CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Barry J. Maron, MD,
Douglas Zipes, MD and
Antonio Pelliccia, MD*
* Institute of Sports Medicine and Science, Department of Medicine of Sport, Largo Piero Gabrielli, 1, 00197 Rome, Italy (Email: ant.pelliccia{at}libero.it).
We thank Dr. Reich for his interest in our article (1) and enthusiasm regarding pre-participation screening and the detection of those cardiovascular diseases that may place trained athletes at risk for sudden death. We concur with Dr. Reich's concern regarding the difficulty in reliably identifying congenital coronary anomalies of wrong sinus origin by cardiovascular screening in large populations of competitive athletes. This is a particularly relevant issue, given that these anomalies account for 17% of sudden deaths in young athletes tabulated in the U.S. Registry, second in prevalence only to hypertrophic cardiomyopathy (2). Unfortunately, congenital coronary anomalies cannot be suspected or reliably diagnosed with routine history and physical examination, or even 12-lead electrocardiography (3). Furthermore, although the noninvasive identification of coronary anomalies of wrong sinus origin has been reported with standard 2-dimensional echocardiography (4), this can be a challenging task. Certainly, we agree with Dr. Reich that coronary anomalies have (and continue to) represented malformations underdiagnosed within the broad-based screening strategies in place for young healthy athlete populations (1,5), sadly are not uncommon causes of sudden death on the athletic field, and are usually identified for the first time at autopsy.
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1. Pelliccia A, Zipes DP, Maron BJ. Bethesda Conference #36 and European Society of Cardiology Consensus Recommendations revisited: a comparison of U.S. and European criteria for eligibility and disqualification of competitive athletes with cardiovascular abnormalities J Am Coll Cardiol 2008;52:1990-1996.[Abstract/Free Full Text]2. Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: analysis of 1,866 deaths in the U.S., 1980–2006 Circulation 2009;119:1085-1092.[Abstract/Free Full Text] 3. Basso C, Maron BJ, Corrado D, Thiene G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes J Am Coll Cardiol 2000;35:1493-1501.[Abstract/Free Full Text] 4. Maron BJ, Leon MB, Swain JA, Cannon RO, Pelliccia A. Prospective identification by two-dimensional echocardiography of anomalous origin of the left main coronary artery from the right sinus of Valsalva Am J Cardiol 1991;68:140-142.[CrossRef][Web of Science][Medline] 5. Maron BJ, Thompson PD, Ackerman MJ, et al. Recommendations and considerations related to pre-participation screening for cardiovascular abnormalities in competitive athletes: update 2007. A Scientific Statement from the American Heart Association, Nutrition, Physical Activity, and Metabolism Council. Circulation 2007;115:1643-1645.[Free Full Text]
Related Article
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Pre-Participation Sports Clearance
- Jonathan D. Reich
J. Am. Coll. Cardiol. 2009 53: 2310.
[Full Text]
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