Article

Previous studies revealed a relatively high prevalence of
electrocardiographic findings indicative for myocardial ischemia in asymptomatic
athletes undergoing pre-participation screening. Myocardial perfusion
scintigraphy is generally considered a valuable diagnostic and prognostic
modality and often used for further diagnostic evaluation in these subjects.
However, data on the diagnostic accuracy of myocardial perfusion scintigraphy in
athletes are scarce.
The main purpose of this study was to investigate
the positive predictive value of myocardial perfusion scintigraphy for detection
of coronary artery disease in asymptomatic athletes with abnormal exercise
testing results during pre-participation screening. The secondary aim was to
evaluate the prognostic value of myocardial perfusion scintigraphy. Methods
Electronic charts of asymptomatic athletes who underwent myocardial perfusion
scintigraphy following an abnormal exercise testing were retrospectively
reviewed. Myocardial perfusion scintigraphy and exercise testing studies were
revised. Athlete characteristics and cardiovascular risk factors were evaluated.
Results One hundred and forty-three athletes were included. 29 athletes (20%)
showed concordant abnormal exercise testing and myocardial perfusion scintigraphy
results. Coronary imaging was performed in 20 of these 29 athletes. Four athletes
showed significant coronary artery disease (positive predictive value = 20%). The
positive predictive value increased to 33% when athletes were selected who should
have undergone exercise testing according to the guideline recommendations.
During a mean follow-up interval of 4.7 +/- 2.2 years, eight cardiac events
occurred. Athletes with an abnormal myocardial perfusion scintigraphy result had
a fourfold increased risk at a future cardiac event (2.9%/year versus 0.75%/year,
p = 0.031). Conclusions The positive predictive value of myocardial perfusion
scintigraphy for the detection of significant coronary artery disease in
asymptomatic athletes with a positive exercise testing result is low, even in a
selection of athletes with a relatively high cardiovascular risk. Although an
abnormal myocardial perfusion scintigraphy result was associated with a fourfold
higher annual event rate, the absolute annual event rate in this group was still
low. Efforts should be made to develop better diagnostic strategies to evaluate
asymptomatic athletes with abnormal exercise testing results during
pre-participation screening.

Langue : ANGLAIS