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Cardiovascular diseases in Paralympic athletes
  1. Antonio Pelliccia1,
  2. Filippo M Quattrini1,
  3. Maria Rosaria Squeo1,
  4. Stefano Caselli1,
  5. Franco Culasso2,
  6. Mark S Link3,
  7. Antonio Spataro1,
  8. Marco Bernardi2,4
  1. 1Institute of Sport Medicine and Science, Rome, Italy
  2. 2Department of Human Physiology and Pharmacology, University Sapienza, Rome, Italy
  3. 3TUFTS Medical Center, Boston, Massachusetts, USA
  4. 4Italian Paralympic Committee, Rome, Italy
  1. Correspondence to Dr Antonio Pelliccia, Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, Rome 00197, Italy; antonio.pelliccia{at}coni.it

Abstract

Background Sport participation (SP) of individuals with impairments has recently grown exponentially. Scarce scientific data, however, exist regarding cardiovascular (CV) risk associated with competitive SP.

Objective Assessing the prevalence of CV abnormalities and the risk for SP in Paralympic athletes (PA).

Methods PA (n=267; 76% men), aged 35±9 years, engaged in 18 sport disciplines, with a spectrum of lesions including: spinal cord injury (paraplegia and spina bifida) (n=116); amputation, poliomyelitis, cerebral palsy and other neuromuscular and/or skeletal disorders (Les autres) or visual impairment (n=151) entered the study. CV evaluation included history, PE, 12-lead and exercise ECG, echocardiography. Of these, 105 participated in ≥2 consecutive games, and had evaluations available over a 6±4 year follow-up.

Results Structural CV abnormalities were identified in 33 athletes (12%), including arrhythmogenic cardiomyopathies in 3, aortic root dilation in 3, valvular diseases in 7 (mitral valve prolapse in 4, bicuspid aortic valve in 3) and systemic hypertension in 11 (4%). In addition, ventricular (polymorphic, couplets or non-sustained ventricular tachycardia) or supraventricular tachyarrhythmias (atrial flutter, paroxysmal atrial fibrillation or SVT) were identified in 9 others. Over a 6-year follow-up, 6 of the 105 athletes (6%) developed CV diseases, including dilated cardiomyopathy in 1 and systemic hypertension in 5.

Conclusions PA present an unexpected high prevalence of CV abnormalities (12%), including a non-trivial proportion of diseases at risk for sudden death (2%), such as arrhythmogenic cardiomyopathies and dilated aortic root. This observation suggests that tailored recommendations for preparticipation screening and safe SP in this special athletic population are timely and appropriate.

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