Cardiovascular diseases in paralympic athletes

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 prevalence of CV abnormalities and the risk for SP in Paralympic athletes (PA). Methods. PA (n=267; 76% males), aged 35±9, engaged in 18 sport disciplines, with 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 them, 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 dilatation 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 NSVT) or supraventricular tachyarrhythmias (atrial flutter, paroxysmal atrial fibrillation or SVT) were identified in 9 others. Over 6-year follow-up, 6 of 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 not 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.