In Vivo Detection of Coronary Artery Anomalies in Asymptomatic Athletes by Echocardiographic Screening

¹ From the Centro Studi di Medicina dello Sport, Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Roma, Italy
² From the Centro Studi di Medicina dello Sport, the Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy
³ From the Centro Studi di Medicina dello Sport, the Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Roma, Italy
⁴ From the Centro Studi di Medicina dello Sport, the Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma, Italy

Background: Anomalous origin of coronary arteries (AOCA) is a rare congenital disease. Although it may have a benign course, it has been identified as a frequent cause of sports-related sudden death. Unfortunately, in vivo detection of AOCA is not easy, as individuals with this anomaly often are asymptomatic and show no signs of myocardial ischemia. Presently, transthoracic two-dimensional echocardiography (TTE) is the only noninvasive, widely available tool to visualize the ostia and first tracts of coronary arteries.

Objective: To assess the efficacy of TTE in the screening of AOCA in a large athletic population.

Study design: In a prospective study, we assessed the ostia and first tracts of coronary arteries in 3,650 subjects (mean age, 30±12 years) practicing different sports at various competitive levels. Subjects underwent a TTE examination in our laboratory for scientific or diagnostic purposes.

Results: Technically satisfactory echocardiograms were obtained in 3,504 subjects (96%); a clear visualization of the ostia and first tracts of both coronary arteries was obtained in 3,150 cases (90%). Three asymptomatic athletes (0.09%) were suspected to have an AOCA; two with a right coronary artery origin from the left sinus, and one with a left coronary artery origin from the right sinus. Diagnosis was confirmed by coronary angiography.

Conclusions: Our study indicated that AOCA is rare in asymptomatic athletes. Systematic and accurate exploration of coronary anatomy in athletes referred for a diagnostic TTE examination may be useful in identifying those with AOCA.

Key Words: anomalous origin of coronary artery • athletes • echocardiography • sudden death

Submitted on September 26, 1997
Accepted on January 22, 1998

This article has been cited by other articles:

				P. C. Frommelt, M. A. Frommelt, J. S. Tweddell, and R. D. B. Jaquiss Prospective echocardiographic diagnosis and surgical repair of anomalous origin of a coronary artery from the opposite sinus with an interarterial course J. Am. Coll. Cardiol., July 2, 2003; 42(1): 148 - 154. [Abstract] [Full Text] [PDF]

				F. Colivicchi, F. Ammirati, and M. Santini Syncope and Coronary Anomalies: Reply Eur. Heart J., February 1, 2003; 24(3): 289 - 289. [Full Text] [PDF]

				J. A. Davis, F. Cecchin, T. K. Jones, and M. A. Portman Major coronary artery anomalies in a pediatric population: incidence and clinical importance J. Am. Coll. Cardiol., February 1, 2001; 37(2): 593 - 597. [Abstract] [Full Text] [PDF]

				A. Pelliccia Congenital coronary artery anomalies in young patients: New perspectives for timely identification J. Am. Coll. Cardiol., February 1, 2001; 37(2): 598 - 600. [Full Text] [PDF]

				C. Basso, B. J. Maron, D. Corrado, and G. Thiene 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., May 1, 2000; 35(6): 1493 - 1501. [Abstract] [Full Text] [PDF]

				A. M. Taylor, S. A. Thorne, M. B. Rubens, P. Jhooti, J. Keegan, P. D. Gatehouse, F. Wiesmann, F. Grothues, J. Somerville, and D. J. Pennell Coronary Artery Imaging in Grown Up Congenital Heart Disease : Complementary Role of Magnetic Resonance and X-Ray Coronary Angiography Circulation, April 11, 2000; 101(14): 1670 - 1678. [Abstract] [Full Text] [PDF]