ĐẶC ĐIỂM, NGUY CƠ VÀ CHIẾN LƯỢC QUẢN LÝ CÁC BỆNH LÝ TIM MẠCH THƯỜNG GẶP Ở VẬN ĐỘNG VIÊN
Nội dung chính của bài viết
Tóm tắt
Đặt vấn đề: Bệnh lý tim mạch ở vận động viên là một vấn đề y khoa phức tạp đang ngày càng được quan tâm trên toàn thế giới. Mặc dù tập luyện thể thao đều đặn mang lại nhiều lợi ích cho sức khỏe tim mạch và giảm nguy cơ tử vong do bệnh tim mạch, nhưng ở một số vận động viên có các bệnh lý tim tiềm ẩn, hoạt động thể thao cường độ cao có thể làm tăng nguy cơ đột tử do tim. Nội dung tổng quan: Đột tử do tim trong thể thao là nguyên nhân tử vong hàng đầu ở vận động viên và có tác động tâm lý sâu sắc đến gia đình, cộng đồng thể thao. Tài liệu này tổng hợp những hiểu biết mới nhất về dịch tễ học, sinh lý bệnh, nguyên nhân, yếu tố nguy cơ, phương pháp chẩn đoán và quản lý bệnh lý tim mạch ở vận động viên, được cập nhật dựa trên các hướng dẫn quốc tế mới nhất năm 2024-2025.
Từ khóa
bệnh tim mạch, vận động viên, sàng lọc tim mạch
Chi tiết bài viết
Bài báo này được cấp phép theo Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Tài liệu tham khảo
1. World Health Organization. Global recommendations on physical activity for health. Geneva: WHO Press. 2010.
2. Mannakkara NN, Sharma S. Sudden cardiac death in athletes. Trends Urol Men's Health. 2020.11(4):10-14.
3. Petek BJ, Churchill TW, Moulson N, et al. Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A 20-Year Study. Circulation. 2024. 149(2):80-90. DOI: 10.1161/CIRCULATIONAHA.123.066953
4. Harmon KG, Asif IM, Klossner D, et al. Incidence of sudden cardiac death in National Collegiate Athletic Association athletes. Circulation. 2011. 123(15),1594-1600. DOI: 10.1161/CIRCULATIONAHA.110.004622
5. Finocchiaro G, Westaby J, Sheppard MN, et al. Sudden cardiac death in young athletes: JACC state-of-the-art review. J Am Coll Cardiol. 2024. 83(2), 350-370. DOI: 10.1016/j.jacc.2023.11.006
6. Pelliccia A, Link MS, Maron BJ. Screening to prevent sudden cardiac death in competitive athletes. UpToDate. 2025.
7. Maron BJ. Structural features of the athlete heart as defined by echocardiography. J Am Coll Cardiol. 1986. 7(1),190-203. DOI: 10.1016/s0735-1097(86)80282-0
8. Sharma S, Merghani A, Mont L. Exercise and the heart: the good, the bad, and the ugly. Eur Heart J. 2015;36(23):1445-1453. DOI: 10.1093/eurheartj/ehv090
9. Pelliccia A, Kinoshita N, Pisicchio C, et al. Long-term clinical consequences of intense, uninterrupted endurance training in Olympic athletes. J Am Coll Cardiol. 2010. 55(15),16191625. DOI: 10.1016/j.jacc.2009.10.068
10. Pelliccia A, Sharma S, Gati S, et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J. 2021. 42(1), 17-96. DOI: 10.1093/eurheartj/ehaa605
11. Charfeddine S, Mallek S, Triki F, et al. Echocardiographic analysis of the left ventricular function in young athletes: a focus on speckle tracking imaging. Pan Afr Med J. 2016. 25,171. DOI: 10.11604/pamj.2016.25.171.10032
12. Khan AA, Safi L, Wood M. Cardiac Imaging In Athletes. Methodist Debakey Cardiovasc J. 2016. 12(2), 86-92. DOI: 10.14797/mdcj-12-2-86
13. Fagard R. Athlete's heart. Heart. 2003. 89(12), 1455-1461. DOI: 10.1136/heart.89.12.1455
14. Elliott PM, Anastasakis A, Borger MA, et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J. 2014. 35(39), 2733-2779. DOI: 10.1093/eurheartj/ehu284
15. Malhotra A, Sharma S. Hypertrophic cardiomyopathy in athletes. Eur Cardiol Rev. 2017. 12(2), 80. DOI: 10.15420/ecr.2017:16:1
16. Prior D, La Gerche A. Exercise and arrhythmogenic right ventricular cardiomyopathy. Heart Lung Circ. 2020. 29(4), 547-555. DOI: 10.1016/j.hlc.2019.12.007
17. Corrado D, Zorzi A, Cerrone M, et al. Proposed diagnostic criteria for arrhythmogenic cardiomyopathy: European Task Force consensus report. Int J Cardiol. 2024. 395, 131447. DOI: 10.1016/j.ijcard.2023.131447
18. Molossi S, Mery CM. Controversies Surrounding Coronary Arteries Anomalies in Young Athletes. American College of Cardiology. 2015.
19. Rajpal S, Tong MS, Borchers J, et al. Cardiovascular magnetic resonance findings in competitive athletes recovering from COVID-19 infection. JAMA Cardiol. 2021. 6(1),116-118. DOI: 10.1001/jamacardio.2020.4916
20. Clark DE, Parikh A, Dendy JM, et al. COVID-19 myocardial pathology evaluation in athletes with cardiac magnetic resonance (COMPETE CMR). Circulation. 2021.143(6), 609-612. DOI: 10.1161/CIRCULATIONAHA.120.052573
21. Merghani A, Maestrini V, Rosmini S, et al. Prevalence of subclinical coronary artery disease in masters endurance athletes with a low atherosclerotic risk profile. Circulation. 2017. 136, 126-137. DOI: 10.1161/CIRCULATIONAHA.116.026964
22. Chhabra L, Goyal A, Benham MD. Wolff-Parkinson-White Syndrome. StatPearls. 2023.
23. Charron P, Villard E, Sébillon P, et al. Danon disease as a cause of hypertrophic cardiomyopathy in women. Am J Cardiol. 2004. 93(8), 1022-1026. DOI: 10.1016/j.amjcard.2004.01.021
24. Han J, Lalario A, Merro E, et al. Sudden Cardiac Death in Athletes: Facts and Fallacies. J Cardiovasc Dev Dis. 2023. 10(2). DOI: 10.3390/jcdd10020085
25. Sharma S, Drezner JA, Baggish A, et al. International recommendations for electrocardiographic interpretation in athletes. J Am Coll Cardiol. 2017. 69(8), 1057-1075. DOI: 10.1016/j.jacc.2017.01.015
26. Asif IM, Drezner JA. Sudden cardiac death and preparticipation screening: the debate continues. Curr Sports Med Rep. 2012. 11(2), 62-68. DOI: 10.1249/JSR.0b013e318251c9f2.
27. Dores H, Dinis P, Viegas JM, et al. Preparticipation Cardiovascular Screening of Athletes: Current Controversies and Challenges for the Future. Diagnostics. 2024. 14(21). DOI: 10.3390/diagnostics14212440
28. Friedrich MG, Sechtem U, Schulz-Menger J, et al. Cardiovascular magnetic resonance in myocarditis: A JACC White Paper. J Am Coll Cardiol. 2009. 53(17), 1475-1487. DOI: 10.1016/j.jacc.2009.02.007
29. Priori SG, Blomström-Lundqvist C, Mazzanti A, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2015. 36(41), 2793-2867. DOI: 10.1093/eurheartj/ehv316
30. Rigelsky C, Zahka KG. Genetic evaluation of athletes with cardiovascular disease: Incorporating a genetic counselor on your team. American College of Cardiology. 2017.
31. Kim JH, Baggish AL, Levine BD, et al. Clinical considerations for competitive sports participation for athletes with cardiovascular abnormalities: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2025. 85(10), 1059-1108. DOI: 10.1016/j.jacc.2024.12.017
32. Drezner JA, Rao AL, Heistand J, et al. Effectiveness of emergency response planning for sudden cardiac arrest in United States high schools with automated external defibrillators. Circulation. 2009. 120(6), 518-525. DOI: 10.1161/CIRCULATIONAHA.109.855890
33. Astley C, Petek BJ, DeLong RN, et al. Sudden Cardiac Arrest Among Young Competitive Athletes Before and During the COVID-19 Pandemic. JAMA Netw Open. 2025. 8(2),e2461327. DOI: 10.1001/jamanetworkopen.2024.61327
34. Hannun AY, Rajpurkar P, Haghpanahi M, et al. Cardiologist-level arrhythmia detection and classification in ambulatory electrocardiograms using a deep neural network. Nat Med. 2019. 25(1), 65-69. DOI: 10.1038/s41591-018-0268-3
35. Seshadri DR, Bittel B, Browsky D, et al. Accuracy of Apple Watch for detection of atrial fibrillation. Circulation. 2020. 141(8), 702-703. DOI: 10.1161/CIRCULATIONAHA.119.044126
36. Task Force Members, Monserrat L, Elliott PM, et al. Non-invasive prediction of sudden arrhythmic death in hypertrophic cardiomyopathy: the HCM Risk-SCD model. Eur Heart J. 2018. 39(22), 2058-2064. DOI: 10.1093/eurheartj/ehy102.
2. Mannakkara NN, Sharma S. Sudden cardiac death in athletes. Trends Urol Men's Health. 2020.11(4):10-14.
3. Petek BJ, Churchill TW, Moulson N, et al. Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A 20-Year Study. Circulation. 2024. 149(2):80-90. DOI: 10.1161/CIRCULATIONAHA.123.066953
4. Harmon KG, Asif IM, Klossner D, et al. Incidence of sudden cardiac death in National Collegiate Athletic Association athletes. Circulation. 2011. 123(15),1594-1600. DOI: 10.1161/CIRCULATIONAHA.110.004622
5. Finocchiaro G, Westaby J, Sheppard MN, et al. Sudden cardiac death in young athletes: JACC state-of-the-art review. J Am Coll Cardiol. 2024. 83(2), 350-370. DOI: 10.1016/j.jacc.2023.11.006
6. Pelliccia A, Link MS, Maron BJ. Screening to prevent sudden cardiac death in competitive athletes. UpToDate. 2025.
7. Maron BJ. Structural features of the athlete heart as defined by echocardiography. J Am Coll Cardiol. 1986. 7(1),190-203. DOI: 10.1016/s0735-1097(86)80282-0
8. Sharma S, Merghani A, Mont L. Exercise and the heart: the good, the bad, and the ugly. Eur Heart J. 2015;36(23):1445-1453. DOI: 10.1093/eurheartj/ehv090
9. Pelliccia A, Kinoshita N, Pisicchio C, et al. Long-term clinical consequences of intense, uninterrupted endurance training in Olympic athletes. J Am Coll Cardiol. 2010. 55(15),16191625. DOI: 10.1016/j.jacc.2009.10.068
10. Pelliccia A, Sharma S, Gati S, et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J. 2021. 42(1), 17-96. DOI: 10.1093/eurheartj/ehaa605
11. Charfeddine S, Mallek S, Triki F, et al. Echocardiographic analysis of the left ventricular function in young athletes: a focus on speckle tracking imaging. Pan Afr Med J. 2016. 25,171. DOI: 10.11604/pamj.2016.25.171.10032
12. Khan AA, Safi L, Wood M. Cardiac Imaging In Athletes. Methodist Debakey Cardiovasc J. 2016. 12(2), 86-92. DOI: 10.14797/mdcj-12-2-86
13. Fagard R. Athlete's heart. Heart. 2003. 89(12), 1455-1461. DOI: 10.1136/heart.89.12.1455
14. Elliott PM, Anastasakis A, Borger MA, et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J. 2014. 35(39), 2733-2779. DOI: 10.1093/eurheartj/ehu284
15. Malhotra A, Sharma S. Hypertrophic cardiomyopathy in athletes. Eur Cardiol Rev. 2017. 12(2), 80. DOI: 10.15420/ecr.2017:16:1
16. Prior D, La Gerche A. Exercise and arrhythmogenic right ventricular cardiomyopathy. Heart Lung Circ. 2020. 29(4), 547-555. DOI: 10.1016/j.hlc.2019.12.007
17. Corrado D, Zorzi A, Cerrone M, et al. Proposed diagnostic criteria for arrhythmogenic cardiomyopathy: European Task Force consensus report. Int J Cardiol. 2024. 395, 131447. DOI: 10.1016/j.ijcard.2023.131447
18. Molossi S, Mery CM. Controversies Surrounding Coronary Arteries Anomalies in Young Athletes. American College of Cardiology. 2015.
19. Rajpal S, Tong MS, Borchers J, et al. Cardiovascular magnetic resonance findings in competitive athletes recovering from COVID-19 infection. JAMA Cardiol. 2021. 6(1),116-118. DOI: 10.1001/jamacardio.2020.4916
20. Clark DE, Parikh A, Dendy JM, et al. COVID-19 myocardial pathology evaluation in athletes with cardiac magnetic resonance (COMPETE CMR). Circulation. 2021.143(6), 609-612. DOI: 10.1161/CIRCULATIONAHA.120.052573
21. Merghani A, Maestrini V, Rosmini S, et al. Prevalence of subclinical coronary artery disease in masters endurance athletes with a low atherosclerotic risk profile. Circulation. 2017. 136, 126-137. DOI: 10.1161/CIRCULATIONAHA.116.026964
22. Chhabra L, Goyal A, Benham MD. Wolff-Parkinson-White Syndrome. StatPearls. 2023.
23. Charron P, Villard E, Sébillon P, et al. Danon disease as a cause of hypertrophic cardiomyopathy in women. Am J Cardiol. 2004. 93(8), 1022-1026. DOI: 10.1016/j.amjcard.2004.01.021
24. Han J, Lalario A, Merro E, et al. Sudden Cardiac Death in Athletes: Facts and Fallacies. J Cardiovasc Dev Dis. 2023. 10(2). DOI: 10.3390/jcdd10020085
25. Sharma S, Drezner JA, Baggish A, et al. International recommendations for electrocardiographic interpretation in athletes. J Am Coll Cardiol. 2017. 69(8), 1057-1075. DOI: 10.1016/j.jacc.2017.01.015
26. Asif IM, Drezner JA. Sudden cardiac death and preparticipation screening: the debate continues. Curr Sports Med Rep. 2012. 11(2), 62-68. DOI: 10.1249/JSR.0b013e318251c9f2.
27. Dores H, Dinis P, Viegas JM, et al. Preparticipation Cardiovascular Screening of Athletes: Current Controversies and Challenges for the Future. Diagnostics. 2024. 14(21). DOI: 10.3390/diagnostics14212440
28. Friedrich MG, Sechtem U, Schulz-Menger J, et al. Cardiovascular magnetic resonance in myocarditis: A JACC White Paper. J Am Coll Cardiol. 2009. 53(17), 1475-1487. DOI: 10.1016/j.jacc.2009.02.007
29. Priori SG, Blomström-Lundqvist C, Mazzanti A, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2015. 36(41), 2793-2867. DOI: 10.1093/eurheartj/ehv316
30. Rigelsky C, Zahka KG. Genetic evaluation of athletes with cardiovascular disease: Incorporating a genetic counselor on your team. American College of Cardiology. 2017.
31. Kim JH, Baggish AL, Levine BD, et al. Clinical considerations for competitive sports participation for athletes with cardiovascular abnormalities: a scientific statement from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2025. 85(10), 1059-1108. DOI: 10.1016/j.jacc.2024.12.017
32. Drezner JA, Rao AL, Heistand J, et al. Effectiveness of emergency response planning for sudden cardiac arrest in United States high schools with automated external defibrillators. Circulation. 2009. 120(6), 518-525. DOI: 10.1161/CIRCULATIONAHA.109.855890
33. Astley C, Petek BJ, DeLong RN, et al. Sudden Cardiac Arrest Among Young Competitive Athletes Before and During the COVID-19 Pandemic. JAMA Netw Open. 2025. 8(2),e2461327. DOI: 10.1001/jamanetworkopen.2024.61327
34. Hannun AY, Rajpurkar P, Haghpanahi M, et al. Cardiologist-level arrhythmia detection and classification in ambulatory electrocardiograms using a deep neural network. Nat Med. 2019. 25(1), 65-69. DOI: 10.1038/s41591-018-0268-3
35. Seshadri DR, Bittel B, Browsky D, et al. Accuracy of Apple Watch for detection of atrial fibrillation. Circulation. 2020. 141(8), 702-703. DOI: 10.1161/CIRCULATIONAHA.119.044126
36. Task Force Members, Monserrat L, Elliott PM, et al. Non-invasive prediction of sudden arrhythmic death in hypertrophic cardiomyopathy: the HCM Risk-SCD model. Eur Heart J. 2018. 39(22), 2058-2064. DOI: 10.1093/eurheartj/ehy102.