Early Screening for Cardiovascular Abnormalities With Preparticipation Echocardiography

Abstract

The traditional history and physical (H&P) is a poor screening modality to identify athletes at risk for sudden cardiac death (SCD). Although better than H&P alone, electrocardiograms (ECG) have also been found to have high false positive rates. Portable echocardiogram by a non-cardiologist (PENC) physician done during preparticipation evaluation (PPE) allows for direct measurements of the heart to more accurately identify patients with structural abnormalities that can result in SCD. Therefore, it is worthwhile to assess the feasibility of PENC as part of PPEs. PURPOSE: To investigate the feasibility of incorporating PENC into routine PPEs. METHODS: Thirty-five Division I male college athletes were prospectively enrolled in the study after informed consent was obtained. Each athlete underwent a screening H&P, ECG, and PENC. The H&P was based on the 12-element preparticipation cardiovascular screening guidelines from the American Heart Association. The ECGs were interpreted using the 2010 European Society of Cardiology criteria. The PENC measurements were obtained in the parasternal long-axis view. End-diastolic measurements were recorded of the left ventricular (LV) diameter, LV posterior wall thickness, interventricular septal wall thickness, aortic root diameter, and ascending aorta. The length of time for screening at each station was recorded and reported in seconds (sec). A paired t-test with alpha level of <0.5 was used to compare length of time (mean ± standard deviation) of each screening method. RESULTS: Six athletes had a positive finding in H&P screening and four athletes had positive ECG findings. One athlete had both a positive H&P and screening ECG. All athletes had negative PENC screens. All four athletes with positive ECG findings have been referred for formal evaluation with cardiology_outcome of cardiology referrals pending. The length of time for screening was significantly shorter with PENC (137.7 ± 40.4 sec) compared with H&P (244.2 ± 80.0 sec) and ECG (244.9 ± 85.6 sec, P<0.01). The screening time did not differ between H&P and ECG (P=.97). CONCLUSION: Incorporating PENC into PPEs has the potential to limit the number of false positive cardiac screens. PENC was the fastest screening modality compared with traditional H&P and ECG methods and can feasibly be incorporated into PPE screening.