Abstract 13454: Cardiac Abnormalities in a Large Student Athletes Screening Cohort in Central Texas

Abstract

Introduction: Sudden cardiac death (SCD) in the young is a rare but devastating event. Pre-participation evaluation is required prior to competitive sports. The Texas Adolescent Athlete Heart Screening Registry (TAAHSR) performs screening events including history, ECG and limited echocardiogram (ECHO). Hypothesis: Cardiac abnormalities are identified in athlete screening and challenges exist in long-term follow up. Methods: The TAAHSR database of 4309 participants between 2013-2020 was analyzed and follow up data obtained from phone and electronic medical records. Screening results were classified as: I - no abnormality (abnl) identified, II - abnl identified and further evaluation but no activity restriction recommended, level III - abnl identified and further evaluation with activity restriction recommended if concern for SCD. Results: Of 4309 participants, 218 (5%) screened positive on either ECG, ECHO, or both. ECG abnl were seen in 117/4309 (2.7%) level II and 23/4309 level III (0.5%). ECHO abnl were seen in 73/4309 (1.7%) level II and 13/4307 (0.3%) level III. The most frequent abnl in 218 positive screenings included: ECG - right ventricular hypertrophy (27, 12%), right bundle branch block (26, 12%), T-wave abnormalities (23, 10%), left ventricular hypertrophy (22, 10%), left axis deviation (17, 8%), Wolff-Parkinson-White (8, 4%); ECHO - bicuspid aortic valve (15, 7%), mitral valve prolapse (9, 4%), increased left ventricular trabeculations (9, 4%). The most frequent positive history in the cohort (218) was family history of heart disease (56, 25%), racing or skipped beats (30, 14%), chest pain after exercise (28, 13%), family history of SCD before age 50 (21, 10%). Follow up data was obtained, to date, in 130/218 (60%) positive screening participants and 72/130 (55%) had the suspected diagnosis confirmed. Of 130, 42 (32%) were reached and are alive at median follow up of 5.3 years. Conclusions: Our data shows 3.2% ECG and 2% ECHO positive screening for suspected cardiovascular abnl. Screening results may improve with better utilization of ECG criteria in athletes and lower referral based on ECHO findings that may represent normal pattern in certain populations. Follow up remains a challenge to determine long term outcomes of athlete screening.