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.
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