Abstract
Sudden cardiac death (SCD) in a young athlete represents a dramatic event, and an increasing number of medico-legal cases have addressed this topic. In addition to representing an ethical and medico-legal responsibility, prevention of SCD is directly correlated with accurate eligibility/disqualification decisions, with an inappropriate pronouncement in either direction potentially leading to legal controversy. This review summarizes the common causes of SCD in young athletes, divided into structural (hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, congenital coronary artery anomalies, etc.), electrical (Brugada, congenital LQT, Wolf-Parkinson-White syndrome, etc.), and acquired cardiac abnormalities (myocarditis, etc.). In addition, the roles of hereditary cardiac anomalies in SCD in athletes and the effects of a positive result on them and their families are discussed. The medico-legal relevance of pre-participation screening is analyzed, and recommendations from the American Heart Association and European Society of Cardiology are compared. Finally, the main issues concerning the differentiation between physiologic cardiac adaptation in athletes and pathologic findings and, thereby, definition of the so-called gray zone, which is based on exact knowledge of the mechanism of cardiac remodeling including structural or functional adaptions, will be addressed.
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Maron BJ, Haas TS, Ahluwalia A, Murphy CJ, Garberich RF (2016) Demographics and epidemiology of sudden deaths in young competitive athletes: from the U.S. National registry. Am J Med. doi:10.1016/j.amjmed.2016.02.031
Maron BJ, Haas TS, Duncanson ER, Garberich RF, Baker AM, Mackey-Bojack S (2016) Comparison of the frequency of sudden cardiovascular deaths in young competitive athletes versus nonathletes: should we really screen only athletes? Am J Cardiol 117:1339–1341. doi:10.1016/j.amjcard.2016.01.026
Maron BJ, Murphy CJ, Haas TS, Ahluwalia A, Garberich RF (2014) Strategies for assessing the prevalence of cardiovascular sudden deaths in young competitive athletes. Int J Cardiol 173:369–372. doi:10.1016/j.ijcard.2014.02.021
Bayes de Luna A, Elosua R (2012) Sudden death. Rev Esp Cardiol (Engl Ed) 65:1039–1052. doi:10.1016/j.recesp.2012.03.032
Corrado D, Basso C, Rizzoli G, Schiavon M, Thiene G (2003) Does sports activity enhance the risk of sudden death in adolescents and young adults? J Am Coll Cardiol 42:1959–1963
Grazioli G, Merino B, Montserrat S, Vidal B, Azqueta M, Pare C, Sarquella-Brugada G, Yanguas X, Pi R, Til L, Escoda J, Brugada J, Sitges M (2014) Usefulness of echocardiography in preparticipation screening of competitive athletes. Rev Esp Cardiol (Engl Ed) 67:701–705. doi:10.1016/j.rec.2013.11.023
Fletcher GF, Balady G, Blair SN, Blumenthal J, Caspersen C, Chaitman B, Epstein S, Sivarajan Froelicher ES, Froelicher VF, Pina IL, Pollock ML (1996) Statement on exercise: benefits and recommendations for physical activity programs for all Americans. A statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart Association. Circulation 94:857–862
Pate RR, Davis MG, Robinson TN, Stone EJ, McKenzie TL, Young JC (2006) Promoting physical activity in children and youth: a leadership role for schools: a scientific statement from the American Heart Association council on nutrition, physical activity, and metabolism (physical activity committee) in collaboration with the councils on cardiovascular disease in the young and cardiovascular nursing. Circulation 114:1214–1224. doi:10.1161/circulationaha.106.177052
Swift DL, Lavie CJ, Johannsen NM, Arena R, Earnest CP, O’Keefe JH, Milani RV, Blair SN, Church TS (2013) Physical activity, cardiorespiratory fitness, and exercise training in primary and secondary coronary prevention. Circ J 77:281–292
Thompson PD, Franklin BA, Balady GJ, Blair SN, Corrado D, Estes NA 3rd, Fulton JE, Gordon NF, Haskell WL, Link MS, Maron BJ, Mittleman MA, Pelliccia A, Wenger NK, Willich SN, Costa F (2007) Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association council on nutrition, physical activity, and metabolism and the council on clinical cardiology. Circulation 115:2358–2368. doi:10.1161/circulationaha.107.181485
Albano AJ, Thompson PD, Kapur NK (2012) Acute coronary thrombosis in Boston marathon runners. N Engl J Med 366:184–185. doi:10.1056/NEJMc1111015
Thompson PD, Funk EJ, Carleton RA, Sturner WQ (1982) Incidence of death during jogging in Rhode Island from 1975 through 1980. JAMA 247:2535–2538
Elefteriades JA, Hatzaras I, Tranquilli MA, Elefteriades AJ, Stout R, Shaw RK, Silverman D, Barash P (2003) Weight lifting and rupture of silent aortic aneurysms. JAMA 290:2803. doi:10.1001/jama.290.21.2803
Hatzaras I, Tranquilli M, Coady M, Barrett PM, Bible J, Elefteriades JA (2007) Weight lifting and aortic dissection: more evidence for a connection. Cardiology 107:103–106. doi:10.1159/000094530
Abdulla J, Nielsen JR (2009) Is the risk of atrial fibrillation higher in athletes than in the general population? A systematic review and meta-analysis. Europace 11:1156–1159. doi:10.1093/europace/eup197
Aizer A, Gaziano JM, Cook NR, Manson JE, Buring JE, Albert CM (2009) Relation of vigorous exercise to risk of atrial fibrillation. Am J Cardiol 103:1572–1577. doi:10.1016/j.amjcard.2009.01.374
Mozaffarian D, Furberg CD, Psaty BM, Siscovick D (2008) Physical activity and incidence of atrial fibrillation in older adults: the cardiovascular health study. Circulation 118:800–807. doi:10.1161/circulationaha.108.785626
Ofman P, Khawaja O, Rahilly-Tierney CR, Peralta A, Hoffmeister P, Reynolds MR, Gaziano JM, Djousse L (2013) Regular physical activity and risk of atrial fibrillation: a systematic review and meta-analysis. Circ Arrhythm Electrophysiol 6:252–256. doi:10.1161/circep.113.000147
Rosengren A, Hauptman PJ, Lappas G, Olsson L, Wilhelmsen L, Swedberg K (2009) Big men and atrial fibrillation: effects of body size and weight gain on risk of atrial fibrillation in men. Eur Heart J 30:1113–1120. doi:10.1093/eurheartj/ehp076
Link MS, Estes NA 3rd (2012) Sudden cardiac death in the athlete: bridging the gaps between evidence, policy, and practice. Circulation 125:2511–2516. doi:10.1161/circulationaha.111.023861
Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO (2009) Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980–2006. Circulation 119:1085–1092. doi:10.1161/circulationaha.108.804617
Marijon E, Tafflet M, Celermajer DS, Dumas F, Perier M-C, Mustafic H, Toussaint J-F, Desnos M, Rieu M, Benameur N, Le Heuzey J-Y, Empana J-P, Jouven X (2011) Sports-related sudden death in the general population. Circulation 124:672–681. doi:10.1161/circulationaha.110.008979
Grani C, Chappex N, Fracasso T, Vital C, Kellerhals C, Schmied C, Saguner AM, Trachsel LD, Eser P, Michaud K, Wilhelm M (2016) Sports-related sudden cardiac death in Switzerland classified by static and dynamic components of exercise. Eur J Prev Cardiol. doi:10.1177/2047487316632967
Toresdahl BG, Rao AL, Harmon KG, Drezner JA (2014) Incidence of sudden cardiac arrest in high school student athletes on school campus. Heart Rhythm 11:1190–1194, doi:10.1016/j.hrthm.2014.04.017
Maron BJ, Haas TS, Ahluwalia A, Rutten-Ramos SC (2013) Incidence of cardiovascular sudden deaths in Minnesota high school athletes. Heart Rhythm 10:374–377, doi:10.1016/j.hrthm.2012.11.024
Holst AG, Winkel BG, Theilade J, Kristensen IB, Thomsen JL, Ottesen GL, Svendsen JH, Haunso S, Prescott E, Tfelt-Hansen J (2010) Incidence and etiology of sports-related sudden cardiac death in Denmark—implications for preparticipation screening. Heart Rhythm 7:1365–1371. doi:10.1016/j.hrthm.2010.05.021
Sharma S (2003) Athlete’s heart—effect of age, sex, ethnicity and sporting discipline. Exp Physiol 88:665–669
Risgaard B, Winkel BG, Jabbari R, Glinge C, Ingemann-Hansen O, Thomsen JL, Ottesen GL, Haunso S, Holst AG, Tfelt-Hansen J (2014) Sports-related sudden cardiac death in a competitive and a noncompetitive athlete population aged 12 to 49 years: data from an unselected nationwide study in Denmark. Heart Rhythm 11:1673–1681. doi:10.1016/j.hrthm.2014.05.026
Chandra N, Bastiaenen R, Papadakis M, Sharma S (2013) Sudden cardiac death in young athletes: practical challenges and diagnostic dilemmas. J Am Coll Cardiol 61:1027–1040. doi:10.1016/j.jacc.2012.08.1032
Friedewald VE, Maron BJ, Roberts WC (2007) The editor’s roundtable: sudden cardiac death in athletes. Am J Cardiol 100:1451–1459. doi:10.1016/j.amjcard.2007.07.012
Corrado D, Basso C, Thiene G, McKenna WJ, Davies MJ, Fontaliran F, Nava A, Silvestri F, Blomstrom-Lundqvist C, Wlodarska EK, Fontaine G, Camerini F (1997) Spectrum of clinicopathologic manifestations of arrhythmogenic right ventricular cardiomyopathy/dysplasia: a multicenter study. J Am Coll Cardiol 30:1512–1520
Maron BJ (2002) Hypertrophic cardiomyopathy: a systematic review. JAMA 287:1308–1320
Maron BJ, Shirani J, Poliac LC, Mathenge R, Roberts WC, Mueller FO (1996) Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles. JAMA 276:199–204
Maron BJ, Gardin JM, Flack JM, Gidding SS, Kurosaki TT, Bild DE (1995) Prevalence of hypertrophic cardiomyopathy in a general population of young adults. Echocardiographic analysis of 4111 subjects in the CARDIA study. Coronary artery risk development in (young) adults. Circulation 92:785–789
Maron BJ, Udelson JE, Bonow RO, Nishimura RA, Ackerman MJ, Estes NA III, Cooper LT Jr, Link MS, Maron MS (2015) Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 3: hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and other cardiomyopathies, and myocarditis: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol 66:2362–2371. doi:10.1016/j.jacc.2015.09.035
Basso C, Corrado D, Marcus FI, Nava A, Thiene G (2009) Arrhythmogenic right ventricular cardiomyopathy. Lancet 373:1289–1300. doi:10.1016/s0140-6736(09)60256-7
Corrado D, Wichter T, Link MS, Hauer RN, Marchlinski FE, Anastasakis A, Bauce B, Basso C, Brunckhorst C, Tsatsopoulou A, Tandri H, Paul M, Schmied C, Pelliccia A, Duru F, Protonotarios N, Estes NM 3rd, McKenna WJ, Thiene G, Marcus FI, Calkins H (2015) Treatment of arrhythmogenic right ventricular cardiomyopathy/dysplasia: an international task force consensus statement. Circulation 132:441–453. doi:10.1161/circulationaha.115.017944
James CA, Bhonsale A, Tichnell C, Murray B, Russell SD, Tandri H, Tedford RJ, Judge DP, Calkins H (2013) Exercise increases age-related penetrance and arrhythmic risk in arrhythmogenic right ventricular dysplasia/cardiomyopathy-associated desmosomal mutation carriers. J Am Coll Cardiol 62:1290–1297. doi:10.1016/j.jacc.2013.06.033
Campuzano O, Alcalde M, Allegue C, Iglesias A, Garcia-Pavia P, Partemi S, Oliva A, Pascali VL, Berne P, Sarquella-Brugada G, Brugada J, Brugada P, Brugada R (2013) Genetics of arrhythmogenic right ventricular cardiomyopathy. J Med Genet 50:280–289. doi:10.1136/jmedgenet-2013-101523
Ruwald AC, Marcus F, Estes NA 3rd, Link M, McNitt S, Polonsky B, Calkins H, Towbin JA, Moss AJ, Zareba W (2015) Association of competitive and recreational sport participation with cardiac events in patients with arrhythmogenic right ventricular cardiomyopathy: results from the North American multidisciplinary study of arrhythmogenic right ventricular cardiomyopathy. Eur Heart J 36:1735–1743. doi:10.1093/eurheartj/ehv110
Angelini P (2007) Coronary artery anomalies: an entity in search of an identity. Circulation 115:1296–1305. doi:10.1161/circulationaha.106.618082
Thompson PD, Myerburg RJ, Levine BD, Udelson JE, Kovacs RJ (2015) Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 8: coronary artery disease: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol 66:2406–2411. doi:10.1016/j.jacc.2015.09.040
Maron BJ, Zipes DP (2005) Introduction: eligibility recommendations for competitive athletes with cardiovascular abnormalities—general considerations. J Am Coll Cardiol 45:1318–1321. doi:10.1016/j.jacc.2005.02.006
Yetman AT, Bornemeier RA, McCrindle BW (2003) Long-term outcome in patients with Marfan syndrome: is aortic dissection the only cause of sudden death? J Am Coll Cardiol 41:329–332
Braverman AC, Harris KM, Kovacs RJ, Maron BJ (2015) Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 7: aortic diseases, including Marfan syndrome: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol 66:2398–2405. doi:10.1016/j.jacc.2015.09.039
Maron BJ, Ackerman MJ, Nishimura RA, Pyeritz RE, Towbin JA, Udelson JE (2005) Task Force 4: HCM and other cardiomyopathies, mitral valve prolapse, myocarditis, and Marfan syndrome. J Am Coll Cardiol 45:1340–1345. doi:10.1016/j.jacc.2005.02.011
Jeresaty RM (1986) Mitral valve prolapse: definition and implications in athletes. J Am Coll Cardiol 7:231–236
Kligfield P, Levy D, Devereux RB, Savage DD (1987) Arrhythmias and sudden death in mitral valve prolapse. Am Heart J 113:1298–1307
Nordhues BD, Siontis KC, Scott CG, Nkomo VT, Ackerman MJ, Asirvatham SJ, Noseworthy PA (2016) Bileaflet mitral valve prolapse and risk of ventricular dysrhythmias and death. J Cardiovasc Electrophysiol 27:463–468. doi:10.1111/jce.12914
Basso C, Perazzolo Marra M, Rizzo S, De Lazzari M, Giorgi B, Cipriani A, Frigo AC, Rigato I, Migliore F, Pilichou K, Bertaglia E, Cacciavillani L, Bauce B, Corrado D, Thiene G, Iliceto S (2015) Arrhythmic mitral valve prolapse and sudden cardiac death. Circulation 132:556–566. doi:10.1161/circulationaha.115.016291
Bonow RO, Nishimura RA, Thompson PD, Udelson JE (2015) Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 5: valvular heart disease: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol 66:2385–2392. doi:10.1016/j.jacc.2015.09.037
Kulbertus HE (1988) Ventricular arrhythmias, syncope and sudden death in aortic stenosis. Eur Heart J 9(Suppl E):51–52
Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Baron-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Iung B, Lancellotti P, Pierard L, Price S, Schafers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M (2012) Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 33:2451–2496. doi:10.1093/eurheartj/ehs109
Brugada P, Brugada J (1992) Right bundle branch block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol 20:1391–1396
Jellins J, Milanovic M, Taitz DJ, Wan SH, Yam PW (2013) Brugada syndrome. Hong Kong Med J 19:159–167
Campuzano O, Brugada R, Iglesias A (2010) Genetics of Brugada syndrome. Curr Opin Cardiol 25:210–215. doi:10.1097/HCO.0b013e32833846ee
Juang JM, Huang SK (2004) Brugada syndrome—an under-recognized electrical disease in patients with sudden cardiac death. Cardiology 101:157–169. doi:10.1159/000076693
Berne P, Brugada J (2012) Brugada syndrome 2012. Circ J 76:1563–1571
Ackerman MJ, Zipes DP, Kovacs RJ, Maron BJ (2015) Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 10: the cardiac channelopathies: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol 66:2424–2428. doi:10.1016/j.jacc.2015.09.042
Schwartz PJ, Ackerman MJ (2013) The long QT syndrome: a transatlantic clinical approach to diagnosis and therapy. Eur Heart J 34:3109–3116. doi:10.1093/eurheartj/eht089
Schwartz PJ, Stramba-Badiale M, Crotti L, Pedrazzini M, Besana A, Bosi G, Gabbarini F, Goulene K, Insolia R, Mannarino S, Mosca F, Nespoli L, Rimini A, Rosati E, Salice P, Spazzolini C (2009) Prevalence of the congenital long-QT syndrome. Circulation 120:1761–1767. doi:10.1161/circulationaha.109.863209
Puranik R, Chow CK, Duflou JA, Kilborn MJ, McGuire MA (2005) Sudden death in the young. Heart Rhythm 2:1277–1282. doi:10.1016/j.hrthm.2005.09.008
Corrado D, Basso C, Pavei A, Michieli P, Schiavon M, Thiene G (2006) Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA 296:1593–1601. doi:10.1001/jama.296.13.1593
Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO (2006) Profile and frequency of sudden death in 1463 young competitive athletes: from a 25 year U.S: national registry: 1980–2005. Circulation. 114
Crotti L, Hu D, Barajas-Martinez H, De Ferrari GM, Oliva A, Insolia R, Pollevick GD, Dagradi F, Guerchicoff A, Greco F, Schwartz PJ, Viskin S, Antzelevitch C (2012) Torsades de pointes following acute myocardial infarction: evidence for a deadly link with a common genetic variant. Heart Rhythm 9:1104–1112. doi:10.1016/j.hrthm.2012.02.014
Johnson JN, Ackerman MJ (2012) Competitive sports participation in athletes with congenital long QT syndrome. JAMA 308:764–765. doi:10.1001/jama.2012.9334
Neuspiel DR, Kuller LH (1985) Sudden and unexpected natural death in childhood and adolescence. JAMA 254:1321–1325
Heidbuchel H, Panhuyzen-Goedkoop N, Corrado D, Hoffmann E, Biffi A, Delise P, Blomstrom-Lundqvist C, Vanhees L, Ivarhoff P, Dorwarth U, Pelliccia A (2006) Recommendations for participation in leisure-time physical activity and competitive sports in patients with arrhythmias and potentially arrhythmogenic conditions Part I: Supraventricular arrhythmias and pacemakers. Eur J Cardiovasc Prev Rehabil 13:475–484. doi:10.1097/01.hjr.0000216543.54066.72
Pappone C, Santinelli V, Rosanio S, Vicedomini G, Nardi S, Pappone A, Tortoriello V, Manguso F, Mazzone P, Gulletta S, Oreto G, Alfieri O (2003) Usefulness of invasive electrophysiologic testing to stratify the risk of arrhythmic events in asymptomatic patients with Wolff-Parkinson-White pattern: results from a large prospective long-term follow-up study. J Am Coll Cardiol 41:239–244
Biffi A, Pelliccia A, Verdile L, Fernando F, Spataro A, Caselli S, Santini M, Maron BJ (2002) Long-term clinical significance of frequent and complex ventricular tachyarrhythmias in trained athletes. J Am Coll Cardiol 40:446–452
Al-Khatib SM, Arshad A, Balk EM, Das SR, Hsu JC, Joglar JA, Page RL (2016) Risk stratification for arrhythmic events in patients with asymptomatic pre-excitation: a systematic review for the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the heart rhythm society. J Am Coll Cardiol 67:1624–1638. doi:10.1016/j.jacc.2015.09.018
Timmermans C, Smeets JL, Rodriguez LM, Vrouchos G, van den Dool A, Wellens HJ (1995) Aborted sudden death in the Wolff-Parkinson-White syndrome. Am J Cardiol 76:492–494
Zipes DP, Ackerman MJ, Estes NA 3rd, Grant AO, Myerburg RJ, Van Hare G (2005) Task force 7: arrhythmias. J Am Coll Cardiol 45:1354–1363. doi:10.1016/j.jacc.2005.02.014
Cohen MI, Triedman JK, Cannon BC, Davis AM, Drago F, Janousek J, Klein GJ, Law IH, Morady FJ, Paul T, Perry JC, Sanatani S, Tanel RE (2012) PACES/HRS expert consensus statement on the management of the asymptomatic young patient with a Wolff-Parkinson-White (WPW, ventricular preexcitation) electrocardiographic pattern: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology Foundation (ACCF), the American Heart Association (AHA), the American Academy of Pediatrics (AAP), and the Canadian Heart Rhythm Society (CHRS). Heart Rhythm 9:1006–1024. doi:10.1016/j.hrthm.2012.03.050
Zipes DP, Link MS, Ackerman MJ, Kovacs RJ, Myerburg RJ, Estes NA 3rd (2015) Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 9: arrhythmias and conduction defects: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol 66:2412–2423. doi:10.1016/j.jacc.2015.09.041
Priori SG, Napolitano C, Memmi M, Colombi B, Drago F, Gasparini M, DeSimone L, Coltorti F, Bloise R, Keegan R, Cruz Filho FE, Vignati G, Benatar A, DeLogu A (2002) Clinical and molecular characterization of patients with catecholaminergic polymorphic ventricular tachycardia. Circulation 106:69–74
Priori SG, Napolitano C, Tiso N, Memmi M, Vignati G, Bloise R, Sorrentino V, Danieli GA (2001) Mutations in the cardiac ryanodine receptor gene (hRyR2) underlie catecholaminergic polymorphic ventricular tachycardia. Circulation 103:196–200
Trusty JM, Beinborn DS, Jahangir A (2004) Dysrhythmias and the athlete. AACN Clin Issues 15:432–448
Maron BJ, Pelliccia A, Spirito P (1995) Cardiac disease in young trained athletes. Insights into methods for distinguishing athlete’s heart from structural heart disease, with particular emphasis on hypertrophic cardiomyopathy. Circulation 91:1596–1601
Eckart RE, Scoville SL, Campbell CL, Shry EA, Stajduhar KC, Potter RN, Pearse LA, Virmani R (2004) Sudden death in young adults: a 25-year review of autopsies in military recruits. Ann Intern Med 141:829–834
Cooper LT Jr (2009) Myocarditis. N Engl J Med 360:1526–1538. doi:10.1056/NEJMra0800028
Corrado D, Basso C, Thiene G (2001) Sudden cardiac death in young people with apparently normal heart. Cardiovasc Res 50:399–408
Karjalainen J, Heikkila J (1999) Incidence of three presentations of acute myocarditis in young men in military service. A 20-year experience. Eur Heart J 20:1120–1125. doi:10.1053/euhj.1998.1444
Haller CA, Benowitz NL (2000) Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. N Engl J Med 343:1833–1838. doi:10.1056/nejm200012213432502
Shekelle PG, Hardy ML, Morton SC, Maglione M, Mojica WA, Suttorp MJ, Rhodes SL, Jungvig L, Gagne J (2003) Efficacy and safety of ephedra and ephedrine for weight loss and athletic performance: a meta-analysis. JAMA 289:1537–1545. doi:10.1001/jama.289.12.1537
Riebe D, Fernhall B, Thompson PD (1992) The blood pressure response to exercise in anabolic steroid users. Med Sci Sports Exerc 24:633–637
Freed DL, Banks AJ, Longson D, Burley DM (1975) Anabolic steroids in athelics: crossover double-blind trial on weightlifters. Br Med J 2:471–473
Fineschi V, Riezzo I, Centini F, Silingardi E, Licata M, Beduschi G, Karch SB (2007) Sudden cardiac death during anabolic steroid abuse: morphologic and toxicologic findings in two fatal cases of bodybuilders. Int J Legal Med 121:48–53. doi:10.1007/s00414-005-0055-9
To LB, Sangster JF, Rampling D, Cammens I (1980) Ephedrine-induced cardiomyopathy. Med J Aust 2:35–36
Bruno A, Nolte KB, Chapin J (1993) Stroke associated with ephedrine use. Neurology 43:1313–1316
Cantu C, Arauz A, Murillo-Bonilla LM, Lopez M, Barinagarrementeria F (2003) Stroke associated with sympathomimetics contained in over-the-counter cough and cold drugs. Stroke 34:1667–1672. doi:10.1161/01.str.0000075293.45936.fa
Wiener I, Tilkian AG, Palazzolo M (1990) Coronary artery spasm and myocardial infarction in a patient with normal coronary arteries: temporal relationship to pseudoephedrine ingestion. Catheter Cardiovasc Diagn 20:51–53
Dhar R, Stout CW, Link MS, Homoud MK, Weinstock J, Estes NA 3rd (2005) Cardiovascular toxicities of performance-enhancing substances in sports. Mayo Clin Proc 80:1307–1315. doi:10.4065/80.10.1307
Chappex N, Schlaepfer J, Fellmann F, Bhuiyan ZA, Wilhelm M, Michaud K (2015) Sudden cardiac death among general population and sport related population in forensic experience. J Forensic Legal Med 35:62–68. doi:10.1016/j.jflm.2015.07.004
Hertz CL, Christiansen SL, Ferrero-Miliani L, Fordyce SL, Dahl M, Holst AG, Ottesen GL, Frank-Hansen R, Bundgaard H, Morling N (2015) Next-generation sequencing of 34 genes in sudden unexplained death victims in forensics and in patients with channelopathic cardiac diseases. Int J Legal Med 129:793–800. doi:10.1007/s00414-014-1105-y
Thomas MJ, Battle RW (2015) Something old, something new: using family history and genetic testing to diagnose and manage athletes with inherited cardiovascular disease. Clin Sports Med 34:517–537. doi:10.1016/j.csm.2015.03.006
Sarquella-Brugada G, Campuzano O, Iglesias A, Sanchez-Malagon J, Guerra-Balic M, Brugada J, Brugada R (2013) Genetics of sudden cardiac death in children and young athletes. Cardiol Young 23:159–173. doi:10.1017/s1047951112001138
Maron BJ, Thompson PD, Ackerman MJ, Balady G, Berger S, Cohen D, Dimeff R, Douglas PS, Glover DW, Hutter AM Jr, Krauss MD, Maron MS, Mitten MJ, Roberts WO, Puffer JC (2007) Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association council on nutrition, physical activity, and metabolism: endorsed by the American College of Cardiology Foundation. Circulation 115:1643–1455. doi:10.1161/circulationaha.107.181423
Corrado D, Pelliccia A, Bjornstad HH, Vanhees L, Biffi A, Borjesson M, Panhuyzen-Goedkoop N, Deligiannis A, Solberg E, Dugmore D, Mellwig KP, Assanelli D, Delise P, Van-Buuren F, Anastasakis A, Heidbuchel H, Hoffmann E, Fagard R, Priori SG, Basso C, Arbustini E, Blomstrom-Lundqvist C, McKenna WJ, Thiene G (2005) Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus statement of the study group of sport cardiology of the working group of cardiac rehabilitation and exercise physiology and the working group of myocardial and pericardial diseases of the European Society of Cardiology. Eur Heart J 26:516–524. doi:10.1093/eurheartj/ehi108
Richard P, Denjoy I, Fressart V, Wilson MG, Carre F, Charron P (2012) Advising a cardiac disease gene positive yet phenotype negative or borderline abnormal athlete: is sporting disqualification really necessary? Br J Sports Med 46(Suppl 1):i59–i68. doi:10.1136/bjsports-2012-091318
Priori SG, Wilde AA, Horie M, Cho Y, Behr ER, Berul C, Blom N, Brugada J, Chiang CE, Huikuri H, Kannankeril P, Krahn A, Leenhardt A, Moss A, Schwartz PJ, Shimizu W, Tomaselli G, Tracy C (2013) HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes: document endorsed by HRS, EHRA, and APHRS in May 2013 and by ACCF, AHA, PACES, and AEPC in June 2013. Heart Rhythm 10:1932–1963. doi:10.1016/j.hrthm.2013.05.014
Boggess BR, Bytomski JR (2013) Medicolegal aspects of sports medicine. Prim Care 40:525–535. doi:10.1016/j.pop.2013.02.008
Kaltman JR, Thompson PD, Lantos J, Berul CI, Botkin J, Cohen JT, Cook NR, Corrado D, Drezner J, Frick KD, Goldman S, Hlatky M, Kannankeril PJ, Leslie L, Priori S, Saul JP, Shapiro-Mendoza CK, Siscovick D, Vetter VL, Boineau R, Burns KM, Friedman RA (2011) Screening for sudden cardiac death in the young: report from a national heart, lung, and blood institute working group. Circulation 123:1911–1918. doi:10.1161/circulationaha.110.017228
Maron BJ, Pelliccia A (2006) The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death. Circulation 114:1633–1644. doi:10.1161/circulationaha.106.613562
Paterick TE, Paterick TJ, Fletcher GF, Maron BJ (2005) Medical and legal issues in the cardiovascular evaluation of competitive athletes. JAMA 294:3011–3018. doi:10.1001/jama.294.23.3011
Panhuyzen-Goedkoop NM, Smeets JL (2014) Legal responsibilities of physicians when making participation decisions in athletes with cardiac disorders: do guidelines provide a solid legal footing? Br J Sports Med 48:1193–1195. doi:10.1136/bjsports-2013-093023
Kleinknecht v. Gettysburg College FdCoA, 3rd Ci http://law.justia.com/cases/federal/district-courts/FSupp/786/449/1380085/
Emery MS, Quandt EF (2015) Legal and ethical issues in the cardiovascular care of elite athletes. Clin Sports Med 34:507–516. doi:10.1016/j.csm.2015.02.004
Mitten MJ, Zipes DP, Maron BJ, Bryant WJ (2015) Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 15: legal aspects of medical eligibility and disqualification recommendations: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol 66:2447–2450. doi:10.1016/j.jacc.2015.09.047
Garritano NF, Willmarth-Stec M (2015) Student athletes, sudden cardiac death, and lifesaving legislation: a review of the literature. J Pediatr Health Care 29:233–242. doi:10.1016/j.pedhc.2014.11.006
Higgins JP, Ananaba IE, Higgins CL (2013) Sudden cardiac death in young athletes: preparticipation screening for underlying cardiovascular abnormalities and approaches to prevention. Phys Sportsmed 41:81–93. doi:10.3810/psm.2013.02.2002
Basso C, Maron BJ, Corrado D, Thiene G (2000) 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 35:1493–1501
Corrado D, Basso C, Fontaine G, McKenna WJ, Marcus FI, Nava A, Thiene G (2002) Clinical profile of young competitive athletes who died suddenly of arrhythmogenic right ventricular cardiomyopathy/dysplasia: a multicenter study. Pacing Clin Electrophysiol 25:544. doi:10.1111/j.1540-8159.2002.tb00021.x
Tester DJ, Spoon DB, Valdivia HH, Makielski JC, Ackerman MJ (2004) Targeted mutational analysis of the RyR2-encoded cardiac ryanodine receptor in sudden unexplained death: a molecular autopsy of 49 medical examiner/coroner’s cases. Mayo Clin Proc 79:1380–1384. doi:10.4065/79.11.1380
Goldberger JJ, Cain ME, Hohnloser SH, Kadish AH, Knight BP, Lauer MS, Maron BJ, Page RL, Passman RS, Siscovick D, Stevenson WG, Zipes DP (2008) American Heart Association/American College of Cardiology Foundation/heart rhythm society scientific statement on noninvasive risk stratification techniques for identifying patients at risk for sudden cardiac death: a scientific statement from the American Heart Association council on clinical cardiology committee on electrocardiography and arrhythmias and council on epidemiology and prevention. Heart Rhythm 5:e1–e21. doi:10.1016/j.hrthm.2008.05.031
Maron BJ, Friedman RA, Kligfield P, Levine BD, Viskin S, Chaitman BR, Okin PM, Saul JP, Salberg L, Van Hare GF, Soliman EZ, Chen J, Matherne GP, Bolling SF, Mitten MJ, Caplan A, Balady GJ, Thompson PD (2014) Assessment of the 12-lead electrocardiogram as a screening test for detection of cardiovascular disease in healthy general populations of young people (12–25 years of age): a scientific statement from the American Heart Association and the American College of Cardiology. J Am Coll Cardiol 64:1479–1514. doi:10.1016/j.jacc.2014.05.006
Maron BJ, Levine BD, Washington RL, Baggish AL, Kovacs RJ, Maron MS (2015) Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 2: preparticipation screening for cardiovascular disease in competitive athletes: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol 66:2356–2361. doi:10.1016/j.jacc.2015.09.034
Migliore F, Zorzi A, Michieli P, Perazzolo Marra M, Siciliano M, Rigato I, Bauce B, Basso C, Toazza D, Schiavon M, Iliceto S, Thiene G, Corrado D (2012) Prevalence of cardiomyopathy in Italian asymptomatic children with electrocardiographic T-wave inversion at preparticipation screening. Circulation 125:529–538. doi:10.1161/circulationaha.111.055673
Marcus FI (2000) Electrocardiographic features of inherited diseases that predispose to the development of cardiac arrhythmias, long QT syndrome, arrhythmogenic right ventricular cardiomyopathy/dysplasia, and Brugada syndrome. J Electrocardiol 33(Suppl):1–10
Wheeler MT, Heidenreich PA, Froelicher VF, Hlatky MA, Ashley EA (2010) Cost-effectiveness of preparticipation screening for prevention of sudden cardiac death in young athletes. Ann Intern Med 152:276–286. doi:10.7326/0003-4819-152-5-201003020-00005
Viskin S (2007) Antagonist: routine screening of all athletes prior to participation in competitive sports should be mandatory to prevent sudden cardiac death. Heart Rhythm 4:525–528. doi:10.1016/j.hrthm.2007.01.003
Pelliccia A, Maron BJ (1995) Preparticipation cardiovascular evaluation of the competitive athlete: perspectives from the 30-year Italian experience. Am J Cardiol 75:827–829
Myerburg RJ, Vetter VL (2007) Electrocardiograms should be included in preparticipation screening of athletes. Circulation 116:2616–2626. doi:10.1161/circulationaha.107.733519, discussion 2626
Corrado D, Thiene G (2007) Protagonist: routine screening of all athletes prior to participation in competitive sports should be mandatory to prevent sudden cardiac death. Heart Rhythm 4:520–524. doi:10.1016/j.hrthm.2007.01.002
Pelliccia A, Zipes DP, Maron BJ (2008) Bethesda conference #36 and the 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 52:1990–1996. doi:10.1016/j.jacc.2008.08.055
Corrado D, Pelliccia A, Heidbuchel H, Sharma S, Link M, Basso C, Biffi A, Buja G, Delise P, Gussac I, Anastasakis A, Borjesson M, Bjornstad HH, Carre F, Deligiannis A, Dugmore D, Fagard R, Hoogsteen J, Mellwig KP, Panhuyzen-Goedkoop N, Solberg E, Vanhees L, Drezner J, Estes NA III, Iliceto S, Maron BJ, Peidro R, Schwartz PJ, Stein R, Thiene G, Zeppilli P, McKenna WJ (2010) Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J 31:243–259. doi:10.1093/eurheartj/ehp473
Drezner JA (2011) ECG screening in athletes: time to develop infrastructure. Heart Rhythm 8:1560–1561. doi:10.1016/j.hrthm.2011.05.012
Drezner JA (2013) Detect, manage, inform: a paradigm shift in the care of athletes with cardiac disorders? Br J Sports Med 47:4–5. doi:10.1136/bjsports-2012-091963
Thiene G, Corrado D, Schiavon M, Basso C (2013) Screening of competitive athletes to prevent sudden death: implement programmes now. Heart 99:304–306. doi:10.1136/heartjnl-2012-302411
Maron BJ (2010) National electrocardiography screening for competitive athletes: feasible in the United States? Ann Intern Med 152:324–326. doi:10.7326/0003-4819-152-5-201003020-00012
Chaitman BR (2007) An electrocardiogram should not be included in routine preparticipation screening of young athletes. Circulation 116:2610–2614. doi:10.1161/circulationaha.107.711465, discussion 2615
Maron BJ, Haas TS, Doerer JJ, Thompson PD, Hodges JS (2009) Comparison of U.S. and Italian experiences with sudden cardiac deaths in young competitive athletes and implications for preparticipation screening strategies. Am J Cardiol 104:276–280. doi:10.1016/j.amjcard.2009.03.037
Steinvil A, Chundadze T, Zeltser D, Rogowski O, Halkin A, Galily Y, Perluk H, Viskin S (2011) Mandatory electrocardiographic screening of athletes to reduce their risk for sudden death proven fact or wishful thinking? J Am Coll Cardiol 57:1291–1296. doi:10.1016/j.jacc.2010.10.037
Baggish AL, Hutter AM Jr, Wang F, Yared K, Weiner RB, Kupperman E, Picard MH, Wood MJ (2010) Cardiovascular screening in college athletes with and without electrocardiography: a cross-sectional study. Ann Intern Med 152:269–275. doi:10.7326/0003-4819-152-5-201003020-00004
Pelliccia A, Culasso F, Di Paolo FM, Accettura D, Cantore R, Castagna W, Ciacciarelli A, Costini G, Cuffari B, Drago E, Federici V, Gribaudo CG, Iacovelli G, Landolfi L, Menichetti G, Atzeni UO, Parisi A, Pizzi AR, Rosa M, Santelli F, Santilio F, Vagnini A, Casasco M, Di Luigi L (2007) Prevalence of abnormal electrocardiograms in a large, unselected population undergoing pre-participation cardiovascular screening. Eur Heart J 28:2006–2010. doi:10.1093/eurheartj/ehm219
Pelliccia A, Maron BJ, Culasso F, Di Paolo FM, Spataro A, Biffi A, Caselli G, Piovano P (2000) Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation 102:278–284
Rowin EJ, Maron BJ, Appelbaum E, Link MS, Gibson CM, Lesser JR, Haas TS, Udelson JE, Manning WJ, Maron MS (2012) Significance of false negative electrocardiograms in preparticipation screening of athletes for hypertrophic cardiomyopathy. Am J Cardiol 110:1027–1032. doi:10.1016/j.amjcard.2012.05.035
Baggish AL (2015) A decade of athlete ECG criteria: where we’ve come and where we’re going. J Electrocardiol 48:324–328. doi:10.1016/j.jelectrocard.2015.02.002
Baggish AL, Wood MJ (2011) Athlete’s heart and cardiovascular care of the athlete: scientific and clinical update. Circulation 123:2723–2735. doi:10.1161/circulationaha.110.981571
Uberoi A, Stein R, Perez MV, Freeman J, Wheeler M, Dewey F, Peidro R, Hadley D, Drezner J, Sharma S, Pelliccia A, Corrado D, Niebauer J, Estes NA 3rd, Ashley E, Froelicher V (2011) Interpretation of the electrocardiogram of young athletes. Circulation 124:746–757. doi:10.1161/circulationaha.110.013078
Sheikh N, Papadakis M, Ghani S, Zaidi A, Gati S, Adami PE, Carre F, Schnell F, Wilson M, Avila P, McKenna W, Sharma S (2014) Comparison of electrocardiographic criteria for the detection of cardiac abnormalities in elite black and white athletes. Circulation 129:1637–1649. doi:10.1161/circulationaha.113.006179
Koester MC (2001) A review of sudden cardiac death in young athletes and strategies for preparticipation cardiovascular screening. J Athl Train 36:197–204
Tan HL, Hofman N, van Langen IM, van der Wal AC, Wilde AA (2005) Sudden unexplained death: heritability and diagnostic yield of cardiological and genetic examination in surviving relatives. Circulation 112:207–213. doi:10.1161/circulationaha.104.522581
Hofer F, Fellmann F, Schlapfer J, Michaud K (2014) Sudden cardiac death in the young (5–39 years) in the canton of Vaud, Switzerland. BMC Cardiovasc Disord 14:140. doi:10.1186/1471-2261-14-140
Elger B, Michaud K, Mangin P (2010) When information can save lives: the duty to warn relatives about sudden cardiac death and environmental risks. Hastings Cent Rep 40:39–45
Campuzano O, Allegue C, Partemi S, Iglesias A, Oliva A, Brugada R (2014) Negative autopsy and sudden cardiac death. Int J Legal Med 128:599–606. doi:10.1007/s00414-014-0966-4
Semsarian C, Sweeting J, Ackerman MJ (2015) Sudden cardiac death in athletes. BMJ 350:h1218. doi:10.1136/bmj.h1218
Harmon KG, Asif IM, Klossner D, Drezner JA (2011) Incidence of sudden cardiac death in National Collegiate Athletic Association athletes. Circulation 123:1594–1600. doi:10.1161/circulationaha.110.004622
Maron BJ, Haas TS, Murphy CJ, Ahluwalia A, Rutten-Ramos S (2014) Incidence and causes of sudden death in U.S. college athletes. J Am Coll Cardiol 63:1636–1643. doi:10.1016/j.jacc.2014.01.041
Harmon KG, Asif IM, Maleszewski JJ, Owens DS, Prutkin JM, Salerno JC, Zigman ML, Ellenbogen R, Rao AL, Ackerman MJ, Drezner JA (2015) Incidence, cause, and comparative frequency of sudden cardiac death in National Collegiate Athletic Association athletes: a decade in review. Circulation 132:10–19. doi:10.1161/circulationaha.115.015431
Maron BJ (2003) Sudden death in young athletes. N Engl J Med 349:1064–1075. doi:10.1056/NEJMra022783
Maron BJ (1998) Cardiovascular risks to young persons on the athletic field. Ann Intern Med 129:379–386
Van Camp SP, Bloor CM, Mueller FO, Cantu RC, Olson HG (1995) Nontraumatic sports death in high school and college athletes. Med Sci Sports Exerc 27:641–647
Dores H, Freitas A, Malhotra A, Mendes M, Sharma S (2015) The hearts of competitive athletes: an up-to-date overview of exercise-induced cardiac adaptations. Rev Port Cardiol 34:51–64. doi:10.1016/j.repc.2014.07.010
White PD (1942) Bradycardia (below rate of 40) in athletes, especially in long distance runners. JAMA 120:642–642. doi:10.1001/jama.1942.02830430064025
Breuckmann F, Mohlenkamp S, Nassenstein K, Lehmann N, Ladd S, Schmermund A, Sievers B, Schlosser T, Jockel KH, Heusch G, Erbel R, Barkhausen J (2009) Myocardial late gadolinium enhancement: prevalence, pattern, and prognostic relevance in marathon runners. Radiology 251:50–57. doi:10.1148/radiol.2511081118
Basso C, Burke M, Fornes P, Gallagher PJ, de Gouveia RH, Sheppard M, Thiene G, van der Wal A (2008) Guidelines for autopsy investigation of sudden cardiac death. Virchows Arch 452:11–18. doi:10.1007/s00428-007-0505-5
Pelliccia A, Maron BJ, Spataro A, Proschan MA, Spirito P (1991) The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. N Engl J Med 324:295–301. doi:10.1056/nejm199101313240504
Sheppard MN (2012) Aetiology of sudden cardiac death in sport: a histopathologist’s perspective. Br J Sports Med 46(Suppl 1):i15–i21. doi:10.1136/bjsports-2012-091415
Martinez-Diaz F, Bernal-Gilar M, Gomez-Zapata M, Luna A (2004) Expression and significance of cell immunohistochemical markers (HHF-35, CD-31, Bcl-2, P-53 and apopDETEC) in hypertrophic cardiomyopathy. Histol Histopathol 19:9–14
Hellstrom M, Engstrom-Laurent A, Morner S, Johansson B (2012) Hyaluronan and collagen in human hypertrophic cardiomyopathy: a morphological analysis. Cardiol Res Pract 2012:545219. doi:10.1155/2012/545219
Kuusisto J, Karja V, Sipola P, Kholova I, Peuhkurinen K, Jaaskelainen P, Naukkarinen A, Yla-Herttuala S, Punnonen K, Laakso M (2012) Low-grade inflammation and the phenotypic expression of myocardial fibrosis in hypertrophic cardiomyopathy. Heart 98:1007–1013. doi:10.1136/heartjnl-2011-300960
La Gerche A, Robberecht C, Kuiperi C, Nuyens D, Willems R, de Ravel T, Matthijs G, Heidbuchel H (2010) Lower than expected desmosomal gene mutation prevalence in endurance athletes with complex ventricular arrhythmias of right ventricular origin. Heart 96:1268–1274. doi:10.1136/hrt.2009.189621
Munkholm J, Andersen CB, Ottesen GL (2015) Plakoglobin: a diagnostic marker of arrhythmogenic right ventricular cardiomyopathy in forensic pathology? Forensic Sci Med Pathol 11:47–52. doi:10.1007/s12024-014-9644-6
Basso C, Pilichou K, Thiene G (2013) Is it time for plakoglobin immune-histochemical diagnostic test for arrhythmogenic cardiomyopathy in the routine pathology practice? Cardiovasc Pathol 22:312–313. doi:10.1016/j.carpath.2013.06.001
Asimaki A, Tandri H, Huang H, Halushka MK, Gautam S, Basso C, Thiene G, Tsatsopoulou A, Protonotarios N, McKenna WJ, Calkins H, Saffitz JE (2009) A new diagnostic test for arrhythmogenic right ventricular cardiomyopathy. N Engl J Med 360:1075–1084. doi:10.1056/NEJMoa0808138
Yoshida T, Kawano H, Kusumoto S, Fukae S, Koga S, Ikeda S, Koide Y, Abe K, Hayashi T, Maemura K (2015) Relationships between clinical characteristics and decreased plakoglobin and connexin 43 expressions in myocardial biopsies from patients with arrhythmogenic right ventricular cardiomyopathy. Int Heart J 56:626–631. doi:10.1536/ihj.15-144
Siragam V, Cui X, Masse S, Ackerley C, Aafaqi S, Strandberg L, Tropak M, Fridman MD, Nanthakumar K, Liu J, Sun Y, Su B, Wang C, Liu X, Yan Y, Mendlowitz A, Hamilton RM (2014) TMEM43 mutation p.S358L alters intercalated disc protein expression and reduces conduction velocity in arrhythmogenic right ventricular cardiomyopathy. PLoS One 9:e109128. doi:10.1371/journal.pone.0109128
Kwon YS, Park TI, Cho Y, Bae MH, Kim S (2013) Clinical usefulness of immunohistochemistry for plakoglobin, N-cadherin, and connexin-43 in the diagnosis of arrhythmogenic right ventricular cardiomyopathy. Int J Clin Exp Pathol 6:2928–2935
Nasuti JF, Zhang PJ, Feldman MD, Pasha T, Khurana JS, Gorman JH 3rd, Gorman RC, Narula J, Narula N (2004) Fibrillin and other matrix proteins in mitral valve prolapse syndrome. Ann Thorac Surg 77:532–536. doi:10.1016/s0003-4975(03)01584-4
Rizzo S, Basso C, Lazzarini E, Celeghin R, Paolin A, Gerosa G, Valente M, Thiene G, Pilichou K (2015) TGF-beta1 pathway activation and adherens junction molecular pattern in nonsyndromic mitral valve prolapse. Cardiovasc Pathol 24:359–367. doi:10.1016/j.carpath.2015.07.009
Corrado D, Nava A, Buja G, Martini B, Fasoli G, Oselladore L, Turrini P, Thiene G (1996) Familial cardiomyopathy underlies syndrome of right bundle branch block, ST segment elevation and sudden death. J Am Coll Cardiol 27:443–448
James TN, Zipes DP, Finegan RE, Eisele JW, Carter JE (1979) Cardiac ganglionitis associated with sudden unexpected death. Ann Intern Med 91:727–730
Rizzo S, Basso C, Troost D, Aronica E, Frigo AC, Driessen AH, Thiene G, Wilde AA, van der Wal AC (2014) T-cell-mediated inflammatory activity in the stellate ganglia of patients with ion-channel disease and severe ventricular arrhythmias. Circ Arrhythm Electrophysiol 7:224–229. doi:10.1161/circep.113.001184
Basso C, Bauce B, Corrado D, Thiene G (2012) Pathophysiology of arrhythmogenic cardiomyopathy. Nat Rev Cardiol 9:223–233. doi:10.1038/nrcardio.2011.173
Angelini A, Crosato M, Boffa GM, Calabrese F, Calzolari V, Chioin R, Daliento L, Thiene G (2002) Active versus borderline myocarditis: clinicopathological correlates and prognostic implications. Heart 87:210–215
Angelini A, Calzolari V, Calabrese F, Boffa GM, Maddalena F, Chioin R, Thiene G (2000) Myocarditis mimicking acute myocardial infarction: role of endomyocardial biopsy in the differential diagnosis. Heart 84:245–250
Fineschi V, Baroldi G, Monciotti F, Paglicci Reattelli L, Turillazzi E (2001) Anabolic steroid abuse and cardiac sudden death: a pathologic study. Arch Pathol Lab Med 125:253–255. doi:10.1043/0003-9985(2001)125<0253:asaacs>2.0.co;2
Pelliccia A, Maron BJ, De Luca R, Di Paolo FM, Spataro A, Culasso F (2002) Remodeling of left ventricular hypertrophy in elite athletes after long-term deconditioning. Circulation 105:944–949
Pelliccia A, Culasso F, Di Paolo FM, Maron BJ (1999) Physiologic left ventricular cavity dilatation in elite athletes. Ann Intern Med 130:23–31
Abergel E, Chatellier G, Hagege AA, Oblak A, Linhart A, Ducardonnet A, Menard J (2004) Serial left ventricular adaptations in world-class professional cyclists: implications for disease screening and follow-up. J Am Coll Cardiol 44:144–149. doi:10.1016/j.jacc.2004.02.057
Mahon NG, Madden BP, Caforio AL, Elliott PM, Haven AJ, Keogh BE, Davies MJ, McKenna WJ (2002) Immunohistologic evidence of myocardial disease in apparently healthy relatives of patients with dilated cardiomyopathy. J Am Coll Cardiol 39:455–462
Burke A, Mont E, Kutys R, Virmani R (2005) Left ventricular noncompaction: a pathological study of 14 cases. Hum Pathol 36:403–411. doi:10.1016/j.humpath.2005.02.004
Arbustini E, Weidemann F, Hall JL (2014) Left ventricular noncompaction: a distinct cardiomyopathy or a trait shared by different cardiac diseases? J Am Coll Cardiol 64:1840–1850. doi:10.1016/j.jacc.2014.08.030
Gati S, Chandra N, Bennett RL, Reed M, Kervio G, Panoulas VF, Ghani S, Sheikh N, Zaidi A, Wilson M, Papadakis M, Carre F, Sharma S (2013) Increased left ventricular trabeculation in highly trained athletes: do we need more stringent criteria for the diagnosis of left ventricular non-compaction in athletes? Heart 99:401–408. doi:10.1136/heartjnl-2012-303418
Chaowu Y, Li L, Shihua Z (2011) Histopathological features of delayed enhancement cardiovascular magnetic resonance in isolated left ventricular noncompaction. J Am Coll Cardiol 58:311–312. doi:10.1016/j.jacc.2011.02.053
Pujadas S, Bordes R, Bayes-Genis A (2005) Ventricular non-compaction cardiomyopathy: CMR and pathology findings. Heart 91:582. doi:10.1136/hrt.2004.041327
Hertz CL, Christiansen SL, Ferrero-Miliani L, Dahl M, Weeke PE, Ottesen GL, Frank-Hansen R, Bundgaard H, Morling N (2016) Next-generation sequencing of 100 candidate genes in young victims of suspected sudden cardiac death with structural abnormalities of the heart. Int J Legal Med 130:91–102. doi:10.1007/s00414-015-1261-8
Papadakis M, Raju H, Behr ER, De Noronha SV, Spath N, Kouloubinis A, Sheppard MN, Sharma S (2013) Sudden cardiac death with autopsy findings of uncertain significance: potential for erroneous interpretation. Circ Arrhythm Electrophysiol 6:588–596. doi:10.1161/circep.113.000111
Michaud K, Mangin P, Elger BS (2011) Genetic analysis of sudden cardiac death victims: a survey of current forensic autopsy practices. Int J Legal Med 125:359–366. doi:10.1007/s00414-010-0474-0
Stattin EL, Westin IM, Cederquist K, Jonasson J, Jonsson BA, Morner S, Norberg A, Krantz P, Wisten A (2016) Genetic screening in sudden cardiac death in the young can save future lives. Int J Legal Med 130:59–66. doi:10.1007/s00414-015-1237-8
Kauferstein S, Kiehne N, Peigneur S, Tytgat J, Bratzke H (2013) Cardiac channelopathy causing sudden death as revealed by molecular autopsy. Int J Legal Med 127:145–151. doi:10.1007/s00414-012-0679-5
Wilhelm M, Bolliger SA, Bartsch C, Fokstuen S, Grani C, Martos V, Medeiros Domingo A, Osculati A, Rieubland C, Sabatasso S, Saguner AM, Schyma C, Tschui J, Wyler D, Bhuiyan ZA, Fellmann F, Michaud K (2015) Sudden cardiac death in forensic medicine—Swiss recommendations for a multidisciplinary approach. Swiss Med Wkly 145:w14129. doi:10.4414/smw.2015.14129
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Angel Carracedo and Ramon Brugada are co-senior authors.
Antonio Oliva, Vincenzo M. Grassi and Oscar Campuzano contributed equally to this work.
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Oliva, A., Grassi, V.M., Campuzano, O. et al. Medico-legal perspectives on sudden cardiac death in young athletes. Int J Legal Med 131, 393–409 (2017). https://doi.org/10.1007/s00414-016-1452-y
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DOI: https://doi.org/10.1007/s00414-016-1452-y