Cardiovascular screening of master athletes. Insights from the Master Athletes Screening Study

The master athlete (MA) is generally an individual ≥35 years old who trains and participates in specifically designed competitions. Master athletes are former professional athletes who wish to continue competition, usually in a different sport, or individuals who return to competitive sports after a period of inactivity or who decide to start training systematically in adult life to improve their fitness. While the systematic practice of physical activity matches with the holistic concept of active ageing, the ever-increased participation of MAs in competitions requires tailoring an appropriate pre-participation screening (PPS) that addresses the increased cardiovascular (CV) risk of this population.1 Cardiovascular prevention is a lifelong process from the cradle to the grave and beyond,2 but if paediatric athletes are predominantly affected by congenital and genetic diseases,3 MAs are mainly affected by coronary artery disease (CAD); ischaemic and non-ischaemic myocardial fibrosis; supraventricular tachyarrhythmias, in particular atrial fibrillation; and aortic dilatation.1 In this issue, Morrison et al.4 present the results of the Master Athletes Screening Study (MASS), a 5-year prospective study, which represents an important step forward in the definition of an appropriate PPS protocol in MAs, a growing athletic population. The inclusion criteria were not very strict, as eligible participants had to engage in moderate to vigorous intensity physical activity at least 3 days per week during the preceding 3 months.4 The authors included 798 MAs who underwent CV screening on a yearly basis including personal and family history, sport practice and the use of drugs,5 12-lead electrocardiogram (ECG), resting blood pressure, anthropometrics, and Framingham Risk Score (FRS). Those presenting abnormal findings underwent stress ECG (Stage 2) and/or a consultation with a sports cardiologist or other evaluations (Stage 3). The participants were then followed up for 4 years to record major adverse cardiac events (MACE) (sudden cardiac arrest/death, myocardial infarction, stroke), and additional CV diagnoses, as arrhythmias (37%), which were the most common finding during follow-up. Major adverse cardiac events occurred despite yearly screening in 10 male MAs (2.8/1000 athlete-years) who had an abnormal cardiac screening, but cardiac functional tests (i.e. echocardiogram, electrocardiogram, nuclear) failed to detect the underlying CAD in most cases. I

An overview of sport participation and exercise prescription in mitral valve disease

The incidence of heart valve disease (HVD) has been rising over the last few decades, mainly due to the increasing average age of the general population, and mitral valve (MV) disease is the second most prevalent HVD after calcific aortic stenosis, but MV disease is a heterogeneous group of different pathophysiological diseases. It is widely proven that regular physical activity reduces all-cause mortality rates, and exercise prescription is part of the medical recommendations for patients affected by cardiovascular diseases. However, changes in hemodynamic balance during physical exercise (including the increase in heart rate, preload, or afterload) could favor the progression of the MV disease and potentially trigger major cardiac events. In young patients with HVD, it is therefore important to define criteria for allowing competitive sport or exercise prescription, balancing the positive effects as well as the potential risks. This review focuses on mitral valve disease pathophysiology, diagnosis, risk stratification, exercise prescription, and competitive sport participation selection, and offers an overview of the principal mitral valve diseases with the aim of encouraging physicians to embody exercise in their daily practice when appropriate

Very slightly anomalous leakage of CO2, CH4 and radon along the main activated faults of the strong L’Aquila earthquake (Magnitude 6.3, Italy). Implications for risk assessment monitoring tools & public acceptance of CO2 and CH4 underground storage.

The 2009-2010 L'Aquila seismic sequence is still slightly occurring along the central Apenninic Belt (August 2010), spanning more than one year period. The main- shock (Mw 6.3) occurred on April 6th at 1:32 (UTC). The earthquake was destructive and caused among 300 casualties. The hypocenter has been located at 42.35°N, 13.38° at a depth of around 10 km. The main shock was preceded by a long seismic sequence starting several months before (i.e., March, 30, 2009 with Mw 4.1; April, 5 with Mw 3.9 and Mw 3.5, a few hours before the main shock). A lot of evidences stress the role of deep fluids porepressure evolution – possibly CO2 or brines - as occurred in the past, along seismically activated segments in Apennines. Our geochemical group started to survey the seismically activated area soon after the main-shock, by sampling around 1000 soil gas points and around 80 groundwater points (springs and wells, sampled on monthly basis still ongoing), to help in understanding the activated fault segments geometry and behaviour, as well as leakage patterns at surface (CO2, CH4, Radon and other geogas as He, H2, N2, H2S, O2, etc...), in the main sector of the activated seismic sequence, not far from a deep natural CO2 reservoir underground (termomethamorphic CO2 from carbonate diagenesis), degassing at surface only over the Cotilia-Canetra area, 20 km NW from the seismically activated area. The work highlighted that geochemical measurements on soils are very powerful to discriminate the activated seismogenic segments at surface, their jointing belt, as well as co-seismic depocenter of deformation. Mostly where the measured “threshold” magnitude of earthquakes (around 6), involve that the superficial effects could be absent or masked, our geochemical method demonstrated to be strategic, and we wish to use these methods in CO2 analogues/CO2 reservoir studies abroad, after done in Weyburn. The highlighted geochemical -slight but clear- anomalies are, in any case, not dangerous for the human health and keep away the fear around the CO2-CH4 bursts or explosions during strong earthquakes, as the L'Aquila one, when these gases are stored naturally/industrially underground in the vicinity (1-2 km deep). These findings are not new for these kind of Italian seismically activated faults and are very useful for the CO2- CH4 geological storage public acceptance: not necessarily (rarely or never) these geogas escape abruptly from underground along strongly activated faults

Long-term follow-up in paroxysmal atrial fibrillation patients with documented isolated trigger

Aims: Supraventricular tachycardias may trigger atrial fibrillation (AF). The aim of the study was to evaluate the prevalence of supraventricular tachycardia (SVT) inducibility in patients referred for AF ablation and to evaluate the effects of SVT ablation on AF recurrences. Methods and results: 249 patients (mean age: 54 ± 14 years) referred for paroxysmal AF ablation were studied. In all patients, only AF relapses had been documented in the clinical history. 47 patients (19%; mean age: 42 ± 11 years) had inducible SVT during the electrophysiological study and underwent an ablation targeted only at SVT suppression. Ablation was successful in all 47 patients. The ablative procedures were: 11 slow-pathway ablations for atrioventricular nodal re-entrant tachycardia; 6 concealed accessory pathway ablations for atrioventricular re-entrant tachycardia; 17 focal ectopic atrial tachycardia ablations; 13 with only one arrhythmogenic pulmonary vein. No recurrences of SVT were observed during the follow-up (32 ± 18 months). 4 patients (8.5%) showed recurrence of at least one episode of AF. Patients with inducible SVT had less structural heart disease and were younger than those without inducible SVT. Conclusion: A significant proportion of candidates for AF ablation are inducible for an SVT. SVT ablation showed a preventive effect on AF recurrences. Those patients should be selected for simpler ablation procedures tailored only to the triggering arrhythmia suppression