Enhancing cardiovascular screening in master athletes: the role of exercise stress echocardiography

Background: Cardiovascular (CV) disease is a significant risk even among seemingly healthier populations like master athletes, who face unique CV challenges due to their advanced age and high-intensity physical activities. Exercise stress echocardiography (ESE) has emerged as a valuable diagnostic tool to detect exercise-induced coronary artery disease (CAD), offering advantages over traditional exercise stress testing (EST) by integrating echocardiographic imaging. This article aimed to assess the diagnostic value and efficacy of ESE for detecting CAD in master athletes who exhibit exercise-induced alterations during pre-participation screening (PPS) EST. Methods: This retrospective study analyzed 521 master athletes (aged 35 years and older) who underwent annual CV assessments including EST as part of their PPS at Noale Hospital, Venice, Italy, from September 2020 to August 2023. Participants who showed exercise-induced alterations suspicious for CAD on EST were further evaluated using ESE. Results: Of the 521 athletes screened, 58 (11.1%) exhibited suspicious alterations for CAD during EST. ESE further identified 13 athletes with wall motion abnormalities (WMA), of whom 10 were subsequently diagnosed with critical CAD and received appropriate interventions. The positive predictive value of ESE was 0.77. Comparatively, athletes with WMA had significantly higher CV risk scores. No major adverse CV events (MACE) were reported during the 43.9-month follow-up. Conclusions: ESE is an effective third-line diagnostic tool in master athletes, demonstrating a high diagnostic yield for identifying significant CAD. Its integration into routine CV screening for master athletes can enhance the detection of underlying pathologies, potentially leading to timely and life-saving interventions.