title: No psychological distress in sportsmen aged 45 years and older after cardiovascular screening, including cardiac CT: The Measuring Athlete's Risk of Cardiovascular events (MARC) study.
abstract: BACKGROUND
  Psychological distress caused by cardiovascular pre-participation screening (PPS) may be a reason not to implement a PPS program. We assessed the psychological impact of PPS, including cardiac computed tomography (CT), in 318 asymptomatic sportsmen aged ≥45 years.
  
  
  METHODS
  Coronary artery disease (CAD) was defined as a coronary artery calcium score ≥100 Agatson units and/or ≥50% luminal stenosis on contrast-enhanced cardiac CT. Psychological impact was measured with the Impact of Event Scale (IES) (seven items) on a six-point scale (grade 0-5). A sum score ≥19 indicates clinically relevant psychological distress. A Likert scale was used to assess overall experiences and impact on sports and lifestyle.
  
  
  RESULTS
  A total of 275 participants (86.5% response rate, 95% CI 83-90%) with a mean age of 54.5 ± 6.4 years completed the questionnaires, 48 (17.5%, 95% CI 13-22%) of whom had CAD. The median IES score was 1 (IQR 0-2, [0-23]). IES was slightly higher in those with CAD (mean rank 175 vs. 130, p < 0.001). One participant (with CAD) experienced clinically relevant psychological distress (IES = 23). Participants reported numerous benefits, including feeling safer exercising (58.6%, 95% CI 53-65%) and positive lifestyle changes, especially in those with CAD (17.2 vs. 52.1%, p < 0.001). The majority were satisfied with their participation (93.8%, 95% CI 91-97%).
  
  
  CONCLUSIONS
  Cardiovascular PPS, including cardiac CT, causes no relevant psychological distress in older sportsmen. Psychological distress should not be a reason to forego screening in sportsmen.
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.|Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.|Department of Cardiology, Meander Medical Center Amersfoort, Amersfoort, The Netherlands.
authors.forename: M M
authors.initials: MM
authors.lastname: Schurink
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.|Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.|Department of Cardiology, Meander Medical Center Amersfoort, Amersfoort, The Netherlands.
authors.forename: T L
authors.initials: TL
authors.lastname: Braber
authors.affiliation: Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: N H J
authors.initials: NH
authors.lastname: Prakken
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: P A F M
authors.initials: PA
authors.lastname: Doevendans
authors.affiliation: Department of Rehabilitation, Nursing Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: F J G
authors.initials: FJ
authors.lastname: Backx
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: D E
authors.initials: DE
authors.lastname: Grobbee
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Rienks
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: H M
authors.initials: HM
authors.lastname: Nathoe
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: M L
authors.initials: ML
authors.lastname: Bots
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands. b.k.velthuis@umcutrecht.nl.
authors.forename: B K
authors.initials: BK
authors.lastname: Velthuis
authors.affiliation: Department of Cardiology, Meander Medical Center Amersfoort, Amersfoort, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Mosterd
keywords: Athletes; Coronary computed tomography angiography (CCTA); Psychological stress; Screening; Sports