title: Cardiovascular diseases in Paralympic athletes.
abstract: BACKGROUND
  Sport participation (SP) of individuals with impairments has recently grown exponentially. Scarce scientific data, however, exist regarding cardiovascular (CV) risk associated with competitive SP.
  
  
  OBJECTIVE
  Assessing the prevalence of CV abnormalities and the risk for SP in Paralympic athletes (PA).
  
  
  METHODS
  PA (n=267; 76% men), aged 35±9 years, engaged in 18 sport disciplines, with a spectrum of lesions including: spinal cord injury (paraplegia and spina bifida) (n=116); amputation, poliomyelitis, cerebral palsy and other neuromuscular and/or skeletal disorders (Les autres) or visual impairment (n=151) entered the study. CV evaluation included history, PE, 12-lead and exercise ECG, echocardiography. Of these, 105 participated in ≥2 consecutive games, and had evaluations available over a 6±4 year follow-up.
  
  
  RESULTS
  Structural CV abnormalities were identified in 33 athletes (12%), including arrhythmogenic cardiomyopathies in 3, aortic root dilation in 3, valvular diseases in 7 (mitral valve prolapse in 4, bicuspid aortic valve in 3) and systemic hypertension in 11 (4%). In addition, ventricular (polymorphic, couplets or non-sustained ventricular tachycardia) or supraventricular tachyarrhythmias (atrial flutter, paroxysmal atrial fibrillation or SVT) were identified in 9 others. Over a 6-year follow-up, 6 of the 105 athletes (6%) developed CV diseases, including dilated cardiomyopathy in 1 and systemic hypertension in 5.
  
  
  CONCLUSIONS
  PA present an unexpected high prevalence of CV abnormalities (12%), including a non-trivial proportion of diseases at risk for sudden death (2%), such as arrhythmogenic cardiomyopathies and dilated aortic root. This observation suggests that tailored recommendations for preparticipation screening and safe SP in this special athletic population are timely and appropriate.
authors.affiliation: Institute of Sport Medicine and Science, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pelliccia
authors.affiliation: Institute of Sport Medicine and Science, Rome, Italy.
authors.forename: Filippo M
authors.initials: FM
authors.lastname: Quattrini
authors.affiliation: Institute of Sport Medicine and Science, Rome, Italy.
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Squeo
authors.affiliation: Institute of Sport Medicine and Science, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Caselli
authors.affiliation: Department of Human Physiology and Pharmacology, University Sapienza, Rome, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Culasso
authors.affiliation: TUFTS Medical Center, Boston, Massachusetts, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Link
authors.affiliation: Institute of Sport Medicine and Science, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Spataro
authors.affiliation: Department of Human Physiology and Pharmacology, University Sapienza, Rome, Italy Italian Paralympic Committee, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Bernardi
mesh_terms: D000293:Adolescent; D000328:Adult; D000359:Aftercare; D000846:Anniversaries and Special Events; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D064846:Sports for Persons with Disabilities / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Athlete; Disabled; Heart disease