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31-01-2017 | Original Article | Uitgave 4/2017 Open Access

Netherlands Heart Journal 4/2017

No psychological distress in sportsmen aged 45 years and older after cardiovascular screening, including cardiac CT: The Measuring Athlete’s Risk of Cardiovascular events (MARC) study

Netherlands Heart Journal > Uitgave 4/2017
M. M. Schurink, T. L. Braber, N. H. J. Prakken, P. A. F. M. Doevendans, F. J. G. Backx, D. E. Grobbee, R. Rienks, H. M. Nathoe, M. L. Bots, B. K. Velthuis, A. Mosterd
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Electronic supplementary material

The online version of this article (doi: 10.​1007/​s12471-017-0948-5) contains supplementary material, which is available to authorized users.

Author contributions

M.M. Schurink and T.L. Braber contributed equally to this paper.



Psychological distress caused by cardiovascular pre-participation screening (PPS) may be a reason not to implement a PPS program. We assessed the psychological impact of PPS, including cardiac computed tomography (CT), in 318 asymptomatic sportsmen aged ≥45 years.


Coronary artery disease (CAD) was defined as a coronary artery calcium score ≥100 Agatson units and/or ≥50% luminal stenosis on contrast-enhanced cardiac CT. Psychological impact was measured with the Impact of Event Scale (IES) (seven items) on a six-point scale (grade 0–5). A sum score ≥19 indicates clinically relevant psychological distress. A Likert scale was used to assess overall experiences and impact on sports and lifestyle.


A total of 275 participants (86.5% response rate, 95% CI 83–90%) with a mean age of 54.5 ± 6.4 years completed the questionnaires, 48 (17.5%, 95% CI 13–22%) of whom had CAD. The median IES score was 1 (IQR 0–2, [0–23]). IES was slightly higher in those with CAD (mean rank 175 vs. 130, p < 0.001). One participant (with CAD) experienced clinically relevant psychological distress (IES = 23). Participants reported numerous benefits, including feeling safer exercising (58.6%, 95% CI 53–65%) and positive lifestyle changes, especially in those with CAD (17.2 vs. 52.1%, p < 0.001). The majority were satisfied with their participation (93.8%, 95% CI 91–97%).


Cardiovascular PPS, including cardiac CT, causes no relevant psychological distress in older sportsmen. Psychological distress should not be a reason to forego screening in sportsmen.

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