Author(s): SCARFÒ, G., BIANCHI, M.; MAZZARISI, A.; FALCETTA, G.; COLLI, A.; FRANZONI, F. , Institution: VAT IT00286820501 UNIVERSITY OF PISA, Country: ITALY, Abstract-ID: 1251

INTRODUCTION:
Myocardial bridging (MB) consists of the intramyocardial course of a coronary artery. The evaluation of the MB-induced ischemia, caused by the compression of the “tunneled” tract during the systolic phase, represents a debated issue during preparticipation screening. Specifically, the assessment of MB hemodynamic effects becomes a crucial factor in athlete management. Indeed, participation in competitive sports, according to ESC and Italian guidelines, should be considered only in the absence of induced ischemia. The issue becomes of relevance in master athletes (> 35 years old) in which impaired vasomotor adaptations, inflammation, myocardial remodeling and atherosclerotic phenomena can alter compensation mechanisms and trigger an ischemic condition downstream of the tunneled segment. The aim of the study was to evaluate the correlation between myocardial perfusion data and the coronary anatomy in asymptomatic master athletes.
METHODS:
25 master endurance athletes (mean age: 66+3,4; Males: 20, Females: 5) came to our attention due to the finding of stress ECG abnormalities (ST-T tract depression or premature ventricular beats) performed during the annual preparticipation screening. None of them reported symptoms, cardiovascular risk factors or previous cardiovascular diseases. In order to precisely identify the cause of these findings, they were all subjected to a myocardial Single Photon Emission Computed Tomography (SPECT) and subsequently to a coronary CT angiography (CCTA).
RESULTS:
In these athletes, myocardial SPECT detected a mild perfusion defect (<5%) in absence of left ventricular dysfunction. Anatomical data obtained by CCTA showed the relationship between the ischemic area and the presence of a MB, involving the left anterior descending artery in 21 athletes. In 18 patients, the systolic phase caused the total occlusion of the tunneled segment, thus demonstrating a severe hemodynamic impact on ventricular myocardium.
CONCLUSION:
The evidence of mild inducible ischemia is generally not an indication for further diagnostic investigation; however, our data showed that restricted perfusion defect could be associated with the presence of hemodynamically significant MBs. Therefore, during preparticipation screening it is crucial to perform the anatomical study of coronary arteries of master athletes, even in the presence of mild inducible ischemia to prevent cardiovascular adverse events during exercise.