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Clerico A, Zaninotto M, Aimo A, Galli C, Sandri MT, Correale M, Dittadi R, Migliardi M, Fortunato A, Belloni L, Plebani M. Assessment of cardiovascular risk and physical activity: the role of cardiac-specific biomarkers in the general population and athletes. Clin Chem Lab Med 2024; 0:cclm-2024-0596. [PMID: 39016272 DOI: 10.1515/cclm-2024-0596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/11/2024] [Indexed: 07/18/2024]
Abstract
The first part of this Inter-Society Document describes the mechanisms involved in the development of cardiovascular diseases, particularly arterial hypertension, in adults and the elderly. It will also examine how consistent physical exercise during adolescence and adulthood can help maintain blood pressure levels and prevent progression to symptomatic heart failure. The discussion will include experimental and clinical evidence on the use of specific exercise programs for preventing and controlling cardiovascular diseases in adults and the elderly. In the second part, the clinical relevance of cardiac-specific biomarkers in assessing cardiovascular risk in the general adult population will be examined, with a focus on individuals engaged in sports activities. This section will review recent studies that suggest a significant role of biomarkers in assessing cardiovascular risk, particularly the presence of cardiac damage, in athletes who participate in high-intensity sports. Finally, the document will discuss the potential of using cardiac-specific biomarkers to monitor the effectiveness of personalized physical activity programs (Adapted Physical Activity, APA). These programs are prescribed for specific situations, such as chronic diseases or physical disabilities, including cardiovascular diseases. The purposes of this Inter-Society Document are the following: 1) to discuss the close pathophysiological relationship between physical activity levels (ranging from sedentary behavior to competitive sports), age categories (from adolescence to elderly age), and the development of cardiovascular diseases; 2) to review in detail the experimental and clinical evidences supporting the role of cardiac biomarkers in identifying athletes and individuals of general population at higher cardiovascular risk; 3) to stimulate scientific societies and organizations to develop specific multicenter studies that may take into account the role of cardiac biomarkers in subjects who follow specific exercise programs in order to monitor their cardiovascular risk.
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Affiliation(s)
- Aldo Clerico
- Coordinator of the Study Group on Cardiac Biomarkers of the Italian Societies SIBioC and ELAS, Pisa, Italy
| | | | - Alberto Aimo
- Fondazione CNR - Regione Toscana G. Monasterio, Pisa, Italy
| | | | | | - Mario Correale
- UOC Medical Pathology, IRCCS De Bellis, Castellana Grotte, Bari, Italy
| | | | - Marco Migliardi
- Primario Emerito S.C. Laboratorio Analisi Chimico-Cliniche e Microbiologia, Ospedale Umberto I, A.O. Ordine Mauriziano di Torino, Turin, Italy
| | | | - Lucia Belloni
- Dipartimento di Diagnostica - per Immagini e Medicina di Laboratorio, Laboratorio Autoimmunità, Allergologia e Biotecnologie Innovative, Azienda USL-IRCCS di Reggio Emilia, Emilia-Romagna, Italy
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Parisi EJ, Chung EH. Palpitations in athletes: diagnosis, workup and treatment. Heart 2024; 110:963-969. [PMID: 37562948 DOI: 10.1136/heartjnl-2022-321726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
Palpitations are a common reason for athletes to seek medical care. Although often benign, palpitations may serve as a harbinger for underling cardiac pathology. Given the unique challenges in this population, this review will serve to discuss the basic underlying pathophysiology, which may predispose athletes to palpitations. In addition, we will review the aetiologies, diagnostic evaluation, management and counselling strategies for some of the most common diagnoses seen in athletes.
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Affiliation(s)
- Erika J Parisi
- Internal Medicine/Cardiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Eugene H Chung
- Internal Medicine/Cardiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Panhuyzen-Goedkoop NM, Verbeek ALM, Goedkoop RJ, Malekzadeh A, Wilde AAM, Peters RJG, Jørstad HT. Quality of athlete screening for high-risk cardiovascular conditions-A systematic review. Scand J Med Sci Sports 2023; 33:2094-2109. [PMID: 37449413 DOI: 10.1111/sms.14446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 04/21/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Sudden cardiac death (SCD) is the leading medical cause of death in athletes. To prevent SCD, screening for high-risk cardiovascular conditions (HRCC) is recommended. Screening strategies are based on a limited number of studies and expert consensus. However, evidence and efficacy of athlete HRCC screening is unclear. OBJECTIVE To determine methodological quality and quality of evidence of athlete screening, and screening efficacy to detect HRCC in a systematic review. METHODS We performed a systematic search of Medline, Embase, Scopus and Cochrane Library up to June 2021. We included articles containing original data of athlete cardiovascular screening, providing details of screening strategies, test results and HRCC detection. We assessed methodological quality of the included articles by QUADAS-2, quality of evidence of athlete HRCC screening by GRADE, and athlete HRCC screening efficacy by SWiM. RESULTS Of 2720 citations, we included 33 articles (1991-2018), comprising 82 417 athletes (26.7% elite, 73.4% competitive, 21.7% women, 75.2% aged ≤35). Methodological quality was 'very low' (33 articles), caused by absence of data blinding and inappropriate statistical analysis. Quality of evidence was 'very low' (33 articles), due to observational designs and population heterogeneity. Screening efficacy could not be reliably established. The prevalence of HRCC was 0.43% with false positive rate (FPR) 13.0%. CONCLUSIONS Methodological quality and quality of evidence on athlete screening are suboptimal. Efficacy could not be reliably established. The prevalence of screen detected HRCC was very low and FPR high. Given the limitations of the evidence, individual recommendations need to be prudent.
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Affiliation(s)
- Nicole M Panhuyzen-Goedkoop
- Department of Cardiology, Amsterdam University Medical Centers, Heart Centre, Amsterdam, The Netherlands
- Sports Medical Centre Papendal, Arnhem, The Netherlands
| | - André L M Verbeek
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Arjan Malekzadeh
- University Library, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam University Medical Centers, Heart Centre, Amsterdam, The Netherlands
| | - Ron J G Peters
- Department of Cardiology, Amsterdam University Medical Centers, Heart Centre, Amsterdam, The Netherlands
| | - Harald T Jørstad
- Department of Cardiology, Amsterdam University Medical Centers, Heart Centre, Amsterdam, The Netherlands
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Turska-Kmieć A, Neunhaeuserer D, Mazur A, Dembiński Ł, del Torso S, Grossman Z, Barak S, Hadjipanayis A, Peregud-Pogorzelski J, Kostka T, Bugajski A, Huss G, Kowalczyk-Domagała M, Wyszyńska J. Sport activities for children and adolescents: the Position of the European Academy of Paediatrics and the European Confederation of Primary Care Paediatricians 2023-Part 1. Pre-participation physical evaluation in young athletes. Front Pediatr 2023; 11:1125958. [PMID: 37425260 PMCID: PMC10323832 DOI: 10.3389/fped.2023.1125958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
The European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP) emphasize the importance of promoting healthy lifestyles within the pediatric population. Many health professionals have questions concerning adequate levels of physical activity for both the healthy pediatric population and for those who may have specific complications. Unfortunately, the academic literature that provides recommendations for participation in sport activities within the pediatric population that have been published during the last decade in Europe is limited and is mainly dedicated to specific illnesses or advanced athletes and not toward the general population. The aim of part 1 of the EAP and ECPCP position statement is to assist healthcare professionals in implementing the best management strategies for a pre-participation evaluation (PPE) for participation in sports for individual children and adolescents. In the absence of a uniform protocol, it is necessary to respect physician autonomy for choosing and implementing the most appropriate and familiar PPE screening strategy and to discuss the decisions made with young athletes and their families. This first part of the Position Statement concerning Sport Activities for Children and Adolescents is dedicated to healthy young athletes.
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Affiliation(s)
- Anna Turska-Kmieć
- Department of Cardiology, Children’s Memorial Health Institute, Warsaw, Poland
- Polish PaediatricSociety, Warsaw, Poland
- Working Group on Sports Cardiology, Polish Cardiac Society, Warsaw, Poland
| | - Daniel Neunhaeuserer
- Sports and Exercise Medicine Division, University of Padova Department of Medicine, Padova, Italy
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Artur Mazur
- Polish PaediatricSociety, Warsaw, Poland
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów, Poland
| | - Łukasz Dembiński
- Polish PaediatricSociety, Warsaw, Poland
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- Department of Paediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Stefano del Torso
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- Childcare Worldwide, Padova, Italy
| | - Zachi Grossman
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- Adelson School of Medicine, Ariel University, Ariel, Israel
- Maccabi Health Services, Pediatric Clinic, Tel Aviv, Israel
| | - Shimon Barak
- The European Confederation of Primary Care Paediatricians (ECPCP), Lyon, France
- Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Adamos Hadjipanayis
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- School of Medicine, European University Cyprus, Nicosia, Cyprus
- Paediatric Department, Larnaca General Hospital, Larnaca, Cyprus
| | - Jarosław Peregud-Pogorzelski
- Polish PaediatricSociety, Warsaw, Poland
- Department of Paediatrics, Paediatric Oncology and Immunology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Kostka
- Department of Geriatrics, Medical University of Lodz, Lodz, Poland
- The Polish Society of Sports Medicine, Wroclaw, Poland
| | - Andrzej Bugajski
- The Polish Society of Sports Medicine, Wroclaw, Poland
- Department of Physiotherapy, College of Physiotherapy, Wroclaw, Poland
| | - Gottfried Huss
- The European Confederation of Primary Care Paediatricians (ECPCP), Lyon, France
- Kinder-Permanence Hospital Zollikerberg, Zollikerberg, Switzerland
| | - Monika Kowalczyk-Domagała
- Department of Cardiology, Children’s Memorial Health Institute, Warsaw, Poland
- Working Group on Paediatric Cardiology, Polish Cardiac Society, Warsaw, Poland
| | - Justyna Wyszyńska
- Institute of Health Sciences, Medical College of Rzeszów University, Rzeszów, Poland
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Robles AG, Palamà Z, Nesti M, Tunzi RM, Delise P, Cavarretta E, Penco M, Romano S, Sciarra L. Sport Related Sudden Death: The Importance of Primary and Secondary Prevention. J Clin Med 2022; 11:jcm11164683. [PMID: 36012921 PMCID: PMC9410008 DOI: 10.3390/jcm11164683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/20/2022] [Accepted: 08/01/2022] [Indexed: 12/02/2022] Open
Abstract
Sports are a double-edged sword. On the one hand, cardiovascular benefits from sports activity are well-known, and on the other hand, sports may increase the risk of sudden cardiac death (SCD) in subjects with known or unknown cardiovascular diseases. SCD is rare but has a very strong emotional issue. There are many examples involving famous professional athletes, but this is only scratching the surface of a widespread phenomenon that also involves amateur athletes. The importance of safely performing physical activity appears clear in both professional and amateur athletes. In particular, the former undergo a pre-participation screening for SCD primary prevention with different recommendations in each country. On the other hand, a medical examination is not mandatory for non-professional athletes and, therefore, for people who practice sports as an amateur. Widespread distribution of automatic external defibrillators and people trained for cardiopulmonary resuscitation are necessary to promote secondary prevention of SCD. We briefly report a case series of athletes with aborted SCD during sports activity in order to underline and discuss in this review the previously highlighted issues.
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Affiliation(s)
- Antonio Gianluca Robles
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Zefferino Palamà
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Martina Nesti
- Cardiovascular and Neurological Department, Ospedale San Donato, 52100 Arezzo, Italy
| | | | - Pietro Delise
- Division of Cardiology, Hospital ‘P. Pederzoli’, 37019 Peschiera del Garda, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
- Mediterranea Cardiocentro, 80122 Naples, Italy
| | - Maria Penco
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Silvio Romano
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
- Correspondence: ; Tel.: +39-0862434740; Fax: +39-0862433425
| | - Luigi Sciarra
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
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Krivenko GS, Ribeiro ER, Walker S, Mercado-Gonzalez C, Sima S, Ernst E, Tisma-Dupanovic S, Dadlani GH. Feasibility of electrocardiogram screening in the USA prior to high school sport participation. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mancone M, Maestrini V, Fusto A, Adamo F, Scarparo P, D’Ambrosi A, Cinque A, Gatto MC, Salvi N, Agnes G, Pucci M, Birtolo LI, Marruncheddu L, Genuini I, De Lazzari C, Severino P, Giunta G, Lavalle C, Fegatelli DA, Vestri A, Fedele F. ECG evaluation in 11 949 Italian teenagers: results of screening in secondary school. J Cardiovasc Med (Hagerstown) 2022; 23:98-105. [PMID: 34570036 PMCID: PMC8855949 DOI: 10.2459/jcm.0000000000001259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/04/2021] [Accepted: 08/29/2021] [Indexed: 01/02/2023]
Abstract
AIM There is lack of evidence regarding the screening role of ECG for sudden cardiac death (SCD) prevention. Our aim was to evaluate the prevalence of ECG abnormalities among teenagers according to sport participation and competitive status. METHODS Eleven thousand nine hundred and forty-nine Italian pupils from 179 secondary schools (13-19 years) were consecutively enrolled. ECG abnormalities were divided into minor and major. Medical history, clinical examination and sport activity information were acquired. Further evaluations were suggested in case of major ECG abnormalities. Follow-up was performed at 2 years. RESULTS N = 1945 (16%) pupils had ECG abnormalities. Major ECG abnormalities were detected in 13% of the cohort, minor in 34%. ECG abnormalities were more common in nonathletes compared with athletes. A diagnosis of cardiac disease was reached in 25 (1.6%) of the pupils with major ECG abnormalities. CONCLUSION ECG abnormalities are common among young populations and more prevalent in nonathletes. Among pupils with major ECG abnormalities 1.6% had a cardiac disease diagnosis. Our results are in line with the data supporting ECG screening in the general young population.
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Affiliation(s)
- Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Antonio Fusto
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Francesco Adamo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Paola Scarparo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Alessandra D’Ambrosi
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Alessandra Cinque
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Maria Chiara Gatto
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Nicolò Salvi
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Gianluca Agnes
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Mariateresa Pucci
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Lucia Ilaria Birtolo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Laura Marruncheddu
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Igino Genuini
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | | | - Paolo Severino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Giuseppe Giunta
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Danilo Alunni Fegatelli
- Department of Public Health and Infections Disease, Sapienza University of Rome, Rome, Italy
| | - Annarita Vestri
- Department of Public Health and Infections Disease, Sapienza University of Rome, Rome, Italy
| | - Francesco Fedele
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
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Parizher G, Phelan DM, Ayers C, Goodwin R, Levine BD. A Video-Enhanced, Electronic Modality for Preparticipation Examination of Young Athletes. Curr Sports Med Rep 2021; 20:485-488. [PMID: 34524192 DOI: 10.1249/jsr.0000000000000879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT We developed a video-enhanced preparticipation evaluation symptom questionnaire (the V-PPE), intended to help screen athletes for heart disease. We now report results of a pilot quality improvement study evaluating V-PPE's performance. In a prospective before-and-after study, approximately 5700 high-school athletes were prompted to voluntarily fill out the V-PPE questionnaire. We compared symptom frequencies on standard PPE to those on V-PPE. Of 5700 athletes, 46 (0.8%), 117 (2.0%), 33 (0.6%), and 101 (1.8%) reported syncope, angina, palpitations, and dyspnea, respectively on routine screening. Four hundred and ninety-two (8.6%) voluntarily filled out the V-PPE. Athletes were more likely to report palpitations on V-PPE than PPE, but not angina, dyspnea, syncope, or at least one symptom. Symptom frequencies on electronic PPE questionnaires are lower than recent reports suggest. Embedded videos can alter screening yield. More research is necessary to evaluate the predictive value of the V-PPE for clinically relevant cardiac pathology.
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Affiliation(s)
- Gary Parizher
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Dermot M Phelan
- Sports Cardiology Center, Heart, Vascular, and Thoracic Institute, Cleveland, Clinic, Cleveland OH
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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Guía ESC 2020 sobre cardiología del deporte y el ejercicio en pacientes con enfermedad cardiovascular. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Lear A, Patel N, Mullen C, Simonson M, Leone V, Koshiaris C, Nunan D. Incidence of sudden cardiac arrest and death in young athletes and military members: a systematic review and meta-analysis. J Athl Train 2021; 57:431-443. [PMID: 34038947 PMCID: PMC9205551 DOI: 10.4085/1062-6050-0748.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The goals of this review are to evaluate the quality of the evidence on the incidence of sudden cardiac arrest and death (SCA/D) in athletes and military members; and to estimate annual incidence of SCA/D. DATA SOURCES MEDLINE, Embase, Cochrane CENTRAL, Web of Science, BIOSIS, Scopus, SPORT discus, PEDro, and clinicaltrials.gov were searched from inception to dates between 2/21/19-7/29/19. STUDY SELECTION Studies which reported incidence of SCA/D or both in athletes, or military members under age 40 were eligible for inclusion. 40 studies were identified for inclusion Data Extraction: Risk of bias was assessed using a validated, customized tool for prevalence studies in all included studies. 12 were found to be low ROB, with the remaining 28 moderate or high ROB. Data was extracted for narrative review, and meta-analysis. DATA SYNTHESIS Random-effects meta-analysis was performed in studies judged to be low risk of bias in two separate categories: 5 studies on regional or national level data including athletes at all levels, and both sexes included 130 events of SCD, with a total of 11,272,560 athlete years showing a cumulative incidence rate of 0.98 [95%CI: 0.62, 1.53] per 100,000 athlete years, with high heterogeneity with I2 of 78%; 3 Studies on competitive athletes aged 14 to 25 were combined, and included 183 events, and 17,798758 athlete years showing an incidence rate of 1.91[95%CI: 0.71; 5.14] per 100,000 athlete years with high heterogeneity with I2 of 97%. The remaining low risk of bias studies were in military members, and were not synthesized. CONCLUSION The worldwide incidence of SCD is a rare event. Low risk of bias studies indicate incidence to be below 2 per 100,000 athlete years. Overall, the quality of the evidence available is low, but there are high quality individual studies to inform the question of incidence levels. PROSPERO Registration: CRD42019125560.
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Affiliation(s)
- Aaron Lear
- Cleveland Clinic Akron General, Akron, OH USA
| | | | | | | | - Vince Leone
- Northeast Ohio Medical University (NEOMED), Akron, OH USA
| | | | - David Nunan
- University of Oxford, Oxford, UK Twitter: @dnunan79
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For the Evaluation of Pacific Island Athletes, an ECG and Echocardiography Are Highly Recommended. HEARTS 2021. [DOI: 10.3390/hearts2020021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Physical exercise increases the relative risk of sudden cardiac death (SCD) in athletes when compared to a non-sporting population. Pre-participation evaluation (PPE) of athletes is thus of major importance. For Pacific Island athletes, medical guidelines recommend an echocardiography to complement a PPE including personal and family history, a physical examination and a resting twelve-lead electrocardiogram (ECG). Indeed, silent rheumatoid heart diseases found in up to 7.6% of adolescents give rise to severe valve lesions, which are the main causes of SCD in Pacific Island athletes. This short review examines the incidence rate of SCD in Pacific Island athletes and indicates how a questionnaire, physical examination, ECG and echocardiography can prevent it.
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Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, Collet JP, Corrado D, Drezner JA, Halle M, Hansen D, Heidbuchel H, Myers J, Niebauer J, Papadakis M, Piepoli MF, Prescott E, Roos-Hesselink JW, Graham Stuart A, Taylor RS, Thompson PD, Tiberi M, Vanhees L, Wilhelm M. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J 2021; 42:17-96. [PMID: 32860412 DOI: 10.1093/eurheartj/ehaa605] [Citation(s) in RCA: 751] [Impact Index Per Article: 250.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Abstract
Although the specific content has been recommended, debated, and extensively reviewed over the past several decades, the preparticipation evaluation (PPE) has become standard of care for athletes as they prepare for organized athletic participation. The PPE seeks to detect conditions that predispose the athlete to injury or limit full participation in certain activities. Of particular interest, underlying cardiovascular and musculoskeletal conditions are sought because they are frequently associated with mortality and morbidity in athletes.
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Abstract
Primary care clinicians fulfill critical roles of screening for, diagnosing, and managing cardiovascular disease. In young athletes, primary structural and electrical diseases are the focus. Coronary artery disease is the chief concern in older athletes. Sudden cardiac arrest may be the initial presentation of disease and is more common in young athletes than historically appreciated. The traditional preparticipation evaluation, or sports physical, is limited in its ability to accurately raise suspicion of underlying disease. The 12-lead electrocardiogram is a more accurate screening tool. Contemporary risk stratification and treatment protocols may allow for safe return to sport on a case-by-case basis.
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Affiliation(s)
- David M Siebert
- Department of Family Medicine, UW Medicine Center for Sports Cardiology, University of Washington, 3800 Montlake Boulevard NE, Seattle, WA 98195, USA.
| | - Jonathan A Drezner
- Department of Family Medicine, UW Medicine Center for Sports Cardiology, University of Washington, 3800 Montlake Boulevard NE, Seattle, WA 98195, USA
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Abstract
PURPOSE OF REVIEW The optimal approach to screening young people to decrease the risk of sudden death remains unknown. It deserves the passionate attention that researchers, clinicians and families have given it. The new data from January 2018 to July 2019 are reviewed here. RECENT FINDINGS Cardiac findings associated with a risk of sudden death were reported in 0.4% of screened athletes. Well run programs continue report varying sensitivity for screening ECGs (between 86 and 100%). One major article reported a higher incidence of sudden death in young people than has been previously published (6.8/100 000 athletes). SUMMARY The rate of important findings in sophisticated screening programs is approximately 0.4%, suggesting that this is near the population rate of detectable disease in most athletic groups. ECGs are unquestionably capable of detecting disease that can be missed by history and physical, but the performance characteristics of ECGs continue to vary from study to study. In addition, the underlying cost and infrastructure of ECG and echocardiographic screening remains unaddressed by the recent literature. A few small studies have started to look at alternative technology approaches to ECG screening. VIDEO ABSTRACT.
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Chatard JC, Espinosa F, Donnadieu R, Grangeon JP, Sabot JM, Guivarch C, Dacquin R, Raby FX, Papouin G, Viali S, Braunstein C, Gerbay A, Roche F, Isaaz K, Barthélémy JC, Carré F. Pre-participation cardiovascular evaluation in Pacific Island athletes. Int J Cardiol 2019; 278:273-279. [PMID: 30579721 DOI: 10.1016/j.ijcard.2018.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/23/2018] [Accepted: 11/05/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Pre-participation cardiovascular evaluation (PPE) aims to detect cardiac disease with sudden cardiac death (SCD) risk. No study has focused on Pacific Island athletes. METHODS A total of 2281 Pacific Island athletes were studied with (i) a questionnaire on family, personal history and symptoms, (ii) a physical examination and (iii) a 12-lead ECG. RESULTS 85% presented a normal history and examination. A positive family history was 1.4-1.9 fold higher in Melanesians, Polynesians and Métis than in Caucasians, while a positive personal history, abnormal symptoms and abnormal examination was 1.3 fold higher in Melanesians and Métis than in others. Neither gender nor training level had a bearing on these results. Melanesians had higher T wave inversions (TWIs) in V2-V4 leads but had no CV abnormalities. Lateral or infero-lateral TWIs were found in 6 male and in 5 highly trained athletes and cardiomyopathies were diagnosed in 3/6 athletes. Overall, 3.9% athletes were found to have a CV abnormality and 0.8% had a risk of SCD. Polynesians and males were more at risk than the others while the level of training made no difference. In athletes at risk of SCD, the main detected CV diseases were cardiomyopathies, Wolff-Parkinson-White (WPW) and severe valve lesions of rheumatoid origin. CONCLUSIONS PPE revealed that 3.9% presented CV abnormalities. A risk of SCD was found in 0.8% with cardiomyopathies, WPW, and severe valve lesions of rheumatoid origin. Melanesians, Polynesians and male of high level of training were more at risk than others.
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Affiliation(s)
- Jean-Claude Chatard
- Inter-university Laboratory of Human Movement Science, Faculty of Medicine Jacques Lisfranc, University Lyon-Saint-Etienne, 42023 Saint-Etienne, France.
| | - Florian Espinosa
- Department of Cardiology, Faculty of Medicine Jacques Lisfranc, University Lyon-Saint-Etienne, 42023 Saint-Etienne, France
| | | | | | | | | | | | | | - Gérard Papouin
- Department of cardiology, Taone Hospital, Tahiti, French Polynesia
| | - Satu Viali
- Department of cardiology, Apia Hospital, Samoa
| | - Corinne Braunstein
- Department of cardiology, Gaston Bourret Hospital, Noumea, New Caledonia
| | - Antoine Gerbay
- Department of Cardiology, Faculty of Medicine Jacques Lisfranc, University Lyon-Saint-Etienne, 42023 Saint-Etienne, France
| | - Frédéric Roche
- Laboratory of Autonomous Nervous System, Faculty of Medicine Jacques Lisfranc, University Lyon-Saint-Etienne, 42023 Saint-Etienne, France
| | - Karl Isaaz
- Department of Cardiology, Faculty of Medicine Jacques Lisfranc, University Lyon-Saint-Etienne, 42023 Saint-Etienne, France
| | - Jean-Claude Barthélémy
- Laboratory of Autonomous Nervous System, Faculty of Medicine Jacques Lisfranc, University Lyon-Saint-Etienne, 42023 Saint-Etienne, France
| | - François Carré
- CHU Pontchaillou, University of Rennes 1, INSERM U1099, France
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17
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Tague L, Wiggs J, Li Q, McCarter R, Sherwin E, Weinberg J, Sable C. Comparison of Left Ventricular Hypertrophy by Electrocardiography and Echocardiography in Children Using Analytics Tool. Pediatr Cardiol 2018; 39:1378-1388. [PMID: 29774391 DOI: 10.1007/s00246-018-1907-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/08/2018] [Indexed: 12/16/2022]
Abstract
Left ventricular hypertrophy (LVH) is a common finding on pediatric electrocardiography (ECG) leading to many referrals for echocardiography (echo). This study utilizes a novel analytics tool that combines ECG and echo databases to evaluate ECG as a screening tool for LVH. SQL Server 2012 data warehouse incorporated ECG and echo databases for all patients from a single institution from 2006 to 2016. Customized queries identified patients 0-18 years old with LVH on ECG and an echo performed within 24 h. Using data visualization (Tableau) and analytic (Stata 14) software, ECG and echo findings were compared. Of 437,699 encounters, 4637 met inclusion criteria. ECG had high sensitivity (≥ 90%) but poor specificity (43%), and low positive predictive value (< 20%) for echo abnormalities. ECG performed only 11-22% better than chance (AROC = 0.50). 83% of subjects with LVH on ECG had normal left ventricle (LV) structure and size on echo. African-Americans with LVH were least likely to have an abnormal echo. There was a low correlation between V6R on ECG and echo-derived Z score of left ventricle diastolic diameter (r = 0.14) and LV mass index (r = 0.24). The data analytics client was able to mine a database of ECG and echo reports, comparing LVH by ECG and LV measurements and qualitative findings by echo, identifying an abnormal LV by echo in only 17% of cases with LVH on ECG. This novel tool is useful for rapid data mining for both clinical and research endeavors.
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Affiliation(s)
- Lauren Tague
- Division of Cardiology, Children's National Health System, Washington, DC, USA.
- Department of Cardiology, Children's National Health System, 111 Michigan Avenue NW, Suite WW3-200, Washington, DC, 20010, USA.
| | - Justin Wiggs
- Division of Cardiology, Children's National Health System, Washington, DC, USA
| | - Qianxi Li
- Philips Research North America, Cambridge, MA, USA
| | - Robert McCarter
- Division of Biostatistics and Study Methods, Children's National Health System, Washington, DC, USA
| | - Elizabeth Sherwin
- Division of Cardiology, Children's National Health System, Washington, DC, USA
| | - Jacqueline Weinberg
- Division of Cardiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Craig Sable
- Division of Cardiology, Children's National Health System, Washington, DC, USA
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18
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Malhotra A, Dhutia H, Finocchiaro G, Gati S, Beasley I, Clift P, Cowie C, Kenny A, Mayet J, Oxborough D, Patel K, Pieles G, Rakhit D, Ramsdale D, Shapiro L, Somauroo J, Stuart G, Varnava A, Walsh J, Yousef Z, Tome M, Papadakis M, Sharma S. Outcomes of Cardiac Screening in Adolescent Soccer Players. N Engl J Med 2018; 379:524-534. [PMID: 30089062 DOI: 10.1056/nejmoa1714719] [Citation(s) in RCA: 172] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Reports on the incidence and causes of sudden cardiac death among young athletes have relied largely on estimated rates of participation and varied methods of reporting. We sought to investigate the incidence and causes of sudden cardiac death among adolescent soccer players in the United Kingdom. METHODS From 1996 through 2016, we screened 11,168 adolescent athletes with a mean (±SD) age of 16.4±1.2 years (95% of whom were male) in the English Football Association (FA) cardiac screening program, which consisted of a health questionnaire, physical examination, electrocardiography, and echocardiography. The FA registry was interrogated to identify sudden cardiac deaths, which were confirmed with autopsy reports. RESULTS During screening, 42 athletes (0.38%) were found to have cardiac disorders that are associated with sudden cardiac death. A further 225 athletes (2%) with congenital or valvular abnormalities were identified. After screening, there were 23 deaths from any cause, of which 8 (35%) were sudden deaths attributed to cardiac disease. Cardiomyopathy accounted for 7 of 8 sudden cardiac deaths (88%). Six athletes (75%) with sudden cardiac death had had normal cardiac screening results. The mean time between screening and sudden cardiac death was 6.8 years. On the basis of a total of 118,351 person-years, the incidence of sudden cardiac death among previously screened adolescent soccer players was 1 per 14,794 person-years (6.8 per 100,000 athletes). CONCLUSIONS Diseases that are associated with sudden cardiac death were identified in 0.38% of adolescent soccer players in a cohort that underwent cardiovascular screening. The incidence of sudden cardiac death was 1 per 14,794 person-years, or 6.8 per 100,000 athletes; most of these deaths were due to cardiomyopathies that had not been detected on screening. (Funded by the English Football Association and others.).
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Affiliation(s)
- Aneil Malhotra
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Harshil Dhutia
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Gherardo Finocchiaro
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Sabiha Gati
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Ian Beasley
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Paul Clift
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Charlotte Cowie
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Antoinette Kenny
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Jamil Mayet
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - David Oxborough
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Kiran Patel
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Guido Pieles
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Dhrubo Rakhit
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - David Ramsdale
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Leonard Shapiro
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - John Somauroo
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Graham Stuart
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Amanda Varnava
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - John Walsh
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Zaheer Yousef
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Maite Tome
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Michael Papadakis
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Sanjay Sharma
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
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AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current Evidence, Knowledge Gaps, Recommendations, and Future Directions: Erratum. Clin J Sport Med 2018; 28:324. [PMID: 29762263 DOI: 10.1097/jsm.0000000000000382] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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20
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Drezner JA, O'Connor FG, Harmon KG, Fields KB, Asplund CA, Asif IM, Price DE, Dimeff RJ, Bernhardt DT, Roberts WO. AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current Evidence, Knowledge Gaps, Recommendations and Future Directions. Curr Sports Med Rep 2017; 15:359-75. [PMID: 27618246 DOI: 10.1249/jsr.0000000000000296] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cardiovascular screening in young athletes is widely recommended and routinely performed prior to participation in competitive sports. While there is general agreement that early detection of cardiac conditions at risk for sudden cardiac arrest and death (SCA/D) is an important objective, the optimal strategy for cardiovascular screening in athletes remains an issue of considerable debate. At the center of the controversy is the addition of a resting electrocardiogram (ECG) to the standard preparticipation evaluation using history and physical examination. The American Medical Society for Sports Medicine (AMSSM) formed a task force to address the current evidence and knowledge gaps regarding preparticipation cardiovascular screening in athletes from the perspective of a primary care sports medicine physician. The absence of definitive outcomes-based evidence at this time precludes AMSSM from endorsing any single or universal cardiovascular screening strategy for all athletes, including legislative mandates. This statement presents a new paradigm to assist the individual physician in assessing the most appropriate cardiovascular screening strategy unique to their athlete population, community needs, and resources. The decision to implement a cardiovascular screening program, with or without the addition of ECG, necessitates careful consideration of the risk of SCA/D in the targeted population and the availability of cardiology resources and infrastructure. Importantly, it is the individual physician's assessment in the context of an emerging evidence-base that the chosen model for early detection of cardiac disorders in the specific population provides greater benefit than harm. AMSSM is committed to advancing evidenced-based research and educational initiatives that will validate and promote the most efficacious strategies to foster safe sport participation and reduce SCA/D in athletes.
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Affiliation(s)
- Jonathan A Drezner
- 1Department of Family Medicine, University of Washington, Seattle, WA; 2Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; 3Department of Family Medicine, University of North Carolina, Greensboro, NC; 4Department of Health and Kinesiology, Georgia Southern University, Statesboro, GA; 5Department of Family Medicine, University of South Carolina Greenville School of Medicine, Greenville, SC; 6Department of Family Medicine, Carolinas Healthcare System, Charlotte, NC; 7Departments of Orthopedic Surgery, Family & Community Medicine, and Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; 8Departments of Pediatrics, Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI; 9Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
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21
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Drezner JA, O'Connor FG, Harmon KG, Fields KB, Asplund CA, Asif IM, Price DE, Dimeff RJ, Bernhardt DT, Roberts WO. AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current evidence, knowledge gaps, recommendations and future directions. Br J Sports Med 2016; 51:153-167. [PMID: 27660369 DOI: 10.1136/bjsports-2016-096781] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 11/04/2022]
Abstract
Cardiovascular screening in young athletes is widely recommended and routinely performed prior to participation in competitive sports. While there is general agreement that early detection of cardiac conditions at risk for sudden cardiac arrest and death (SCA/D) is an important objective, the optimal strategy for cardiovascular screening in athletes remains an issue of considerable debate. At the centre of the controversy is the addition of a resting ECG to the standard preparticipation evaluation using history and physical examination. The American Medical Society for Sports Medicine (AMSSM) formed a task force to address the current evidence and knowledge gaps regarding preparticipation cardiovascular screening in athletes from the perspective of a primary care sports medicine physician. The absence of definitive outcome-based evidence at this time precludes AMSSM from endorsing any single or universal cardiovascular screening strategy for all athletes, including legislative mandates. This statement presents a new paradigm to assist the individual physician in assessing the most appropriate cardiovascular screening strategy unique to their athlete population, community needs and resources. The decision to implement a cardiovascular screening programme, with or without the addition of ECG, necessitates careful consideration of the risk of SCA/D in the targeted population and the availability of cardiology resources and infrastructure. Importantly, it is the individual physician's assessment in the context of an emerging evidence base that the chosen model for early detection of cardiac disorders in the specific population provides greater benefit than harm. AMSSM is committed to advancing evidenced-based research and educational initiatives that will validate and promote the most efficacious strategies to foster safe sport participation and reduce SCA/D in athletes.
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Affiliation(s)
- Jonathan A Drezner
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Francis G O'Connor
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Kimberly G Harmon
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Karl B Fields
- Department of Family Medicine, University of North Carolina, Greensboro, North Carolina, USA
| | - Chad A Asplund
- Department of Health and Kinesiology, Georgia Southern University, Statesboro, Georgia, USA
| | - Irfan M Asif
- Department of Family Medicine, University of South Carolina Greenville School of Medicine, Greenville, South Carolina, USA
| | - David E Price
- Department of Family Medicine, Carolinas Healthcare System, Charlotte, North Carolina, USA
| | - Robert J Dimeff
- Departments of Orthopedic Surgery, Family and Community Medicine, and Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - David T Bernhardt
- Departments of Pediatrics, Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - William O Roberts
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
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22
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Ghani S, Papadakis M, Kemp S, Zaidi A, Sheikh N, Gati S, Raju H, Smith A, Palmer C, Somauroo J, Sharma S. Results of a nationally implemented de novo cardiac screening programme in elite rugby players in England. Br J Sports Med 2016; 50:1338-1344. [PMID: 27340147 DOI: 10.1136/bjsports-2015-095902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIM Screening of young competitive athletes remains a contentious issue. In 2010, a nationwide cardiac screening for all elite rugby players was introduced in England. This provided a unique opportunity to prospectively assess the feasibility and cost-effectiveness of a de novo, ECG-based cardiac screening programme. METHODS Between 2010 and 2012, 1191 rugby players aged ≥14 years underwent cardiac screening with a health questionnaire, 12-lead ECG and a consultation with a cardiologist. The players with concerning findings on initial evaluation were offered on-site transthoracic echocardiogram (TTE). Athletes were referred for further investigations as deemed necessary. The overall cost of the screening programme was estimated. RESULTS After initial evaluation, 9.7% of athletes underwent on-site TTE; 8.2% underwent on-site TTE due to ECG anomalies and 1.4% underwent on-site TTE due to concerns on the questionnaire. After TTE, only 2.9% of the total cohort was referred for further evaluation. Two players were diagnosed with potentially serious conditions; one with Wolff-Parkinson-White, who resumed competition after catheter ablation, and one with hypertrophic cardiomyopathy, who withdrew from competition. During a mean follow-up of 52.8±5.5 months, none of the players who were reassured experienced any adverse cardiac events. The total cost of the screening programme was £59 875, which averaged to a cost of £50 per player or £29 938 per condition identified. Application of refined ECG criteria would reduce the ECG false-positive rate to 4.9%. CONCLUSIONS Preparticipation cardiac screening with 12-lead ECG is feasible. Refinement of the ECG criteria, the use of on-site TTE and expert setting can minimise the burden of unnecessary investigations and reduce costs.
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Affiliation(s)
- Saqib Ghani
- Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
| | - Michael Papadakis
- Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
| | | | - Abbas Zaidi
- Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
| | - Nabeel Sheikh
- Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
| | - Sabiha Gati
- Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
| | - Hariharan Raju
- Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
| | - Andy Smith
- Mid Yorkshire Hospital NHS Trust, Wakefield, UK.,RWC England 2015 Medical Advisory Group.,Premiership Rugby, Twickenham, UK
| | | | - John Somauroo
- Countess of Chester NHS Hospital Trust, UK.,Liverpool Heart and Chest NHS Hospital Trust, Liverpool, UK
| | - Sanjay Sharma
- Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
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Hainline B, Drezner J, Baggish A, Harmon KG, Emery MS, Myerburg RJ, Sanchez E, Molossi S, Parsons JT, Thompson PD. Interassociation consensus statement on cardiovascular care of college student-athletes. Br J Sports Med 2016; 51:74-85. [PMID: 27247099 DOI: 10.1136/bjsports-2016-096323] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 12/24/2022]
Abstract
Cardiovascular evaluation and care of college student-athletes is gaining increasing attention from both the public and medical communities. Emerging strategies include screening of the general athlete population, recommendations of permissible levels of participation by athletes with identified cardiovascular conditions and preparation for responding to unanticipated cardiac events in athletic venues. The primary focus has been sudden cardiac death and the usefulness of screening with or without advanced cardiac screening. The National Collegiate Athletic Association convened a multidisciplinary task force to address cardiovascular concerns in collegiate student-athletes, and to develop consensus for an interassociation statement. This document summarises the task force deliberations and follow-up discussions, and includes available evidence on cardiovascular risk, preparticipation evaluation and the recognition of and response to cardiac arrest. Future recommendations for cardiac research initiatives, education and collaboration are also provided.
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Affiliation(s)
- Brian Hainline
- Sport Science Institute, National Collegiate Athletic Association, Indianapolis, Indiana, USA
| | - Jonathan Drezner
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kimberly G Harmon
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Michael S Emery
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Robert J Myerburg
- Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Silvana Molossi
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - John T Parsons
- Sport Science Institute, National Collegiate Athletic Association, Indianapolis, Indiana, USA
| | - Paul D Thompson
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut, USA
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Hainline B, Drezner JA, Baggish A, Harmon KG, Emery MS, Myerburg RJ, Sanchez E, Molossi S, Parsons JT, Thompson PD. Interassociation Consensus Statement on Cardiovascular Care of College Student-Athletes. J Am Coll Cardiol 2016; 67:2981-95. [PMID: 27090220 DOI: 10.1016/j.jacc.2016.03.527] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 10/21/2022]
Abstract
Cardiovascular evaluation and care of college student-athletes is gaining increasing attention from both the public and medical communities. Emerging strategies include screening of the general athlete population, recommendations of permissible levels of participation by athletes with identified cardiovascular conditions, and preparation for responding to unanticipated cardiac events in athletic venues. The primary focus has been sudden cardiac death and the utility of screening with or without advanced cardiac screening. The National Collegiate Athletic Association convened a multidisciplinary task force to address cardiovascular concerns in collegiate student-athletes and to develop consensus for an interassociation statement. This document summarizes the task force deliberations and follow-up discussions, and includes available evidence on cardiovascular risk, pre-participation evaluation, and the recognition of and response to cardiac arrest. Future recommendations for cardiac research initiatives, education, and collaboration are also provided.
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Affiliation(s)
- Brian Hainline
- Sport Science Institute, National Collegiate Athletic Association, Indianapolis, Indiana.
| | - Jonathan A Drezner
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Kimberly G Harmon
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Michael S Emery
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Robert J Myerburg
- Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Silvana Molossi
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - John T Parsons
- Sport Science Institute, National Collegiate Athletic Association, Indianapolis, Indiana
| | - Paul D Thompson
- Division of Cardiology, Hartford Hospital, Hartford, Connecticut
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Hainline B, Drezner J, Baggish A, Harmon KG, Emery MS, Myerburg RJ, Sanchez E, Molossi S, Parsons JT, Thompson PD. Interassociation Consensus Statement on Cardiovascular Care of College Student-Athletes. J Athl Train 2016; 51:344-57. [PMID: 27111694 PMCID: PMC4874378 DOI: 10.4085/j.jacc.2016.03.527] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 11/09/2022]
Abstract
Cardiovascular evaluation and care of college student-athletes is gaining increasing attention from both the public and medical communities. Emerging strategies include screening of the general athlete population, recommendations of permissible levels of participation by athletes with identified cardiovascular conditions, and preparation for responding to unanticipated cardiac events in athletic venues. The primary focus has been sudden cardiac death and the utility of screening with or without advanced cardiac screening. The National Collegiate Athletic Association convened a multidisciplinary task force to address cardiovascular concerns in collegiate student-athletes and to develop consensus for an interassociation statement. This document summarizes the task force deliberations and follow-up discussions, and includes available evidence on cardiovascular risk, pre-participation evaluation, and the recognition of and response to cardiac arrest. Future recommendations for cardiac research initiatives, education, and collaboration are also provided. (J Am Coll Cardiol 2016;doi: 10.1016/j.jacc.2016.03.527.)
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Affiliation(s)
- Brian Hainline
- From the a Sport Science Institute, National Collegiate Athletic Association, Indianapolis, Indiana
| | - Jonathan Drezner
- b Department of Family Medicine, University of Washington, Seattle, Washington
| | - Aaron Baggish
- c Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Kimberly G Harmon
- b Department of Family Medicine, University of Washington, Seattle, Washington
| | - Michael S Emery
- d Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Robert J Myerburg
- e Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Silvana Molossi
- g Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; and the
| | - John T Parsons
- From the a Sport Science Institute, National Collegiate Athletic Association, Indianapolis, Indiana
| | - Paul D Thompson
- h Division of Cardiology, Hartford Hospital, Hartford, Connecticut
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Sammito S, Gundlach N, Böckelmann I. Correlation between the results of three physical fitness tests (endurance, strength, speed) and the output measured during a bicycle ergometer test in a cohort of military servicemen. Mil Med Res 2016; 3:12. [PMID: 27110382 PMCID: PMC4842291 DOI: 10.1186/s40779-016-0083-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 04/12/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Physical fitness tests are widely used to assess endurance, sprint ability, coordination and/or strength. The objective of the present study was to analyze the degree to which the results of the Bundeswehr Basis Fitness Test (BFT)--a physical fitness test comprising a sprint test (11 × 10-m shuttle test), a flexed-arm hang test and a 1000-m run--are consistent with the output measured during a bicycle ergometer test. The number of false-positive and false-negative results with regard to the assessment of physical fitness were also examined. METHODS As part of a retrospective study, health assessments from 323 reenlistment examinations were evaluated regarding the output measured during a bicycle ergometer test and compared with the BFT results of the candidates. RESULTS Overall, a good correlation was shown between the bicycle ergometer test results and the results achieved in the BFT disciplines. All three disciplines of the BFT showed a highly significant correlation with the relative output achieved during the bicycle ergometer test (P < 0.001), and also, the overall BFT score was highly significantly correlated (P < 0.001). The overall rate of false-positive and false-negative results was 4.0 %. CONCLUSIONS The BFT results measured in the three physical fitness test items were highly correlated with the output measured during the bicycle ergometer tests. The rate of false-positive and false-negative results was low. The test items thus represent an appropriate measurement instrument because the test items require few equipment and less time. Additionally, a large number of subjects can be assessed. We suggest that it would be more useful to assess the physical fitness of this special group exclusively on the basis of the BFT instead of using the bicycle ergometer test.
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Affiliation(s)
- Stefan Sammito
- Bundeswehr Medical Service Headquarters, Section Health Promotion, Sports and Nutrition Medicine, Koblenz, Germany ; Otto von Guericke University Magdeburg, Medical Faculty, Department of Occupational Medicine, Magdeburg, Germany
| | - Nils Gundlach
- Bundeswehr Medical Clinic Rotenburg, Rotenburg (Wümme), Germany
| | - Irina Böckelmann
- Otto von Guericke University Magdeburg, Medical Faculty, Department of Occupational Medicine, Magdeburg, Germany
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27
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Revisiting the challenges of universal screening for long QT syndrome. J Electrocardiol 2015; 48:1053-7. [DOI: 10.1016/j.jelectrocard.2015.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Indexed: 11/18/2022]
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28
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Chatard JC, Mujika I, Goiriena JJ, Carré F. Screening young athletes for prevention of sudden cardiac death: Practical recommendations for sports physicians. Scand J Med Sci Sports 2015; 26:362-74. [PMID: 26432052 DOI: 10.1111/sms.12502] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 12/13/2022]
Abstract
Regular intensive exercise in athletes increases the relative risk of sudden cardiac death (SCD) compared with the relatively sedentary population. Most cases of SCD are due to silent cardiovascular diseases, and pre-participation screening of athletes at risk of SCD is thus of major importance. However, medical guidelines and recommendations differ widely between countries. In Italy, the National Health System recommends pre-participation screening for all competitive athletes including personal and family history, a physical examination, and a resting 12-lead electrocardiogram (ECG). In the United States, the American College of Cardiology and the American Heart Association recommend a pre-participation screening program limited to the use of specific questionnaires and a clinical examination. The value of a 12-lead ECG is debated based on issues surrounding cost-efficiency and feasibility. The aim of this review was to focus on (i) the incidence rate of cardiac diseases in relation to SCD; (ii) the value of conducting a questionnaire and a physical examination; (iii) the value of a 12-lead resting ECG; (iv) the importance of other cardiac evaluations in the prevention of SCD; and (v) the best practice for pre-participation screening.
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Affiliation(s)
- J-C Chatard
- Laboratory of Exercise Physiology, Faculty of Medicine Jacques Lisfranc, University of Lyon-Saint-Etienne, Saint-Etienne, France
| | - I Mujika
- Department of Physiology, Faculty of Medicine and Odontology, University of the Basque Country, Leioa, Basque Country, Spain.,School of Kinesiology and Health Research Center, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - J J Goiriena
- Department of Physiology, Faculty of Medicine and Odontology, University of the Basque Country, Leioa, Basque Country, Spain
| | - F Carré
- Laboratory of Exercise Physiology, Faculty of Medicine, University of Rennes, Rennes, France
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29
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Conley KM, Bolin DJ, Carek PJ, Konin JG, Neal TL, Violette D. National Athletic Trainers' Association position statement: Preparticipation physical examinations and disqualifying conditions. J Athl Train 2015; 49:102-20. [PMID: 24499039 DOI: 10.4085/1062-6050-48.6.05] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To present athletic trainers with recommendations for the content and administration of the preparticipation physical examination (PPE) as well as considerations for determining safe participation in sports and identifying disqualifying conditions. BACKGROUND Preparticipation physical examinations have been used routinely for nearly 40 years. However, considerable debate exists as to their efficacy due to the lack of standardization in the process and the lack of conformity in the information that is gathered. With the continuing rise in sports participation at all levels and the growing number of reported cases of sudden death in organized athletics, the sports medicine community should consider adopting a standardized process for conducting the PPE to protect all parties. RECOMMENDATIONS Recommendations are provided to equip the sports medicine community with the tools necessary to conduct the PPE as effectively and efficiently as possible using available scientific evidence and best practices. In addition, the recommendations will help clinicians identify those conditions that may threaten the health and safety of participants in organized sports, may require further evaluation and intervention, or may result in potential disqualification.
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30
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Screening of sarcomere gene mutations in young athletes with abnormal findings in electrocardiography: identification of a MYH7 mutation and MYBPC3 mutations. J Hum Genet 2015; 60:641-5. [PMID: 26178432 DOI: 10.1038/jhg.2015.81] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 05/15/2015] [Accepted: 06/15/2015] [Indexed: 11/09/2022]
Abstract
There is an overlap between the physiological cardiac remodeling associated with training in athletes, the so-called athlete's heart, and mild forms of hypertrophic cardiomyopathy (HCM), the most common hereditary cardiac disease. HCM is often accompanied by unfavorable outcomes including a sudden cardiac death in the adolescents. Because one of the initial signs of HCM is abnormality in electrocardiogram (ECG), athletes may need to monitor for ECG findings to prevent any unfavorable outcomes. HCM is caused by mutations in genes for sarcomere proteins, but there is no report on the systematic screening of gene mutations in athletes. One hundred and two genetically unrelated young Japanese athletes with abnormal ECG findings were the subjects for the analysis of four sarcomere genes, MYH7, MYBPC3, TNNT2 and TNNI3. We found that 5 out of 102 (4.9%) athletes carried mutations: a heterozygous MYH7 Glu935Lys mutation, a heterozygous MYBPC3 Arg160Trp mutation and another heterozygous MYBPC3 Thr1046Met mutation, all of which had been reported as HCM-associated mutations, in 1, 2 and 2 subjects, respectively. This is the first study of systematic screening of sarcomere gene mutations in a cohort of athletes with abnormal ECG, demonstrating the presence of sarcomere gene mutations in the athlete's heart.
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Abstract
Echocardiography is currently a widely available imaging technique that can provide useful data in the field of sports cardiology particularly in two areas: pre-participation screening and analysis of the cardiac adaptation induced by exercise. The application of pre-participation screening and especially, the type and number of used diagnostic tests remains controversial. Echocardiography has shown though, higher sensitivity and specificity as compared to the ECG, following a protocol adapted to athletes focused on ruling out the causes of sudden death and the most common disorders in this population. It is still a subject of controversy the actual cost of adding it, but depending on the type of sport, echocardiography might be cost-effective if added in the first line of examination. Regarding the evaluation of cardiac adaptation to training in athletes, echocardiography has proved to be useful in the differential diagnosis of diseases that can cause sudden death, analysing both the left ventricle (hypertrophy cardiomyopathy, dilated cardiomyopathy, left ventricle non compaction) and the right ventricle (arrhythmogenic right ventricular cardiomyopathy). The aim of this paper is to review the current knowledge and the clinical practical implications of it on the field of echocardiography when applied in sport cardiology areas.
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Affiliation(s)
- Gonzalo Grazioli
- Cardiology Department, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Institut d'Investigacions Biomèdiques August Pi iSunyer, Barcelona, Catalonia, Spain
| | - Maria Sanz
- Cardiology Department, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Institut d'Investigacions Biomèdiques August Pi iSunyer, Barcelona, Catalonia, Spain
| | - Silvia Montserrat
- Cardiology Department, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Institut d'Investigacions Biomèdiques August Pi iSunyer, Barcelona, Catalonia, Spain
| | - Bàrbara Vidal
- Cardiology Department, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Institut d'Investigacions Biomèdiques August Pi iSunyer, Barcelona, Catalonia, Spain
| | - Marta Sitges
- Cardiology Department, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Institut d'Investigacions Biomèdiques August Pi iSunyer, Barcelona, Catalonia, Spain
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Kim JH, Baggish AL. Electrocardiographic right and left bundle branch block patterns in athletes: Prevalence, pathology, and clinical significance. J Electrocardiol 2015; 48:380-4. [DOI: 10.1016/j.jelectrocard.2015.03.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Indexed: 01/02/2023]
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The effectiveness of screening history, physical exam, and ECG to detect potentially lethal cardiac disorders in athletes: A systematic review/meta-analysis. J Electrocardiol 2015; 48:329-38. [DOI: 10.1016/j.jelectrocard.2015.02.001] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Indexed: 11/22/2022]
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Haberman ZC, Jahn RT, Bose R, Tun H, Shinbane JS, Doshi RN, Chang PM, Saxon LA. Wireless Smartphone ECG Enables Large-Scale Screening in Diverse Populations. J Cardiovasc Electrophysiol 2015; 26:520-6. [PMID: 25651872 DOI: 10.1111/jce.12634] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/29/2015] [Accepted: 02/01/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND The ubiquitous presence of internet-connected phones and tablets presents a new opportunity for cost-effective and efficient electrocardiogram (ECG) screening and on-demand diagnosis. Wireless, single-lead real-time ECG monitoring supported by iOS and android devices can be obtained quickly and on-demand. ECGs can be immediately downloaded and reviewed using any internet browser. OBJECTIVE We compared the standard 12-lead ECG to the smartphone ECG in healthy young adults, elite athletes, and cardiology clinic patients. Accuracy for determining baseline ECG intervals and rate and rhythm was assessed. METHODS In 381 participants, 30-second lead I ECG waveforms were obtained using an iPhone case or iPad. Standard 12-lead ECGs were acquired immediately after the smartphone tracing was obtained. De-identified ECGs were interpreted by automated algorithms and adjudicated by two board-certified electrophysiologists. RESULTS Both smartphone and standard ECGs detected atrial rate and rhythm, AV block, and QRS delay with equal accuracy. Sensitivities ranged from 72% (QRS delay) to 94% (atrial fibrillation). Specificities were all above 94% for both modalities. CONCLUSION Smartphone ECG accurately detects baseline intervals, atrial rate, and rhythm and enables screening in diverse populations. Efficient ECG analysis using automated discrimination and an enhanced smartphone application with notification capabilities are features that can be easily incorporated into the acquisition process.
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Affiliation(s)
| | - Ryan T Jahn
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Rupan Bose
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Han Tun
- Keck School of Medicine of USC, Los Angeles, California, USA
| | | | - Rahul N Doshi
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Philip M Chang
- Keck School of Medicine of USC, Los Angeles, California, USA
| | - Leslie A Saxon
- Keck School of Medicine of USC, Los Angeles, California, USA
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Abstract
Screening for conditions associated with sudden cardiac arrest in the United States (US) is aimed at high school athletes in most states and utilizes a preparticipation history and physical form that is not standardized across the US. In Italy, data have shown that their incidence of sudden cardiac arrest has decreased significantly after implementation of an electrocardiographic-based screening program including history and physical exam. The American Heart Association recommendations do not include an electrocardiogram. A recent AHA statement has suggested that those screening athletes should consider all children of similar ages in the selected venue, but still should not include an electrocardiogram. A number of models of screening are presented along with a best practice recommendation for further evaluation and study.
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Affiliation(s)
- Victoria L Vetter
- The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA.
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36
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Abstract
Sudden cardiac death in the young is a relatively uncommon but marked event usually related to congenital diseases or anomalies. Despite the prevalence of each condition being variable, most common causes include primary myocardial diseases and arrhythmic disorder, frequently with inheritance pattern. Sudden cardiac death is usually preceded by symptoms, thus making personal and family history fundamental for its prevention. Nevertheless, in more than 50% of cases, sudden cardiac death is the first manifestation of the disease. In this review, we describe the different causes of sudden cardiac death, their incidence, and currently used preventive strategies.
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Asif IM, Harmon KG. The Role of Screening for Sudden Cardiac Death in Young Competitive Athletes: A Critical Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-014-0072-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Vetter VL. Electrocardiographic screening of all infants, children, and teenagers should be performed. Circulation 2015; 130:688-97; discussion 697. [PMID: 25135125 DOI: 10.1161/circulationaha.114.009737] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Victoria L Vetter
- From The Children's Hospital of Philadelphia, and Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA.
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Maron BJ, Friedman RA, Kligfield P, Levine BD, Viskin S, Chaitman BR, Okin PM, Saul JP, Salberg L, Van Hare GF, Soliman EZ, Chen J, Matherne GP, Bolling SF, Mitten MJ, Caplan A, Balady GJ, Thompson PD. Assessment of the 12-Lead ECG as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12–25 Years of Age). Circulation 2014; 130:1303-34. [DOI: 10.1161/cir.0000000000000025] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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40
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Maron BJ, Friedman RA, Kligfield P, Levine BD, Viskin S, Chaitman BR, Okin PM, Saul JP, Salberg L, Van Hare GF, Soliman EZ, Chen J, Matherne GP, Bolling SF, Mitten MJ, Caplan A, Balady GJ, Thompson PD. Assessment of the 12-lead electrocardiogram as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 years of age): a scientific statement from the American Heart Association and the American College of Cardiology. J Am Coll Cardiol 2014; 64:1479-514. [PMID: 25234655 DOI: 10.1016/j.jacc.2014.05.006] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Fudge J, Harmon KG, Owens DS, Prutkin JM, Salerno JC, Asif IM, Haruta A, Pelto H, Rao AL, Toresdahl BG, Drezner JA. Cardiovascular screening in adolescents and young adults: a prospective study comparing the Pre-participation Physical Evaluation Monograph 4th Edition and ECG. Br J Sports Med 2014; 48:1172-8. [PMID: 24948082 PMCID: PMC4374061 DOI: 10.1136/bjsports-2014-093840] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study compares the accuracy of cardiovascular screening in active adolescents and young adults using a standardised history, physical examination and resting 12-lead ECG. METHODS Participants were prospectively screened using a standardised questionnaire based on the Pre-participation Physical Evaluation Monograph 4th Edition (PPE-4), physical examination and ECG interpreted using modern standards. Participants with abnormal findings had focused echocardiography and further evaluation. Primary outcomes included disorders associated with sudden cardiac arrest (SCA). RESULTS From September 2010 to July 2011, 1339 participants underwent screening: age 13-24 (mean 16) years, 49% male, 68% Caucasian, 17% African-American and 1071 (80%) participating in organised sports. Abnormal history responses were reported on 916 (68%) questionnaires. After physician review, 495/916 (54%) participants with positive questionnaires were thought to have non-cardiac symptoms and/or a benign family history and did not warrant additional evaluation. Physical examination was abnormal in 124 (9.3%) participants, and 72 (5.4%) had ECG abnormalities. Echocardiograms were performed in 586 (44%) participants for abnormal history (31%), physical examination (8%) or ECG (5%). Five participants (0.4%) were identified with a disorder associated with SCA, all with ECG-detected Wolff-Parkinson-White. The false-positive rates for history, physical examination and ECG were 31.3%, 9.3% and 5%, respectively. CONCLUSIONS A standardised history and physical examination using the PPE-4 yields a high false-positive rate in a young active population with limited sensitivity to identify those at risk for SCA. ECG screening has a low false-positive rate using modern interpretation standards and improves detection of primary electrical disease at risk of SCA.
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Affiliation(s)
- Jessie Fudge
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Kimberly G Harmon
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - David S Owens
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Jordan M Prutkin
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Jack C Salerno
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Irfan M Asif
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Alison Haruta
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Hank Pelto
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Ashwin L Rao
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Brett G Toresdahl
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Jonathan A Drezner
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
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Price DE, McWilliams A, Asif IM, Martin A, Elliott SD, Dulin M, Drezner JA. Electrocardiography-inclusive screening strategies for detection of cardiovascular abnormalities in high school athletes. Heart Rhythm 2014; 11:442-9. [DOI: 10.1016/j.hrthm.2013.12.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Indexed: 11/29/2022]
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Gawroński W, Sobiecka J, Malesza J. Fit and healthy Paralympians—medical care guidelines for disabled athletes: a study of the injuries and illnesses incurred by the Polish Paralympic team in Beijing 2008 and London 2012. Br J Sports Med 2013; 47:844-9. [DOI: 10.1136/bjsports-2013-092298] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Screening for sudden cardiac death before participation in high school and collegiate sports: American College of Preventive Medicine position statement on preventive practice. Am J Prev Med 2013; 45:130-133. [PMID: 23790999 DOI: 10.1016/j.amepre.2013.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 03/23/2013] [Accepted: 04/03/2013] [Indexed: 11/23/2022]
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47
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Dimitros E, Koutlianos N, Anifanti M, Pagourelias E, Kouidi E, Deligiannis A. Comparative study of ECG and echocardiographic parameters indicative of cardiac hypertrophy in athletes. SPORT SCIENCES FOR HEALTH 2012. [DOI: 10.1007/s11332-012-0136-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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48
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Zeltser I, Cannon B, Silvana L, Fenrich A, George J, Schleifer J, Garcia M, Barnes A, Rivenes S, Patt H, Rodgers G, Scott W. Lessons learned from preparticipation cardiovascular screening in a state funded program. Am J Cardiol 2012; 110:902-8. [PMID: 22704711 DOI: 10.1016/j.amjcard.2012.05.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 05/01/2012] [Accepted: 05/01/2012] [Indexed: 11/27/2022]
Abstract
In 2007, the Texas legislature appropriated money for a pilot study to evaluate cardiovascular screening of student athletes to identify those who might be at risk of sudden death using a questionnaire, physical examination, electrocardiography, and limited echocardiography. We sought to determine (1) the feasibility of a state-wide cardiovascular screening program, (2) the ability to reliably identify at-risk subjects, and (3) problems in implementing screening state wide. The data were analyzed using established pediatric electrocardiographic and echocardiographic criteria. Positive results were confirmed by a blinded reviewer. In 31 venues (2,506 students), the electrocardiographic findings met the criteria for cardiovascular disease in 57 (2.3%), with 33 changes suggestive of hypertrophic cardiomyopathy, 14 with long QT syndrome, 7 with Wolff-Parkinson-White syndrome, and 3 with potential ischemic findings related to a coronary anomaly. Of the 2,051 echocardiograms, 11 had findings concerning for disease (9 with hypertrophic cardiomyopathy and 1 with dilated cardiomyopathy). In patients with electrocardiographic findings consistent with hypertrophic cardiomyopathy, the limited echocardiograms were normal in 24 of 33. Of the 33 who remained at risk of sudden death on the electrocardiogram or echocardiogram, 25 (65.8%) pursued the recommended evaluation, which confirmed long QT syndrome in 4, Wolff-Parkinson-White syndrome in 7, and dilated cardiomyopathy in 1. The interobserver agreement was 100% for electrocardiography and 79% for echocardiography. The questionnaire identified 895 (35% of the total) potentially at-risk students, with disease confirmed in 11 (1.23%). In conclusion, in this large state-funded project, electrocardiographic and echocardiographic screening identified 11 of 2,506 patients potentially at risk of cardiovascular disease. The questionnaire was of limited value and had a large number of false-positive results. Interobserver variation was significant for echocardiography and might create problems with limited echocardiographic screening. Finally, many subjects with abnormal screening results declined a follow-up evaluation.
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Affiliation(s)
- Ilana Zeltser
- University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, TX, USA.
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Schoenbaum M, Denchev P, Vitiello B, Kaltman JR. Economic evaluation of strategies to reduce sudden cardiac death in young athletes. Pediatrics 2012; 130:e380-9. [PMID: 22753553 PMCID: PMC4074613 DOI: 10.1542/peds.2011-3241] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE There is controversy about appropriate methods to reduce sudden cardiac death (SCD) in young athletes, but there is limited evidence on costs or consequences of alternative strategies. The objective of this study was to evaluate the cost-effectiveness of adding electrocardiogram (ECG) screening to the currently standard practice of preparticipation history and physical examination (H&P) to reduce SCD. METHODS Decision analysis modeling by using a societal perspective, with annual Markov cycles from age 14 until death. Three screening strategies were evaluated: (1) H&P, with cardiology referral if abnormal (current standard practice); (2) H&P, plus ECG after negative H&P, and cardiology referral if either is abnormal; and (3) ECG only, with cardiology referral if abnormal. Children identified with SCD-associated cardiac abnormalities were restricted from sports and received cardiac treatment. Main outcome measures were costs of screening and treatment, quality-adjusted life years (QALYs), and premature deaths averted. RESULTS Relative to strategy 1, incremental cost-effectiveness is $68800/QALY for strategy 2 and $37700/QALY for strategy 3. Monte Carlo simulation revealed the chance of incremental cost-effectiveness compared with strategy 1 was 30% for strategy 2 and 66% for strategy 3 (assumed willingness to pay ≤$50000/QALY). Compared with strategy 1, strategy 2 averted 131 additional SCDs at $900000 per case, and strategy 3 averted 127 SCDs at $600000 per case. CONCLUSIONS Under a societal willingness to pay threshold of $50000/QALY, adding ECGs to current preparticipation evaluations for athletes is not cost-effective, with costs driven largely by false-positive findings.
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Affiliation(s)
- Michael Schoenbaum
- National Institute of Mental Health, 6001 Executive Blvd, Room 8225 MSC 9669, Bethesda, MD 20892, USA.
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50
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Mahle WT, Sable CA, Matherne PG, Gaynor JW, Gewitz MH. Key Concepts in the Evaluation of Screening Approaches for Heart Disease in Children and Adolescents. Circulation 2012; 125:2796-801. [DOI: 10.1161/cir.0b013e3182579f25] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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