Copyright © 2002 by the European Society of Cardiology.
Exercise-related syncope in young competitive athletes without evidence of structural heart disease. Clinical presentation and long-term outcome
a Division of Cardiology, ‘S. Filippo Neri’ Hospital, Rome, Italy
b Institute of Sports Science, Department of Medicine, Italian National Olympic Committee, Rome, Italy
revised October 5, 2001; accepted October 10, 2001
Abstract
Aims Exercise-related syncopal spells in athletes receive great attention and are a source of anxiety in the sporting world. The aim of the present study is to describe the clinical presentation, the yield of the initial diagnostic work-up and the long-term outcome of a series of consecutive competitive athletes with recurrent exercise-related syncopal spells.
Methods and Results The study cohort included 33 athletes (20 females, mean age 21·4±3·2 years) referred for recurrent unexplained episodes of exercise-related syncope (mean number of spells before evaluation 4·66±1·97). All athletes underwent an extensive evaluation, including echocardiography, 24-h electrocardiographic monitoring, exercise testing, cardiac electrophysiological study and head-up tilt testing. The echocardiographic examination revealed the presence of a mitral valve prolapse in two cases (6·0%). During maximal exercise testing, four athletes (12·1%) developed hypotension associated with pre-syncope. Twenty-two subjects (66·6%) showed a positive response to head-up tilt testing. During follow-up (33·5±17·2 months) 11/33 athletes (33·3%) showed at least one recurrence of exercise-related syncope (mean time to first recurrence 20·4±14·5 months). No other adverse event of any kind was noted during follow-up. The Kaplan–Meier estimates of first recurrence of exercise-related syncope after 12, 36 and 60 months were 9·1%, 24·4% and 42·9%. The number and frequency of exercise-related syncopal spells before evaluation were found to be univariate predictors of syncope recurrence (P<0·001). However, in the multivariate analysis, the number of exercise-related syncopal spells before evaluation was found to be the only independent predictor of syncope recurrence (P<0·05).
Conclusions These findings support the idea that recurrent exercise related-syncope is not associated with an adverse outcome in athletes without cardiac disease. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.
Key Words: Syncope, exercise, athletes
f1 Correspondence: Dott. Furio Colivicchi, Dipartimento per le Malattie Cardiovascolari, Ospedale ‘S. Filippo Neri, Viale Gorgia da Leontini, 330, 00124, Rome, Italy.
References
- Maron BJ, Mitchell JH. Revised eligibility recommendations for competitive athletes with cardiovascular abnormalities. J Am Coll Cardiol. 1994;24:848–850[Web of Science][Medline]
- Maron BJ. Sudden death in young athletes: lessons from the Hank Gaithers affair. N Engl J Med. 1993;329:55–57
[Free Full Text] - O'Connor F, Oriscello RG, Levine BD. Exercise-related syncope in the young athlete: reassurance, restriction or referral. Am Fam Physician. 1999;60:2001–2008[Web of Science][Medline]
- Kosinski DJ. Syncope in the athlete. Grubb BP, Olshansky B. Syncope: mechanisms and management. Armonk: Futura Publishing; 1998. p. 317–335
- Hangarten KH. Syncope in athletes. Life-threatening or benign. Phys Sportsmed. 1991;19:33–36
- Cantwell JD, Varughese A, Pettus CW. Cardiovascular syncope. Which patients can resume exercise? Phys Sportsmed. 1992;20:81–92
- Grubb BP, Temesey-Armos PN, Samoil D, Wolfe DA, Hahn H, Elliott L. Tilt table testing in the evaluation and management of athletes with recurrent exercise-induced syncope. Med Sci Sport Exerc. 1993;25:24–28[CrossRef][Web of Science][Medline]
- Calkins H, Seifert M, Morady F. Clinical presentation and long-term follow-up of athletes with exercise-induced vasodepressor syncope. Am Heart J. 1995;129:1159–1164[CrossRef][Web of Science][Medline]
- Hung-Fat T, Chu-Pak L. Exercise-associated cardiac asystole in persons without heart disease. Chest. 1995;107:572–576
[Abstract/Free Full Text] - Kosinski D, Grubb BP, Kip K, Hahn H. Exercise-induced neurocardiogenic syncope. Am Heart J. 1996;132:451–452[CrossRef][Web of Science][Medline]
- Kosinski D, Grubb BP, Karas BJ, Frederick S. Exercise-induced neurocardiogenic syncope. Clinical data, pathophysiological aspects, and potential role of tilt table testing. Europace. 2000;2:77–82
[Abstract/Free Full Text] - Kapoor WN. Work-up and management of patients with syncope. Med Clin North Am. 1995;79:1153–1170[Web of Science][Medline]
- Ammirati F, Colivicchi F, Biffi A, Magris B, Pandozi C, Santini M. Head-up tilt testing potentiated with low-dose sublingual isosorbide dinitrate: a simplified time-saving approach for the evaluation of unexplained syncope. Am Heart J. 1998;135:671–676[CrossRef][Web of Science][Medline]
- Kapoor WN, Smith M, Miller NL. Upright tilt testing in evaluating syncope: a comprehensive literature review. Am J Med. 1994;97:78–88[CrossRef][Web of Science][Medline]
- Ammirati F, Colivicchi F, Di Battista G, Fiume Garelli F, Santini M. Electroencephalographic correlates of vasovagal syncope induced by head-up tilt testing. Stroke. 1998;29:2347–2351
[Abstract/Free Full Text] - Decree of the Italian Ministry of Health, February 18, 1982. Norme per la tutela sanitaria della attività sportiva agonistica, March 5, 1985, 1715, 19
- Grimm W, Degenhardt M, Hoffman J, Menz V, Wirths A, Maisch B. Syncope recurrence can better be predicted by history than head-up tilt testing in untreated patients with suspected neurally meduated syncope. Eur Heart J. 1997;18:1465–1469
[Abstract/Free Full Text] - Benditt DG, Ferguson DW, Grubb BP. ACC expert consensus document: tilt table testing for assessing syncope. J Am Coll Cadiol. 1996;28:263–275[CrossRef][Web of Science][Medline]
- Zipes DP, Di Marco JP, Gillette PG, Jackman WM, Myerburg RJ, Rahimtoola SH. ACC/AHA Guidelines for Clinical Intracardiac Electrophysiological and Catheter Ablation Procedures. Circulation. 1995;92:673–691
- Josephson ME, Schibgilla VH. Athletes and arrhythmias: clinical considerations and perspectives. Eur Heart J. 1996;17:498–509
[Free Full Text]
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. Brignole, J.-J. Blanc, R. Sutton, and A. Moya CHAPTER 26 Syncope ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. D Esperer, O. Hoos, and K. Hottenrott Syncope due to Brugada syndrome in a young athlete Br. J. Sports Med., March 1, 2007; 41(3): 180 - 181. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Colivicchi, F. Ammirati, and M. Santini Epidemiology and prognostic implications of syncope in young competing athletes Eur. Heart J., October 1, 2004; 25(19): 1749 - 1753. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G Whyte, N Stephens, R Budgett, S Sharma, R E Shave, and W J McKenna Exercise induced neurally mediated syncope in an elite rower: a treatment dilemma Br. J. Sports Med., February 1, 2004; 38(1): 84 - 85. [Full Text] [PDF]
|
|
|
|
 |
|
 Guidelines on Management (diagnosis and treatment) of syncope - update 2004: The Task Force on Syncope, European Society of Cardiology Europace, January 1, 2004; 6(6): 467 - 537. [Full Text] [PDF]
|
|
|
|
|
|
S Firoozi, E Behr, and W McKenna Elite athletes with recurrent ERS Eur. Heart J., April 2, 2003; 24(8): 783 - 783. [Full Text] [PDF]
|
|
|
|
|
|
F. Colivicchi, F. Ammirati, and M. Santini Rescue therapy for failed thrombolysis. Eur. Heart J., April 1, 2003; 24(8): 784 - 785. [Full Text] [PDF]
|
|
|
|
|
|
R. Barriales-Villa and C. Moris Syncope and coronary anomalies Eur. Heart J., February 1, 2003; 24(3): 289 - 289. [Full Text] [PDF]
|
|
|
|
 |
|
 Syncope in Athletes Journal Watch Emergency Medicine, September 25, 2002; 2002(925): 12 - 12. [Full Text]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||