Research Progress on Sport-Related Sudden Cardiac Death

doi:10.12116/j.issn.1004-5619.2021.410407

Abstract

Abstract:

Physical exercise can reduce the overall risk of cardiovascular disease, prolong lifespan and improve the quality of life, but some studies have shown that there is a certain correlation between vigorous physical exercise and sudden cardiac death. A number of retrospective or prospective studies on sports-related sudden cardiac death （SrSCD） have been conducted at home and abroad. This article reviews the related studies on the definition, epidemiological characteristics, common causes of SrSCD and effects of excercise on cardiovascular function, pre-exercise screening and evaluation of SrSCD, in order to understand the latest research progress on SrSCD and provide clues and references for SrSCD research.

Key words: forensic pathology, sport-related sudden cardiac death, exercise, review

CLC Number:

DF795.1

Cheng-dong MA, Qiu-ping WU, Qian-hao ZHAO, Zhi-qiang ZHAO, Kun YIN, Nan ZHOU, Sai-qun WU, Jian-ding CHENG. Research Progress on Sport-Related Sudden Cardiac Death[J]. Journal of Forensic Medicine, 2022, 38(5): 618-624.

Figures/Tables 1

References 58

1	WU N N， TIAN H L， CHEN P J， et al. Physical exercise and selective autophagy： Benefit and risk on cardiovascular health[J]. Cells，2019，8（11）：1436. doi：10.3390/cells8111436 .
2	DE NORONHA S V， SHARMA S， PAPADAKIS M， et al. Aetiology of sudden cardiac death in athletes in the United Kingdom： A pathological study[J]. Heart Br Cardiac Soc，2009，95（17）：1409-1414. doi：10.1136/hrt.2009.168369 .
3	MARIJON E， TAFFLET M， CELERMAJER D S， et al. Sports-related sudden death in the general population[J]. Circulation，2011，124（6）：672-681. doi：10.1161/CIRCULATIONAHA.110.008979 .
4	BAUMAN A E. Updating the evidence that physical activity is good for health： An epidemiological review 2000—2003[J]. J Sci Med Sport，2004，7（1）：6-19. doi：10.1016/S1440-2440（04）80273-1 .
5	BERNARDO B C， OOI J Y Y， WEEKS K L， et al. Understanding key mechanisms of exercise-induced cardiac protection to mitigate disease： Current knowledge and emerging concepts[J]. Physiol Rev，2018，98（1）：419-475. doi：10.1152/physrev.00043. 2016 .
6	AREM H， MOORE S C， PATEL A， et al. Leisure time physical activity and mortality： A detailed pooled analysis of the dose-response relationship[J]. JAMA Intern Med，2015，175（6）：959-967. doi：10.1001/jamainternmed.2015.0533 .
7	SOLBERG E E， GJERTSEN F， HAUGSTAD E， et al. Sudden death in sports among young adults in Norway[J]. Eur J Cardiovasc Prev Rehabil，2010，17（3）：337-341. doi：10.1097/HJR.0b013e328332f8f7 .
8	STOCKMAN J. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program[J]. Yearb Pediatr，2008，2008：220-222. doi：10.1016/S0084-3954 %2808%2970398-1.
9	EIJSVOGELS T M H， FERNANDEZ A B， THOMPSON P D. Are there deleterious cardiac effects of acute and chronic endurance exercise?[J]. Physiol Rev，2016，96（1）：99-125. doi：10.1152/physrev.00029. 2014 .
10	丛斌. 法医病理学[M].5版.北京：人民卫生出版社，2016：375.
	CONG B. Forensic pathology[M]. 5th ed. Beijing： People’s Medical Publishing House，2016：375.
11	成建定，刘超. 猝死法医病理学[M].广州：中山大学出版社，2015：2.
	CHENG J D， LIU C. Forensic pathology of sudden death[M]. Guangzhou： Sun Yat-sen University Press，2015：2.
12	MORENTIN B， SUÁREZ-MIER M P， MONZÓ A， et al. Sports-related sudden cardiac death due to myocardial diseases on a population from 1-35 years： A multicentre forensic study in Spain[J]. Forensic Sci Res，2019，4（3）：257-266. doi：10.1080/20961790.2019.1633729 .
13	HOLST A G， WINKEL B G， THEILADE J， et al. Incidence and etiology of sports-related sudden cardiac death in Denmark—Implications for preparticipation screening[J]. Heart Rhythm，2010，7（10）：1365-1371. doi：10.1016/j.hrthm.2010.05.021 .
14	BOHM P， SCHARHAG J， EGGER F， et al. Sports-related sudden cardiac arrest in Germany[J]. Can J Cardiol，2021，37（1）：105-112. doi：10.1016/j.cjca.2020.03.021 .
15	ALLOUCHE M， BOUDRIGA N， AHMED H B， et al. Sudden death during sport activity in Tunisia： Autopsy study in 32 cases[J]. Ann Cardiol Angeiolo （Paris），2013，62（2）：82-88. doi：10.1016/j.ancard.2012.08.030 .
16	CORRADO D， BASSO C， RIZZOLI G， et al. Does sports activity enhance the risk of sudden death in adolescents and young adults?[J]. J Am Coll Cardiol，2003，42（11）：1959-1963. doi：10.1016/j.jacc.2003.03.002 .
17	GRÄNI C， CHAPPEX N， FRACASSO T， et al. Sports-related sudden cardiac death in Switzerland classified by static and dynamic components of exercise[J]. Eur J Prev Cardiol，2020，23（11）：1228-1236. doi：10.1177/2047487316632967 .
18	CHAPPEX N， SCHLAEPFER J， FELLMANN F， et al. Sudden cardiac death among general population and sport related population in forensic experience[J]. J Forensic Leg Med，2015，35：62-68. doi：10.1016/j.jflm.2015.07.004 .
19	TORELL M F， STRÖMSÖE A， ZAGERHOLM E， et al. Higher survival rates in exercise-related out-of-hospital cardiac arrests， compared to non-exercise-related–a study from the Swedish Register of Cardiopulmonary Resuscitation[J]. Eur J Prev Cardiolog，2017，24（15）：1673-1679. doi：10.1177/2047487317 729251 .
20	NIEBAUER J， BURTSCHER M. Sudden cardiac death risk in downhill skiers and mountain hikers and specific prevention strategies[J]. Int J Environ Res Public Heal，2021，18（4）：1621. doi：10.3390/ijerph18041621 .
21	MARIJON E， UY-EVANADO A， REINIER K， et al. Sudden cardiac arrest during sports activity in middle age[J]. Circulation，2015，131（16）：1384-1391. doi：10.1161/CIRCULATIONAHA.114.011988 .
22	HARMON K G， ZIGMAN M， DREZNER J A. The effectiveness of screening history， physical exam， and ECG to detect potentially lethal cardiac disorders in athletes： A systematic review/meta-analysis[J]. J Electrocardiol，2015，48（3）：329-338. doi：10.1016/j.jelectrocard.2015.02.001 .
23	MARON B J， DOERER J J， HAAS T S， et al. Sudden deaths in young competitive athletes： Analysis of 1866 deaths in the United States，1980-2006[J]. Circulation，2009，119（8）：1085-1092. doi：10.1161/CIRCULATIONAHA.108.804617 .
24	HARMON K G， ASIF I M， MALESZEWSKI J J， et al. Incidence and etiology of sudden cardiac arrest and death in high school athletes in the United States[J]. Mayo Clin Proc，2016，91（11）：1493-1502. doi：10.1016/j.mayocp.2016.07.021 .
25	SWEETING J， SEMSARIAN C. Sudden cardiac death in athletes[J]. Heart Lung Circ，2018，27（9）：1072-1077. doi：10.1016/j.hlc.2018.03.026 .
26	CORRADO D， PELLICCIA A， BJØRNSTAD H H， et al. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death： Proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology[J]. Eur Heart J，2005，26（5）：516-524. doi：10.1093/eurheartj/ehi108 .
27	FINOCCHIARO G， PAPADAKIS M， ROBERTUS J L， et al. Etiology of sudden death in sports： Insights from a united kingdom regional registry[J]. J Am Coll Cardiol，2016，67（18）：2108-2115. doi：10.1016/j.jacc.2016.02.062 .
28	THIENE G， RIZZO S， SCHIAVON M， et al. Structurally normal hearts are uncommonly associated with sudden deaths in athletes and young people[J]. J Am Coll Cardiol，2019，73（23）：3031-3032. doi：10.1016/j.jacc.2019.03.497 .
29	吴卫兵，苏剑清，王继红，等. 我国大学生运动猝死特征规律及现场急救现状研究——基于近十年大学运动猝死案例调查[J].成都体育学院学报，2019，45（3）：100-104. doi：10.15942/j.jcsu.2019.03.016 .
	WU W B， SU J Q， WANG J H， et al. Characteristics and first-aid analysis of exercise-related sudden death among college students in China—Survey of exercise-related sudden death cases based on the last ten years[J]. Chengdu Tiyu Xueyuan Xuebao，2019，45（3）：100-104.
30	盛祥梅，王世强，肖刚，等. 马拉松运动的心脏风险、猝死及防范策略[J].现代预防医学，2021，48（6）：1065-1068.
	SHENG X M， WANG S Q， XIAO G， et al. Cardiac risk， sudden death and prevention strategy of marathon[J]. Xiandai Yufang Yixue，2021，48（6）：1065-1068.
31	TURK E E， RIEDEL A， PÜESCHEL K. Natural and traumatic sports-related fatalities： A 10-year retrospective study[J]. Br J Sports Med，2008，42（7）：604-608. doi：10.1136/bjsm.2007.038505 .
32	SOLLAZZO F， PALMIERI V， GERVASI S F， et al. Sudden cardiac death in athletes in Italy during 2019： Internet-based epidemiological research[J]. Medicina，2021，57（1）：61. doi：10.3390/medicina 57010061 .
33	PETERSON D F， SIEBERT D M， KUCERA K L， et al. Etiology of Sudden Cardiac Arrest and Death in US Competitive Athletes： A 2-Year Prospective Surveillance Study[J]. Clin J Sport Med，2020，30（4）：305-314. doi：10.1097/jsm.0000000000000598 .
34	HARMON K G， ASIF I M， MALESZEWSKI J J， et al. Incidence， cause， and comparative frequency of sudden cardiac death in national collegiate athletic association athletes[J]. Circulation，2015，132（1）：10-19. doi：10.1161/circulationaha.115.015431 .
35	潘怡雯，刘成，刘兰娟，等. 我国高校大学生校内非创伤性运动意外死亡事件诱因识别研究[J].首都体育学院学报，2019，31（3）：281-288. doi：10.14036/j.cnki.cn11-4513.2019.03.017 .
	PAN Y W， LIU C， LIU L J， et al. Research on inducement identification of non-traumatic sports accidental death of college students in China[J]. Shoudu Tiyu Xueyuan Xuebao，2019，31（3）：281-288.
36	ANGELINI P， MUTHUPILLAI R， CHEONG B， et al. We have plenty of reasons to propose new， updated policies for preventing sudden cardiac death in young athletes[J]. J Am Heart Assoc，2020，9（8）：e014368. doi：10.1161/JAHA.119. 014368 .
37	KESSLER K M. Triggering of sudden death from cardiac causes by vigorous exertion[J]. N Engl J Med，2001，344（11）：854-855. doi：10.1056/nejm2001 03153441114 .
38	DAWSON E， GEORGE K， SHAVE R， et al. Does the human heart fatigue subsequent to prolonged exercise?[J]. Sports Med Auckl N Z，2003，33（5）：365-380. doi：10.2165/00007256-200333050-00003 .
39	O’HANLON R， GRASSO A， ROUGHTON M， et al. Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy[J]. J Am Coll Cardiol，2010，56（11）：867-874. doi：10.1016/j.jacc.2010. 05.010 .
40	MIDDLETON N， SHAVE R， GEORGE K， et al. Left ventricular function immediately following prolonged exercise： A meta-analysis[J]. Med Sci Sports Exerc，2006，38（4）：681-687. doi：10.1249/01.mss.0000210203.10200.12 .
41	LA GERCHE A， BURNS A T， MOONEY D J， et al. Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes[J]. Eur Heart J，2011，33（8）：998-1006. doi：10.1093/eurheartj/ehr397 .
42	MCCRORY P. Myocardial injury and ventricular dysfunction related to training levels among nonelite participants in the Boston marathon[J]. Yearb Sports Med，2008，2008：183-184. doi：10.1016/S0162-0908 %2808%2979259-6.
43	LA GERCHE A， HEIDBÜCHEL H， BURNS A T， et al. Disproportionate exercise load and remodeling of the athlete’s right ventricle[J]. Med Sci Sports Exerc，2011，43（6）：974-981. doi：10.1249/MSS.0b013e31820607a3 .
44	SHARMA S， MERGHANI A， MONT L. Exercise and the heart： The good， the bad， and the ugly[J]. Eur Heart J，2015，36（23）：1445-1453. doi：10.1093/eurheartj/ehv090 .
45	POWERS S K， JACKSON M J. Exercise-induced oxidative stress： Cellular mechanisms and impact on muscle force production[J]. Physiol Rev，2008，88（4）：1243-1276. doi：10.1152/physrev.00031.2007 .
46	VEGA R B， KONHILAS J P， KELLY D P， et al. Molecular mechanisms underlying cardiac adaptation to exercise[J]. Cell Metab，2017，25（5）：1012-1026. doi：10.1016/j.cmet.2017.04.025 .
47	PUIGSERVER P， WU Z D， PARK C W， et al. A cold-inducible coactivator of nuclear receptors linked to adaptive thermogenesis[J]. Cell，1998，92（6）：829-839. doi：10.1016/S0092-8674（00）81410-5 .
48	RIEHLE C， WENDE A R， ZHU Y， et al. Insulin receptor substrates are essential for the bioenergetic and hypertrophic response of the heart to exercise training[J]. Mol Cell Biol，2014，34（18）：3450-3460. doi：10.1128/MCB.00426-14 .
49	SCARPULLA R C， VEGA R B， KELLY D P. Transcriptional integration of mitochondrial biogenesis[J]. Trends Endocrinol Metab，2012，23（9）：459-466. doi：10.1016/j.tem.2012.06.006 .
50	BOSTRÖM P， MANN N， WU J， et al. C/EBPβ controls exercise-induced cardiac growth and protects against pathological cardiac remodeling[J]. Cell，2010，143（7）：1072-1083. doi：10.1016/j.cell. 2010.11.036 .
51	MUTHUSAMY V R， KANNAN S， SADHAASIVAM K， et al. Acute exercise stress activates Nrf2/ARE signaling and promotes antioxidant mechanisms in the myocardium[J]. Free Radic Biol Med，2012，52（2）：366-376. doi：10.1016/j.freeradbiomed.2011.10.440 .
52	SOCI U P R， FERNANDES T， HASHIMOTO N Y， et al. microRNAs 29 are involved in the improvement of ventricular compliance promoted by aerobic exercise training in rats[J]. Physiol Genom，2011，43（11）：665-673. doi：10.1152/physiolgenomics.00145.2010 .
53	LIU X J， XIAO J J， ZHU H， et al. miR-222 is necessary for exercise-induced cardiac growth and protects against pathological cardiac remodeling[J]. Cell Metab，2015，21（4）：584-595. doi：10.1016/j.cmet.2015.02.014 .
54	MARON B J， ZIPES D P， KOVACS R J， et al. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities： Preamble， principles， and general considerations： A scientific statement from the American heart association and American college of cardiology[J]. Circulation，2015，132（22）：e256-e261. doi：10.1161/CIR. 0000000000000236 .
55	DREZNER J A. 18 highlights from the International Criteria for ECG interpretation in athletes[J]. Br J Sports Med，2020，54（4）：197-199. doi：10.1136/bjsports-2019-101537 .
56	马云，梁辰，牟秀霞，等. 中国优秀运动员运动性猝死三级预防筛查体系的研究[J].中国运动医学杂志，2011，30（3）：219-223，229. doi：10.16038/j.1000-6710.2011.03.011 .
	MA Y， LIANG C， MOU X X， et al. Three-grade screening system for the prevention of sudden cardiac death in elite Chinese athletes[J]. Zhongguo Yundong Yixue Zazhi，2011，30（3）：219-223，229.
57	GALDERISI M， CARDIM N， D’ANDREA A， et al. The multi-modality cardiac imaging approach to the Athlete’s heart： An expert consensus of the European Association of Cardiovascular Imaging[J]. Eur Heart J Cardiovasc Imaging，2015，16（4）：353-353r. doi：10.1093/ehjci/jeu323 .
58	ANGELINI P， MUTHUPILLAI R， LOPEZ A， et al. Young athletes： Preventing sudden death by adopting a modern screening approach? A critical review and the opening of a debate[J]. IJC Heart Vasc，2021，34：100790. doi：10.1016/j.ijcha.2021.100790 .

国家（地区）	研究类型	研究时段	纳入研究病例数	运动员人数	非运动员人数	年龄分布/岁	总体年均发生率 /（人·10万）^-1	运动员年均发生率 /（人·10万）^-1	非运动员年均发生率 /（人·10万）^-1	参考文献
意大利（威内托）	前瞻	1979—2004年	320	55	265	12~35	-	1.90	0.79	[16]
美国	回顾	1980—2006年	1 866	1 049	-	8~39	-	0.61	-	[23]
挪威	回顾	1990—1997年	23	-	23	17~34	0.90	-	-	[7]
丹麦	回顾	2000—2006年	15	15	-	15~35	-	1.21	0.13	[13]
法国	前瞻	2005—2010年	820^1）	50	770	10~75	0.46	0.98	0.22	[3]
瑞士	回顾	1999—2010年	69	21	48	10~39	-	0.90	0.52	[17]

国家（地区）	研究类型	研究时段	纳入研究病例数	运动员人数	非运动员人数	年龄分布/岁	总体年均发生率 /（人·10万）^-1	运动员年均发生率 /（人·10万）^-1	非运动员年均发生率 /（人·10万）^-1	参考文献
意大利（威内托）	前瞻	1979—2004年	320	55	265	12~35	-	1.90	0.79	[16]
美国	回顾	1980—2006年	1 866	1 049	-	8~39	-	0.61	-	[23]
挪威	回顾	1990—1997年	23	-	23	17~34	0.90	-	-	[7]
丹麦	回顾	2000—2006年	15	15	-	15~35	-	1.21	0.13	[13]
法国	前瞻	2005—2010年	820^1）	50	770	10~75	0.46	0.98	0.22	[3]
瑞士	回顾	1999—2010年	69	21	48	10~39	-	0.90	0.52	[17]

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