Details

Autor(en) / Beteiligte

• Viegas, José Miguel
• Rosa, Sílvia Aguiar
• Freitas, António

Titel

Cardiovascular pre-participation screening in female athletes: Should it be revisited?

Ist Teil von

• Journal of science and medicine in sport, 2023-10, Vol.26 (10), p.530-532

Ort / Verlag

Belconnen: Elsevier Ltd

Erscheinungsjahr

2023

Link zum Volltext

Quelle

Elsevier ScienceDirect Journals Complete

Beschreibungen/Notizen

• Despite smaller absolute biventricular dimensions, female athletes show larger indexed values compared to males.3 The latter are more likely to develop concentric remodelling/hypertrophy, whilst females have a higher proportion of eccentric LV hypertrophy.4 Notably, LV wall thickness typically does not exceed 12 mm, and higher values should prompt consideration of pathology.2,5 Moreover, women display a higher prevalence of anterior T-wave inversion,3,5 exhibit longer corrected QT intervals in the post-pubertal phase,2 and have greater sinoatrial node automaticity and shortened conduction times, including PR interval and QRS duration.5 First-degree atrioventricular block and right bundle branch block are less frequent in females, as well as early repolarization patterns and voltage criteria for right and left ventricular (LV) hypertrophy.3 Remarkably, studies have failed to prove an increased risk of atrial fibrillation amongst women who engage in lifelong vigorous exercise,6 suggesting that the U-shaped pattern between exercise and atrial fibrillation does not apply to the female athletic population. [...]some studies have shown worse survival in female HCM patients, who usually experience a delay in diagnosis (as they require relatively more hypertrophy to reach the current threshold of 15 mm), and hence are detected in a more advanced stage of disease.9 In the context of arrhythmogenic cardiomyopathy, it is widely accepted that males have a higher risk of ventricular arrhythmias. Whilst the ultimate goal of PPS is to identify athletes at risk and to reduce mortality, it may prompt unnecessary disqualifications, either as a result of false positive findings or as risk overestimation of certain diseases.7 There is concern that restricting sport may have significant physical and psychological consequences that may theoretically outweigh its benefits. [...]false positives generate costly unnecessary downstream clinical testing, further calling into question the benefit–cost ratio of broad-based screening, especially in female participants. Whilst a more proactive screening is vital to a timely diagnosis and early management, recent evidence suggesting a minimal risk of Sr-SCD in women has questioned the cost-effectiveness of the current preventive measures and triggered the debate whether PPS should differ based on sex. [...]future research in this field represents an important scientific priority.