Advertisement
Canadian Journal of Cardiology

Detecting Underlying Cardiovascular Disease in Young Competitive Athletes

      Abstract

      Background

      Sudden cardiac death (SCD) is frequently the first manifestation of underlying cardiovascular disease in young competitive athletes (YCAs), yet there are no Canadian guidelines for preparticipation screening in this population. The goal of this study was to determine the prevalence of potentially lethal cardiovascular disease in a sample of Canadian YCAs by comparing 2 screening strategies.

      Methods

      We prospectively screened 1419 YCAs in British Columbia, Canada (age 12-35 years). We initially screened 714 YCAs using the American Heart Association 12-element recommendations, physical examination, and electrocardiogram (ECG) examination (phase 1). This strategy yielded a high number of false positive results; 705 YCAs were subsequently screened using a novel SportsCardiologyBC (SCBC) questionnaire and ECG examination in the absence of a physical examination (phase 2).

      Results

      Overall, 7 YCAs (0.52%) were found to have clinically significant diagnoses associated with SCD (4 pre-excitation, 1 long QT syndrome, 1 mitral valve prolapse, 1 hypertrophic cardiomyopathy). Six of the 7 athletes (85.7%) with disease possessed an abnormal ECG. Conversely, only 2 had a positive personal or family history (1 athlete had an abnormal ECG and family history). The SCBC questionnaire and protocol (phase 2) was associated with fewer false positive screens; 3.7% (25 of 679) compared with 8.1% (55 of 680) in phase 1 (P = 0.0012).

      Conclusions

      The prevalence of conditions associated with SCD in a cohort of Canadian YCAs was comparable with American and European populations. The SCBC questionnaire and protocol were associated with fewer false positive screens. The ECG identified most of the positive cases irrespective of screening strategy used.

      Résumé

      Introduction

      La mort cardiaque subite (MCS) est souvent la première manifestation d’une maladie cardiovasculaire (MCV) sous-jacente chez les jeunes athlètes de compétition. Pourtant, il n’existe pas de lignes directrices canadiennes prônant un dépistage dans le cadre d’un examen de pré-participation chez cette population. Cette étude avait pour objectif de déterminer la prévalence d’une MCV potentiellement mortelle chez un échantillon de jeunes athlètes canadiens de compétition, en fonction de deux stratégies de dépistage.

      Méthodes

      Un dépistage prospectif a été effectué chez 1419 jeunes athlètes de compétition (de 12 à 35 ans) de Colombie-Britannique (Canada). De ce nombre, 714 se sont soumis à un premier dépistage fondé sur une anamnèse en 12 points recommandée par l’American Heart Association, un examen physique et un électrocardiogramme (ECG) (phase 1). Cette stratégie a donné lieu à un nombre élevé de faux positifs. Le dépistage chez les 705 autres athlètes a ensuite été réalisé au moyen d’un nouveau questionnaire proposé par SportsCardiologyBC (SCBC) et d’un ECG, sans examen physique (phase 2).

      Résultats

      Un diagnostic d’importance clinique associé à la MCS a été posé chez 7 (0,52 %) jeunes athlètes de compétition (syndrome de préexcitation [4]; syndrome du QT long [1]; prolapsus de la valve mitrale [1]; et cardiomyopathie hypertrophique [1]). De ces 7 athlètes, 6 (85,7 %) ont obtenu un résultat anormal à l’électrocardiographie. Inversement, seulement 2 athlètes avaient des antécédents personnels ou familiaux (1 athlète cumulait un ECG anormal et des antécédents familiaux). Le pourcentage de faux positifs associé au protocole de la phase 2, qui misait notamment sur le questionnaire de SCBC, a été moins élevé : 3,7 % (25 sur 679) comparativement à 8,1 % (55 sur 680) dans le cadre de la phase 1 (P = 0,0012).

      Conclusions

      La prévalence des troubles associés à la MCS au sein d’une cohorte de jeunes athlètes canadiens de compétition était comparable à celle observée au sein de populations américaines et européennes. Les faux positifs associés au questionnaire de SCBC et au protocole de la phase 2 ont été moins nombreux. L’électrocardiographie a permis de repérer la plupart des cas positifs, peu importe la stratégie de dépistage employée.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Harmon K.G.
        • Drezner J.
        • Wilson M.G.
        • Sharma S.
        Incidence of sudden cardiac death in athletes: a state-of-the-art review.
        Br J Sports Med. 2014; 48: 1185-1192
        • Corrado D.
        • Schmied C.
        • Basso C.
        • et al.
        Risk of sports: do we need a pre-participation screening for competitive and leisure athletes?.
        Eur Heart J. 2011; 32: 934-944
        • Maron B.J.
        • Thompson P.D.
        • Ackerman M.J.
        • et al.
        Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update.
        Circulation. 2007; 115: 1643-1655
        • Maron B.J.
        • Shirani J.
        • Poliac L.C.
        • et al.
        Sudden death in young competitive athletes. Clinical, demographic, and pathological profiles.
        JAMA. 1996; 276: 199-204
        • Poirier P.
        • Sharma S.
        • Pipe A.
        The Atlantic rift: guidelines for athletic screening-where should canada stand?.
        Can J Cardiol. 2016; 32: 400-406
        • Maron B.J.
        • Friedman R.A.
        • Kligfield P.
        • et al.
        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).
        J Am Coll Cardiol. 2014; 64: 1479-1514
        • Maron B.J.
        • Levine B.D.
        • Washington R.L.
        • et al.
        Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 2: preparticipation screening for cardiovascular disease in competitive athletes: a scientific statement from the American Heart Association and American College of Cardiology.
        Circulation. 2015; 132: e267-e272
        • Del Rosso A.
        • Ungar A.
        • Maggi R.
        • et al.
        Clinical predictors of cardiac syncope at initial evaluation in patients referred urgently to a general hospital: the EGSYS score.
        Heart. 2008; 94: 1620-1626
        • Alboni P.
        • Brignole M.
        • Menozzi C.
        • et al.
        Diagnostic value of history in patients with syncope with or without heart disease.
        J Am Coll Cardiol. 2001; 37: 1921-1928
        • Sheldon R.
        • Rose S.
        • Connolly S.
        • et al.
        Diagnostic criteria for vasovagal syncope based on a quantitative history.
        Eur Heart J. 2006; 27: 344-350
        • Sheldon R.
        • Hersi A.
        • Ritchie D.
        • Koshman M.L.
        • Rose S.
        Syncope and structural heart disease: historical criteria for vasovagal syncope and ventricular tachycardia.
        J Cardiovasc Electrophysiol. 2010; 21: 1358-1364
        • Oh J.H.
        • Hanusa B.H.
        • Kapoor W.N.
        Do symptoms predict cardiac arrhythmias and mortality in patients with syncope?.
        Arch Intern Med. 1999; 159: 375-380
        • Calkins H.
        • Shyr Y.
        • Frumin H.
        • Schork A.
        • Morady F.
        The value of the clinical history in the differentiation of syncope due to ventricular tachycardia, atrioventricular block, and neurocardiogenic syncope.
        Am J Med. 1995; 98: 365-373
        • Drezner J.
        • Ackerman M.J.
        • Anderson J.
        • et al.
        Electrocardiographic interpretation in athletes: the “Seattle criteria”.
        Br J Sports Med. 2013; 47: 122-124
      1. Mortara Instrument. Cardioserver. Version 4.1.1. Montara Instrument ECG Machines. 2012. Milwaukee, Wisconsin.

      2. VScan. Milwaukee, Wisconsin: GE Healthcare.

        • Government of British Columbia
        MSC Payment Schedule.
        (Available at:) (Accessed August 10, 2016)
        • Sheikh N.
        • Papadakis M.
        • Schnell F.
        • et al.
        Clinical profile of athletes with hypertrophic cardiomyopathy.
        Circ Cardiovasc Imaging. 2015; 8: 1-11
        • Harmon K.G.
        • Zigman M.
        • Drezner J.A.
        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: 329-338
        • Sharma S.
        Point/Mandatory ECG screening of young competetive athletes.
        Heart Rhythm. 2012; 9: 1642-1645
        • Prakash K.
        • Sharma S.
        Interpretation of the electrocardiogram in athletes.
        Can J Cardiol. 2015; 3: 1234-1237
        • Maron B.J.
        Counterpoint/Mandatory ECG screening of young competitive athletes.
        Heart Rhythm. 2012; 9: 1897
        • Pelliccia A.
        Is the cost the reason for missing the ECG advantages?.
        J Am Coll Cardiol. 2012; 60: 2227-2229
        • Cardiac Risk in the Young
        CRY's Costs.
        (Available at:) (Accessed April 25, 2016)
        • Riding N.R.
        • Sharma S.
        • Salah O.
        • et al.
        Systematic echocardiography is not efficacious when screening an ethnically diverse cohort of athletes in West Asia.
        Eur J Prev Cardiol. 2015; 22: 263-270
        • Magalski A.
        • McCoy M.
        • Zabel M.
        • et al.
        Cardiovascular screening with electrocardiography and echocardiography in collegiate athletes.
        Am J Med. 2011; 124: 511-518