In vivo detection of coronary artery anomalies in asymptomatic athletes by echocardiographic screening.
BACKGROUND
Anomalous origin of coronary arteries (AOCA) is a rare congenital disease. Although it may have a benign course, it has been identified as a frequent cause of sports-related sudden death. Unfortunately, in vivo detection of AOCA is not easy, as individuals with this anomaly often are asymptomatic and show no signs of myocardial ischemia. Presently, transthoracic two-dimensional echocardiography (TTE) is the only noninvasive, widely available tool to visualize the ostia and first tracts of coronary arteries.


OBJECTIVE
To assess the efficacy of TTE in the screening of AOCA in a large athletic population.


METHODS
In a prospective study, we assessed the ostia and first tracts of coronary arteries in 3,650 subjects (mean age, 30+/-12 years) practicing different sports at various competitive levels. Subjects underwent a TTE examination in our laboratory for scientific or diagnostic purposes.


RESULTS
Technically satisfactory echocardiograms were obtained in 3,504 subjects (96%); a clear visualization of the ostia and first tracts of both coronary arteries was obtained in 3,150 cases (90%). Three asymptomatic athletes (0.09%) were suspected to have an AOCA; two with a right coronary artery origin from the left sinus, and one with a left coronary artery origin from the right sinus. Diagnosis was confirmed by coronary angiography.


CONCLUSIONS
Our study indicated that AOCA is rare in asymptomatic athletes. Systematic and accurate exploration of coronary anatomy in athletes referred for a diagnostic TTE examination may be useful in identifying those with AOCA.
Centro Studi di Medicina dello Sport, Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Roma, Italy.
P
P
Zeppilli
A
A
dello Russo
C
C
Santini
V
V
Palmieri
L
L
Natale
A
A
Giordano
A
A
Frustaci
D000293:Adolescent; D000328:Adult; D001146:Arrhythmia, Sinus / Q000209:etiology; D001919:Bradycardia / Q000209:etiology; D002037:Bundle-Branch Block / Q000209:etiology; D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000150:complications / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D004452:Echocardiography; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000517:prevention & control; D011446:Prospective Studies; D013177:Sports; D018879:Ventricular Premature Complexes / Q000209:etiology