Exercise-induced intraventricular pressure gradient may be the cause of sudden cardiac death in patients with unknown cardiac disease

Abstract

Sudden cardiac death (SCD) is a tragedy at any age and under any circumstances, but it is especially poignant, and fortunately very rare, when it takes the life of an athlete, a person who represents health and a healthy lifestyle. Sports cardiologists worldwide have worked to quantify the incidence of SCD in athletes, identify risk factors, develop pre-participation screening tools, and formulate plans to address on-field SCD. While progress has been made, there is still much to do to make both competitive and recreational sports safer for individuals with known cardiac disease and athletes without known or suspected cardiac abnormalities.

We recently published the case of an athlete who practices triathlon and underwent medical evaluation after an episode of aborted sudden death. The complete diagnostic workup including a complete genetic study for myocardiopathy had normal results. An exercise stress echocardiogram (ESE) was finally performed during which he developed a significant intraventricular pressure gradient (IVPG) − a possible cause of ischemia − over 100 mmHg with an end-systolic peak at the end of exercise that was associated with frequent premature ventricular complexes.

We hypothesize the possible role of ESE for IVPG assessment in athletes who have unexplained symptoms related to exercise or aborted sudden death. In our opinion, it should be considered useful and used by routine to improve the clinical approach of this group of patients, detecting possible high-risk athletes.