Pre-participation cardiovascular screening in athletes with a focus on Asia

Abstract

Pre-participation screening (PPS) in young competitive athletes aims to identify conditions associated with sudden cardiac death (SCD) in this population, with a view to appropriate management and potential mitigation of risk. A medical history questionnaire and physical examination are standard components of a PPS programme, whereas controversy still exists regarding mandatory utilisation of resting 12-lead electrocardiogram as a screening tool. Apart from a landmark study from Italy attributing the reduction of SCD rates in athletes to the implementation of a mandatory PPS programme, there remains no additional compelling evidence for similar outcomes to date. Nonetheless, comprehensive PPS programmes when carried out systematically, are efficacious in detection of cardiac pathology and cost-effective. While the incidence rate of SCD in athletes from Western countries is estimated to be around 1:50,000, comparable data in Asian athletes remain lacking. Prospective registries are much needed to accurately determine the magnitude of this issue in Asia and recent recommendations on PPS in young Asian athletes have been published to increase awareness and encourage collaboration. To further reduce SCD events, prompt recognition of sudden cardiac arrests and early defibrillation are vital components in the spectrum of SCD prevention. This review aims to outline the rationale, current status and efficacy of PPS in athletes, with a focus on Asia.