title: Prominent left ventricular trabeculations in competitive athletes: A proposal for risk stratification and management.
abstract: BACKGROUND
  Recently, an unexpectedly large prevalence of Left Ventricular Non Compaction (LVNC) has been reported in athletes, raising the question of the appropriateness of current diagnostic criteria. We sought to describe prevalence and clinical characteristics of athletes with suspected LVNC in a large cohort of Olympic athletes.
  
  
  METHODS
  Over 29months, 2501 consecutive athletes underwent a cardiac evaluation including physical examination, ECG, exercise test and echocardiography. Additional investigations (Cardiac Magnetic Resonance and/or genetic testing) were selectively performed in athletes with abnormal ECGs, ventricular arrhythmias, borderline LV dysfunction or positive family history.
  
  
  RESULTS
  Of the 2501 athletes, 36 (1.4%) showed prominent trabeculations suggestive for LVNC. Of these, 3 (0.1%) were considered to be affected by LVNC, based on presence of LV dysfunction (ejection fraction<50%) and/or positive family history and genetic testing; these athletes were cautiously restricted from competitions and entered a clinical follow-up program. The remaining 33 athletes, in the absence of LV impairment or familial cardiac diseases, were considered normal (n=24) or unlikely affected (n=9), regardless of the extent of the trabeculations.
  
  
  CONCLUSIONS
  In a large athlete population, a marked LV trabecular pattern was seen in 1.4%. Only a small subset of these athletes (0.1%) showed familial, clinical and morphologic changes supporting the diagnosis of LVNC. In the vast majority of the athletes, the increased trabeculations were not associated with LV dysfunction and/or positive family history, likely representing a morphologic LV variant, deprived of clinical significance.
authors: Institute of Sports Medicine and Science, Rome, Italy. Electronic address: stefanocasellimd@gmail.com.
authors: Stefano
authors: S
authors: Caselli
authors: Institute of Sports Medicine and Science, Rome, Italy.
authors: Diana
authors: D
authors: Ferreira
authors: Institute of Sports Medicine and Science, Rome, Italy.
authors: Eyad
authors: E
authors: Kanawati
authors: Institute of Sports Medicine and Science, Rome, Italy.
authors: Fernando
authors: F
authors: Di Paolo
authors: Institute of Sports Medicine and Science, Rome, Italy.
authors: Cataldo
authors: C
authors: Pisicchio
authors: Cardiovascular Center Zurich, Klinik im Park, Zurich, Switzerland.
authors: Christine
authors: C
authors: Attenhofer Jost
authors: Institute of Sports Medicine and Science, Rome, Italy.
authors: Antonio
authors: A
authors: Spataro
authors: University Hospital Zurich, Switzerland.
authors: Rolf
authors: R
authors: Jenni
authors: Institute of Sports Medicine and Science, Rome, Italy.
authors: Antonio
authors: A
authors: Pelliccia
mesh_terms: D000293:Adolescent; D000328:Adult; D056352:Athletes; D019468:Disease Management; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D056830:Isolated Noncompaction of the Ventricular Myocardium / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology; D055815:Young Adult
keywords: Athletes; Cardiomyopathy; Left ventricular non-compaction; Trabeculations