with complex
ventricular arrhythmias (VA), and to identify the presence of an underlying
structural heart disease. Methods: We studied 85 Ath
with VA (61 M,
mean age 32 + 11 years). In all cases a cardiological
evaluation was performed, including TWA . The
patients were evaluated during a follow-up of 30 + 21 months. The
end-point was the occurrence of Sudden Death (SD) or malignant ventricular tachyarrhythmias (VT). Results: A structural heart
disease was identified in 10 patients (12%). Specifically, arrhythmogenic right ventricular dysplasia
was diagnosed in 5 patients, myocarditis in 3 and
early-stage dilated cardiomyopathy in 2. TWA was
negative in 57 Ath (68%), positive in 15 (18%) and
indeterminate in 13 (14%). We considered as abnormal TWA the presence of a
positive or indeterminate test ,and this result was
found in 28 patients (32%). An underlying heart disease was diagnosed in 2
patients with negative TWA (5%) and in 8 patients with abnormal TWA (40%). Therefore,
TWA showed a negative predictive value of 95% and a positive predictive value
of 40% in detecting the presence of structural heart disease. During
follow-up we observed a significant difference in end-point occurrence (VT or
SD) between Ath with negative or abnormal TWA (0% vs 25%, p<0.001) independently from the presence of
structural heart disease. Conclusions: TWA confirm its role as a simple and
non-invasive test, and it seems useful for prognostic stratification of Ath with VA and for the identification of an underlying
structural heart disease..
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