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.
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Article Info
Publication History
Published online: June 23, 2016
Accepted:
June 3,
2016
Received:
March 18,
2016
Footnotes
See editorial by Papadakis and Sharma, pages 33–35 of this issue.
See page 160 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.