1
|
Halasz G, Capelli B, Nardecchia A, Cattaneo M, Cassina T, Biasini V, Barbieri D, Villa M, Beltrami M, Perone F, Villani M, Badini M, Gervasi F, Piepoli M, Via G. Cost-effectiveness and diagnostic accuracy of focused cardiac ultrasound in the pre-participation screening of athletes: the SPORT-FoCUS study. Eur J Prev Cardiol 2023; 30:1748-1757. [PMID: 37668353 DOI: 10.1093/eurjpc/zwad287] [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] [Received: 05/02/2023] [Revised: 08/02/2023] [Accepted: 08/24/2023] [Indexed: 09/06/2023]
Abstract
AIMS The role of pre-participation screening (PPS) modalities in preventing sudden cardiac death (SCD) in athletes is debated due to a high false-positive rate. Focused cardiac ultrasound (FoCUS) has shown higher sensitivity and specificity, but its cost-effectiveness remains uncertain. This study aimed to determine the diagnostic performance and cost-effectiveness of FoCUS use in PPS. METHODS AND RESULTS A total of 2111 athletes (77.4% male, mean age 24.9 ± 15.2years) underwent standardized family and medical history collection, physical examination, resting electrocardiography (ECG), FoCUS (10 min/5 views protocol), comprehensive echocardiography and exercise stress test. We prospectively evaluated three PPS incremental models: Model A, standardized medical history and physical examination Model B, Model A plus resting and stress ECG and Model C, Model B plus FoCUS (10 min/5 views protocol). We determined their incremental diagnostic accuracy and cost-effectiveness ratio. A total of 30 athletes were diagnosed with a cardiac condition associated with SCD: 3 were identified by Model A, 14 by Model B, and 13 athletes by Model C. The introduction of FoCUS markedly increased the sensitivity of PPS, compared with Model A and Model B (sensitivity 94% vs. 19% vs. 58% specificity 93% vs. 93% vs. 92%). The total screening costs were as follows: Model A 35.64 euros, Model B 87.68 euros, and Model C 120.89 euros. Considering the sole conditions at risk of SCD, the incremental cost-effectiveness ratio was 135.62 euros for Model B and 114.31 for Model C. CONCLUSIONS The implementation of FoCUS into the PPS allows to identify a significantly greater number of athletes at risk of SCD and markedly lowers the false negative rate. Furthermore, the incorporation of FoCUS into the screening process has shown to be cost-effective.
Collapse
Affiliation(s)
- Geza Halasz
- Cardiology Department, Azienda Ospedaliera SanCamillo Forlanini, Circonvallazione Gianicolense, 87, Rome 00152, Italy
| | - Bruno Capelli
- Sport and Exercise Medicine, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Alessia Nardecchia
- Italian Ministry of Education and Research, I.I.S Ceccano, Via Gaeta 105, Ceccano 03023, Italy
| | - Mattia Cattaneo
- Cardiologia, Centro Medico, Lugano, Switzerland
- Cardiology Department, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Tiziano Cassina
- Cardiac Anesthesia and Intensive Care, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Vincenzo Biasini
- Sport Medicine and Exercise Medicine, Centro di Medicina dello Sport I° Livello, L'Aquila 67100, Italy
| | - Davide Barbieri
- Department of Neuroscience and Rehabilitation, University of Ferrara, Corso Ercole I d'Este 32, Ferrara, Italy
| | - Michele Villa
- Cardiac Anesthesia and Intensive Care, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Matteo Beltrami
- Cardiology Unit, San Giovanni di Dio Hospital, Florence 50142, Italy
| | - Francesco Perone
- Cardiac Rehabilitation Unit, Rehabilitation Clinic 'Villa delle Magnolie', Castel Morrone, Caserta 81020, Italy
| | - Matteo Villani
- Intensive Care Unit, G. Da Saliceto Hospital, Via Taverna Giuseppe, 49, 29121 Piacenza, Italy
| | - Matteo Badini
- Cardiology Department, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Federico Gervasi
- Postgraduate School of Medical Statistics and Biometry, University of Milan, Via Festa del Perdono 7, Milan 20122, Italy
| | - Massimo Piepoli
- Clinical Cardiology, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, Milan 20097, Italy
- Department of Biomedical Science for Health, University of Milan, Via Festa del Perdono 7, Milan 20122, Italy
| | - Gabriele Via
- Cardiac Anesthesia and Intensive Care, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| |
Collapse
|
2
|
MacLachlan H, Dhutia H, Bhatia R, Boden K, Forenc K, Basu J, Miles C, Osborne R, Chandra N, Malhotra A, Stuart G, Peirce N, Sharma S, Papadakis M. Results of a nationally implemented cardiac screening programme in elite cricket players in England and Wales. J Sci Med Sport 2021; 25:287-292. [PMID: 35016820 DOI: 10.1016/j.jsams.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/30/2021] [Accepted: 12/05/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES We assessed the diagnostic yield and costs of an electrocardiogram-based national screening programme in elite cricket players and the incremental value of transthoracic echocardiography and periodic evaluation. DESIGN Cross-sectional study. METHODS Between 2008 and 2019, 1208 cricketers underwent screening with a health questionnaire, 12-lead electrocardiogram and cardiology consultation. Athletes with concerning findings underwent on-site transthoracic echocardiography and further investigations as necessary. In addition, despite a normal health questionnaire and electrocardiogram, 342 (28.3%) athletes had a transthoracic echocardiogram and 493 (40.8%) underwent repeat evaluations. RESULTS After initial evaluation, 47 (3.9%) athletes underwent on-site transthoracic echocardiography of whom 35 (2.8%) were referred for further evaluation. Four athletes (0.3%) were diagnosed with major cardiac conditions; hypertrophic cardiomyopathy (n = 1), arrhythmogenic cardiomyopathy (n = 1) and Wolff-Parkinson-White pattern (n = 2). Two athletes were identified with minor valvular abnormalities. Repeat evaluation of 493 athletes identified hypertrophic cardiomyopathy in a 22-year-old athlete, two years after his initial normal screening. During a follow-up of 5.8 ± 2.9 years no additional diagnoses or adverse cardiac events were reported. The cost of the electrocardiogram-based programme was £127,844, translating to £106 per athlete and £25,569 per major cardiac condition identified.Routine transthoracic echocardiography in 342 athletes identified two athletes with major cardiac conditions (bicuspid aortic valve with severe aortopathy and aortic regurgitation and an atrial septal defect associated with right ventricular volume overload) and 10 athletes with minor abnormalities. CONCLUSIONS An electrocardiogram-based national screening programme identified a major cardiac condition in 0.3% of athletes. Routine transthoracic echocardiography and periodic evaluation increased the diagnostic yield to 0.6%, at an incremental cost.
Collapse
Affiliation(s)
- H MacLachlan
- Cardiovascular Clinical Academic Group, St Georges, University of London, United Kingdom
| | - H Dhutia
- Department of Cardiology, Glenfield Hospital, United Kingdom
| | - R Bhatia
- Cardiovascular Clinical Academic Group, St Georges, University of London, United Kingdom
| | - K Boden
- England and Wales Cricket Board and National Centre for Sports and Exercise Medicine and National Cricket Performance Centre, Loughborough University, United Kingdom
| | - K Forenc
- Cardiovascular Clinical Academic Group, St Georges, University of London, United Kingdom
| | - J Basu
- Cardiovascular Clinical Academic Group, St Georges, University of London, United Kingdom
| | - C Miles
- Cardiovascular Clinical Academic Group, St Georges, University of London, United Kingdom
| | - R Osborne
- Cardiac Risk in the Young, United Kingdom
| | - N Chandra
- Department of Cardiology, Frimley Park Hospital, United Kingdom
| | - A Malhotra
- Division of Cardiovascular Sciences, University of Manchester, United Kingdom
| | - G Stuart
- National Institute of Health Research Cardiovascular Biomedical Research Centre, Bristol Heart Institute, United Kingdom
| | - N Peirce
- England and Wales Cricket Board and National Centre for Sports and Exercise Medicine and National Cricket Performance Centre, Loughborough University, United Kingdom
| | - S Sharma
- Cardiovascular Clinical Academic Group, St Georges, University of London, United Kingdom
| | - M Papadakis
- Cardiovascular Clinical Academic Group, St Georges, University of London, United Kingdom.
| |
Collapse
|
3
|
Diamantino AC, Nascimento BR, Nunes MCP, Sable CA, Oliveira KKB, Rabelo LC, Franco J, Diamantino LC, Barbosa MM, Reese AT, Olivieri L, de Lima EM, Martins LNA, Colosimo EA, Beaton AZ, Ribeiro ALP. Impact of incorporating echocardiographic screening into a clinical prediction model to optimise utilisation of echocardiography in primary care. Int J Clin Pract 2021; 75:e13686. [PMID: 32852108 DOI: 10.1111/ijcp.13686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/16/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Access to public subspecialty healthcare is limited in underserved areas of Brazil, including echocardiography (echo). Long waiting lines and lack of a prioritisation system lead to diagnostic lag and may contribute to poor outcomes. We developed a prioritisation tool for use in primary care, aimed at improving resource utilisation, by predicting those at highest risk of having an abnormal echo, and thus in highest need of referral. METHODS All patients in the existing primary care waiting list for echo were invited for participation and underwent a clinical questionnaire, simplified 7-view echo screening by non-physicians with handheld devices, and standard echo by experts. Two derivation models were developed, one including only clinical variables and a second including clinical variables and findings of major heart disease (HD) on echo screening (cut point for high/low-risk). For validation, patients were risk-classified according to the clinical score. High-risk patients and a sample of low-risk underwent standard echo. Intermediate-risk patients first had screening echo, with a standard echo if HD was suspected. Discrimination and calibration of the two models were assessed to predict HD in standard echo. RESULTS In derivation (N = 603), clinical variables associated with HD were female gender, body mass index, Chagas disease, prior cardiac surgery, coronary disease, valve disease, hypertension and heart failure, and this model was well calibrated with C-statistic = 0.781. Performance was improved with the addition of echo screening, with C-statistic = 0.871 after cross-validation. For validation (N = 1526), 227 (14.9%) patients were classified as low risk, 1082 (70.9%) as intermediate risk and 217 (14.2%) as high risk by the clinical model. The final model with two categories had high sensitivity (99%) and negative predictive value (97%) for HD in standard echo. Model performance was good with C-statistic = 0.720. CONCLUSION The addition of screening echo to clinical variables significantly improves the performance of a score to predict major HD.
Collapse
Affiliation(s)
- Adriana C Diamantino
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, Brazil
| | - Bruno R Nascimento
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria Carmo P Nunes
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Craig A Sable
- Cardiology, Children's National Health System, Washington, DC, USA
| | - Kaciane K B Oliveira
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, Brazil
| | - Lara C Rabelo
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, Brazil
| | - Juliane Franco
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, Brazil
| | - Luciana C Diamantino
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, Brazil
| | - Marcia M Barbosa
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, Brazil
| | - Alison T Reese
- Cardiology, Children's National Health System, Washington, DC, USA
| | - Laura Olivieri
- Cardiology, Children's National Health System, Washington, DC, USA
| | - Emilly Malveira de Lima
- Department of Statistics, Instituto de Ciência Exatas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Larissa Natany A Martins
- Department of Statistics, Instituto de Ciência Exatas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Enrico Antonio Colosimo
- Department of Statistics, Instituto de Ciência Exatas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Andrea Z Beaton
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Antonio L P Ribeiro
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
4
|
Hammadah M, Ponce C, Sorajja P, Cavalcante JL, Garcia S, Gössl M. Point-of-care ultrasound: Closing guideline gaps in screening for valvular heart disease. Clin Cardiol 2020; 43:1368-1375. [PMID: 33174635 PMCID: PMC7724242 DOI: 10.1002/clc.23499] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A linear increase in the number of valvular heart disease is expected due to the aging population, yet most patients with severe valvular heart disease remain undiagnosed. HYPOTHESIS POCUS can serve as a screening tool for valvular heart disease. METHODS We reviewed the literature to assess the strengths and limitations of POCUS in screening and diagnosing valvular heart disease. RESULTS POCUS is an accurate, affordable, accessible, and comprehensive tool. It has a fast learning curve and can prevent unnecessary and more expensive imaging. Challenges include training availability, lack of simplified screening protocols, and reimbursement. Large scale valvular screening data utilizing POCUS is not available. CONCLUSION POCUS can serve as a screening tool and guide the management of patients with valvular heart disease. More data is needed about its efficacy and cost-effectiveness in the screening of patients with valvular heart disease.
Collapse
Affiliation(s)
- Muhammad Hammadah
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - Christopher Ponce
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - Paul Sorajja
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - João L. Cavalcante
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - Santiago Garcia
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - Mario Gössl
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| |
Collapse
|
5
|
Cassels M, Moulson N, Regan J, MacDonald M, Isserow S, Johri AM, McKinney J. Point-of-Care Ultrasound as a Component of Preparticipation Screening of Athletes: A Systematic Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3123-3130. [PMID: 31081230 DOI: 10.1002/jum.15021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/15/2019] [Accepted: 04/25/2019] [Indexed: 06/09/2023]
Abstract
This review examined whether the addition of point-of-care ultrasound (POCUS) to electrocardiography (ECG)-inclusive preparticipation screening strategies has the potential to reduce false-positive results and detect diseases associated with sudden cardiac death that may not be identified through current modalities. Five studies, representing 2646 athletes, demonstrated that ECG-inclusive preparticipation screening strategies resulted in positive results in 19.9% of the cohort. With the addition of POCUS, positive results were reduced to 4.9%, and 1 additional condition potentially associated with sudden cardiac death was identified. The magnitude of positive results with POCUS may be reduced if current ECG criteria were applied.
Collapse
Affiliation(s)
- Michael Cassels
- SportsCardiologyBC, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathaniel Moulson
- SportsCardiologyBC, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jackie Regan
- SportsCardiologyBC, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mackenzie MacDonald
- SportsCardiologyBC, University of British Columbia, Vancouver, British Columbia, Canada
| | - Saul Isserow
- SportsCardiologyBC, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amer M Johri
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - James McKinney
- SportsCardiologyBC, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
6
|
Cardim N, Dalen H, Voigt JU, Ionescu A, Price S, Neskovic AN, Edvardsen T, Galderisi M, Sicari R, Donal E, Stefanidis A, Delgado V, Zamorano J, Popescu BA. The use of handheld ultrasound devices: a position statement of the European Association of Cardiovascular Imaging (2018 update). Eur Heart J Cardiovasc Imaging 2019; 20:245-252. [PMID: 30351358 DOI: 10.1093/ehjci/jey145] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/13/2018] [Indexed: 12/19/2022] Open
Abstract
Recent technological advances in echocardiography, with progressive miniaturization of ultrasound machines, have led to the development of handheld ultrasound devices (HUD). These devices, no larger than some mobile phones, can be used to perform partial, focused exams as an extension to the physical examination. The European Association of Cardiovascular Imaging (EACVI) acknowledges that the dissemination of appropriate HUD use is inevitable and desirable, because of its potential impact on patient management. However, as a scientific society of cardiac imaging, our role is to provide guidance in order to optimize patient benefit and minimize drawbacks from inappropriate use of this technology. This document provides updated recommendations for the use of HUD, including nomenclature, appropriateness, indications, operators, clinical environments, data management and storage, educational needs, and training of potential users. It also addresses gaps in evidence, controversial issues, and future technological developments.
Collapse
Affiliation(s)
- Nuno Cardim
- Cardiology Department, Hospital da Luz, Av. Lusíada, n° 100, Lisbon, Portugal.,Faculdade Ciências Médicas da Universidade nova de Lisboa, Campo Mártires da Pátria 130, Lisbon, Portugal
| | - Havard Dalen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Cardiology, St. Olav's University Hospital, Trondheim, Norway.,Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Adrian Ionescu
- Morriston Cardiac Regional Centre, ABMU LHB, Swansea, UK
| | - Susanna Price
- Adult Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, UK
| | - Alexsandar N Neskovic
- Department of Cardiology, Clinical Hospital Center Zemun, Vukova 9, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Thor Edvardsen
- Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet and University of Oslo, Sognsvannsveien 20, Oslo, Norway
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, VIa S. Pansini 5, Napples, Italy
| | - Rosa Sicari
- CNR, Institute of Clinical Physiology, Via G. Moruzzi, 1, Pisa, Italy
| | - Erwan Donal
- Service de Cardiologie et CIC-IT INSERM 1414, CHU Pontchaillou, Rennes, France.,LTSI, Université de Rennes 1, INSERM, UMR, Rennes, France
| | | | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, Leiden, The Netherlands
| | - Jose Zamorano
- Department of Cardiology, Hospital Ramón y Cajal, Ctra. de Colmenar Viejo, km. 9, 100, Madrid, Spain.,CIBERV, Madrid, Spain
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila", Euroecolab, Institute of cardiovascular diseases "Prof. Dr. C C Iliescu, Bucharest, Romania
| |
Collapse
|
7
|
Modaff DS, Hegde SM, Wyman RA, Rahko PS. Usefulness of Focused Screening Echocardiography for Collegiate Athletes. Am J Cardiol 2019; 123:169-174. [PMID: 30348435 DOI: 10.1016/j.amjcard.2018.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/05/2018] [Accepted: 09/11/2018] [Indexed: 12/18/2022]
Abstract
Sudden cardiac death in a young healthy athlete is a rare but catastrophic event. The American Heart Association preparticipation screening guidelines recommend a focused history and physical without routine imaging or electrocardiogram screening. We hypothesized that a focused echocardiogram can identify structural abnormalities that may lead to sudden cardiac death in athletes, which might otherwise go undetected by history and physical. We retrospectively reviewed the charts of all incoming collegiate athletes at a single university from 2005 to 2013, all of whom had undergone a focused, 5-minute echocardiogram along with a guideline-based preparticipation history and physical (PPS H&P). Abnormal findings prompted further testing or referral. We report the prevalence of abnormal findings and the relation between an abnormal PPS H&P and screening echocardiogram. A total of 2,898 athletes were screened and 159 (5%) had findings. Forty athletes underwent further testing and evaluation. Of these athletes, 3 had newly diagnosed abnormalities that warranted restriction of participation: 1 apical-variant hypertrophic cardiomyopathy, 1 large bidirectional atrial septal defect with right ventricular dysfunction, and 1 dilated ascending aorta. Two of these athletes had a normal PPS H&P. Conversely, of the 661 athletes with an abnormal PPS H&P, only 1 (0.15%) had an abnormal screening echocardiogram. In conclusion, although the overall number was low, the 5-minute screening echocardiogram detected athletes at risk for sudden cardiac death not discovered on PPS H&P.
Collapse
|
8
|
Moulson N, Jaff Z, Wiltshire V, Taylor T, O'Connor HM, Hopman WM, Johri AM. Feasibility and Reliability of Nonexpert POCUS for Cardiovascular Preparticipation Screening of Varsity Athletes: The SHARP Protocol. Can J Cardiol 2018; 35:35-41. [PMID: 30595181 DOI: 10.1016/j.cjca.2018.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/29/2018] [Accepted: 11/01/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Point of care ultrasound (POCUS) is a potential adjunctive cardiovascular preparticipation screening modality for young competitive athletes. A novel cardiac POCUS screening protocol, Screening the Heart of the Athlete Research Program (SHARP), was developed for nonexpert examiners to assess common structural etiologies associated with sudden cardiac arrest/death (SCA/D). METHODS Assessment of primary outcomes of feasibility, and reliability of obtained measurements, performed by comparison to formal transthoracic echocardiogram was undertaken. Inter-rater reliability was based on Intraclass correlation coefficients (ICC) defined as moderate for 0.40 to 0.59, good for 0.60 to 0.79, and excellent for 0.80 or greater. Electrocardiograms (ECGs) were also obtained. Identification of disease or other abnormalities was a secondary outcome. RESULTS Fifty varsity athletes at our institution underwent the SHARP protocol, with 19 undergoing formal transthoracic echocardiogram and ECG for comparison. POCUS image quality was good to excellent. Feasibility of assessing for hypertrophic cardiomyopathy, aortic root dilatation, and left-ventricular function was deemed highly possible but limited in 20% for right-ventricular assessment. Reliability was good for measurements of interventricular septal thickness (0.67), end diastolic left-ventricular diameter (0.61), aortic root diameter (0.63), and moderate for left-ventricular posterior wall thickness (0.42). No cardiovascular abnormalities were detected. CONCLUSIONS A novel, comprehensive SHARP POCUS protocol performed by nonexpert practitioners demonstrated feasibility and reliability to assess varsity level athletes for common structural etiologies associated with SCA/D. Further large athlete screening cohort studies are required to validate the SHARP protocol and the role of cardiac POCUS as a screening modality.
Collapse
Affiliation(s)
- Nathaniel Moulson
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Zardasht Jaff
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Victoria Wiltshire
- Department of Athletics and Recreation, Queen's University, Kingston, Ontario, Canada
| | - Taryn Taylor
- Department of Sports Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - H Michael O'Connor
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Wilma M Hopman
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Amer M Johri
- Department of Medicine, Queen's University, Kingston, Ontario, Canada.
| |
Collapse
|
9
|
Lucas C, Kerkhof DL, Briggs JE, Corrado GD. The Use of Echocardiograms in Preparticipation Examinations. Curr Sports Med Rep 2017; 16:77-83. [DOI: 10.1249/jsr.0000000000000341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|