Clinical significance of ST depression at exercise stress testing in competitive athletes: usefulness of coronary CT during screening

BACKGROUND: Congenital coronary anomalies (CCAs) and coronary artery disease (CAD)arouse intense scientific and clinical interest in sports medicine and sports cardiology medicalcommunities because of their potential to trigger sudden cardiac death (SCD) in athletes. Exercisestress testing represent the first instrumental assessment to evaluate electrocardiographic changesduring effort. Coronary computed tomography angiography (CCTA) is an advanced accuratenoninvasive imaging modality for excluding CAD and abnormalities of origin and course ofcoronary vessels. The aim of this study is to investigate with CCTA the clinical significance of STdepression suggestive for myocardial ischemia during exercise stress testing in athletes and todetermine the prevalence of CAD and/or CCAs.MATERIALS AND METHODS: 65 consecutive athletes showing electrocardiographic findingspositive or equivocal for myocardial ischemia on exercise stress testing during pre-participationscreening were investigated with CCTA.RESULTS: Among 65 athletes investigated, 36 showed Myocardial Bridge (MB), 1 showed ananomalous coronary origin and 7 showed CAD. Among 36 athletes with MB, 4 were associatedwith mild coronary artery stenosis. Three athletes with CAD needed percutaneous transluminalcoronary angioplasty or coronary artery bypass surgery.CONCLUSIONS: In competitive athletes even with excellent workload capacities, in absence ofcardiomyopathy, the presence of ischaemic electrocardiographic abnormalities could be mainlydetermined by a coronary congenital or acquired pathology. In this population CCTA is an usefulimaging modality of choice for the risk stratification and for the diagnostic process, to allow eligibleathletes to compete and to follow up subjects requiring medical surveillance.