Preparticipation Screening Of Young Athletes Research Articles

Prevalence and determinants of low QRS voltages and QRS fragmentation in children and adolescents undergoing sports preparticipation screening.

Low QRS Voltages (LQRSV) in limb leads and QRS fragmentation (FQRS) are possible electrocardiographic signs of myocardial fibrosis and cardiomyopathy, but they are not listed in current criteria for interpretating athlete's ECG. We investigated the prevalence and determinants of LQRSV and FQRS in a cohort of young apparently healthy athletes undergoing preparticipation screening (PPS). We analysed a consecutive series of 2140 ECG obtained during PPS of young athletes (mean age 12.5±2.6 years, 7-18 year-old, 49% males). The peak-to-peak QRS voltage was measured in all limb leads and LQRSV were defined when maximum value was <0.5 mV. Fragmented QRS morphologies were grouped into five patterns. Lead aVR was not considered. Maximum peak-to-peak QRS voltage in limb leads was 1.4±0.4 mV, similar between younger and older athletes, but significantly lower in females than males (1.35±0.38mV vs 1.45±0.42mV; p<0.001). There was a weak correlation between maximal QRS voltages and body mass index (BMI), but not with type of sport or training load. Only 5 (0.2%) individuals showed LQRSV. At least one fragmented QRS complex was identified in 831 (39%) individuals but excluding the rSr' pattern in V1-V2, only 10 (0.5%) showed FQRS in ≥2 contiguous leads. They were older than those without FQRS, but did not differ in terms of gender, BMI, type of sport or training load. LQRSV in limb leads and FQRSV in ≥2 contiguous leads excluding V1-V2 are rare in young apparently healthy athletes and are not related to the type and intensity of sport activity. Therefore, they may require additional testing to rule out an underlying disease particularly when other abnormalities are present.

The role of preparticipation screening in detecting silent coronary artery disease in master athletes: a way to prevent exercise-related adverse cardiovascular events

Abstract Introduction Regular exercise reduces morbidity and mortality from cardiovascular diseases through cardiac and systemic adaptations including the increased coronary blood flow, an improved endothelial function, a slower progression of atherosclerotic processes as well as the stabilization of pre-existing lesions. However, long-term exercise is frequently associated with adverse cardiovascular events in 35-year older subjects because of a cardiac remodeling that predisposes to malignant arrhythmias and to an earlier atherosclerosis. Moreover, in athletes, ischemia is often silent with a higher risk of sudden cardiac death. Purpose The aim of our observational study was to evaluate the efficacy of preparticipation screening in identifying the presence of coronary artery disease (CAD) in a population of asymptomatic master athletes. Methods Between 2018 and 2019, 420 35-year older athletes (mean age: 55 + 17) underwent a preparticipation screening at the University of Pisa. None of them reported cardiovascular risk factors or previous cardiovascular diseases. After a physical examination, all subjects were submitted to spirometry and ECG stress test. Results The ECG stress test demonstrated signs of myocardial ischemia (ST depression &amp;gt; 1 mm) in 41 subjects; 3 athletes showed a frequency-dependent left bundle-branch block; 24 subjects had exercise-induced premature ventricular complexes during the ECG stress test. These subjects underwent further evaluations (Tc-99 myocardial perfusion SPECT and coronary angio-CT) to detect the presence of perfusion defects or coronary abnormalities: 26 athletes had an important coronary atherosclerosis with significant stenosis in one or more vessels and later subjected to Percutaneous transluminal coronary angioplasty (PTCA) or to coronary artery bypass grafting (CABG). 5 athletes presented a coronary myocardial bridge and 1 subject was demonstrated to have an anomalous origin of the left coronary. Conclusions Preparticipation screening in 35-year-older athletes was able to detect the presence of obstructive coronary artery disease (CAD) in the 38% of suspected cases and anomalous origin or intramural coronary course in 8,8% of cases that showed electric abnormalities during the stress test. Despite recent conflicting opinions about the scientific value of the preparticipation screening in young athletes, the present study demonstrated that it was fundamental to early detect silent conditions that could predispose master athletes to adverse cardiovascular events.

C90 THE ROLE OF PREPARTICIPATION SCREENING IN DETECTING SILENT CORONARY ARTERY DISEASE IN MASTER ATHLETES: A WAY TO PREVENT EXERCISE–RELATED ADVERSE CARDIOVASCULAR EVENTS

Abstract Regular exercise reduces morbidity and mortality from cardiovascular diseases through cardiac and systemic adaptations including the increased coronary blood flow, an improved endothelial function, a slower progression of atherosclerotic processes as well as the stabilization of pre–existing lesions. However, long–term exercise is frequently associated with adverse cardiovascular events in 35–year older subjects because of a cardiac remodeling that predisposes to malignant arrhythmias and to an earlier atherosclerosis. Moreover, in athletes, ischemia is often silent with a higher risk of sudden cardiac death. The purpose of our observational study was to evaluate the efficacy of preparticipation screening in identifying the presence of coronary artery disease (CAD) in a population of asymptomatic master athletes. Between 2018 and 2019, 420 35–year older athletes (mean age: 55 + 17) underwent a preparticipation screening at the University of Pisa. None of them reported cardiovascular risk factors or previous cardiovascular diseases. After a physical examination, all subjects were submitted to spirometry and ECG stress test. The ECG stress test demonstrated signs of myocardial ischemia (ST depression &amp;gt; 1 mm) in 41 subjects; 3 athletes showed a frequency–dependent left bundle–branch block; 24 subjects had exercise–induced premature ventricular complexes during the ECG stress test. These subjects underwent further evaluations (Tc–99 myocardial perfusion SPECT and coronary angio–CT) to detect the presence of perfusion defects or coronary abnormalities: 26 athletes had an important coronary atherosclerosis with significant stenosis in one or more vessels and later subjected to Percutaneous transluminal coronary angioplasty (PTCA) or to coronary artery bypass grafting (CABG). 5 athletes presented a coronary myocardial bridge and 1 subject was demonstrated to have an anomalous origin of the left coronary. Preparticipation screening in 35–year–older athletes was able to detect the presence of obstructive coronary artery disease (CAD) in the 38% of suspected cases and anomalous origin or intramural coronary course in 8,8% of cases that showed electric abnormalities during the stress test. Despite recent conflicting opinions about the scientific value of the preparticipation screening in young athletes, the present study demonstrated that it was fundamental to early detect silent conditions that could predispose master athletes to adverse cardiovascular events.

Evaluation of the Seattle and International Criteria in elite Nigerian athletes

BackgroundThe Seattle Criteria (SC) and International Criteria (IC) were both developed for cardiovascular pre-participation screening in young athletes. Neither set of Criteria has been systematically evaluated in high level indigenous black African athletes. Objectives(1) To determine the pattern of ECG findings in athletes of the University of Port Harcourt, Nigeria; (2) To determine the predictors of altered repolarization in these athletes; and (3) To evaluate the diagnostic performance of the SC and IC in these athletes. Methods77 athletes (42 males, 35 females) without any known cardiovascular disease were recruited alongside 78 similarly healthy non-athletic controls (44 males, 34 females). The two groups were matched for age, sex, and body mass index. Clinical assessment was according to the Lausanne Recommendations. All subjects underwent electrocardiography and echocardiography. Analysis with the IC was retrospective. ResultsThe most common physiological finding in the athletes was sinus bradycardia (n = 37; 48.1%). Early repolarization pattern, ERP (n = 27, 35.1% with SC; n = 42, 54.5% with IC), and dome-shaped ST-segment elevation with T-wave inversion (DSSTWI) in leads V1–4 (n = 21, 29.3% with both criteria), were also prevalent. Compared to controls, only male sex (adjusted odds ratio 2.89, 1.05 to 7.97, p = .040 with SC; OR 2.57, 1.19 to 5.53, p = .016 with IC) and ECG LVH (OR 2.82, 1.18 to 6.75, p = .020 with SC alone) independently predicted ERP, while athletic status (OR 4.76, 1.66 to 13.68, p = .004 with both criteria) alone had a significant multivariate association with DSSTWI. Three athletes (3.9%) had abnormal ECGs while two (2.6%) had major echocardiographic abnormalities. The sensitivity, specificity and accuracy of the SC for structural cardiac disease in the athletes were 50.0% (1.3 to 98.7), 97.3% (90.7 to 99.7) and 96.1% (89.0 to 99.2) respectively. The respective figures for the IC were 50.0% (1.3 to 98.7), 98.7% (92.8 to 100) and 97.4% (90.9 to 99.7). ConclusionBoth criteria showed high accuracy in this Black African cohort with a high frequency of electrocardiographic repolarization changes. While ERP seems to be primarily related to black ethnicity, DSSTWI appears to be a bona fide marker of Athlete's Heart in blacks.

Cardiovascular pre-participation screening in young athletes: Recommendations of the Association of European Paediatric Cardiology – CORRIGENDUM

Cardiovascular pre-participation screening in young athletes: Recommendations of the Association of European Paediatric Cardiology – CORRIGENDUM

The pre-participation screening in young athletes: which protocol do we need exactly?

The aim was to assess the utility and feasibility of a comprehensive cardiac screening protocol in young athletes before participation in sports. A total of 380 athletes referring before participation in sports, between April, 2014 and April, 2015, were included in this study. The mean age was 12.4 years. A screening protocol has been applied to all, including personal and family history, physical examination, 12-lead electrocardiography, transthoracic echocardiography, 24-hour rhythm Holter analysis, and treadmill exercise test. The most frequent complaints were chest pain in 19 (5%), dyspnoea in 13 (3.4%), and dizziness and fainting in five patients (1.3%) on exercise. There was sudden death and arrhythmia in 41 patients (10.7%) owing to family history. Heart murmur was present in 20 (5.2%) and hypertension in 10 patients (2.6%) on physical examination. The 12-lead electrocardiography was abnormal in 9 patients (2.4%). The findings of transthoracic echocardiography were insignificant in 47 patients (12.3%) and in five patients (1.3%) a haemodynamically important condition was detected. The 24-hour rhythm Holter analysis was abnormal in six patients (1.5%). There were significant ST changes in two patients (0.5%) on treadmill exercise test with normal findings on myocardial perfusion scans. No significant relation was present between findings of screening protocol and transthoracic echocardiography, 24-hour rhythm Holter analysis, or treadmill exercise test results. Pre-participation screening in young athletes should consist of a targeted personal history, family history, physical examination, and 12-lead electrocardiography. Other tests should be applied only if the screening indicates the presence of a cardiovascular disease.

Mort subite cardiaque et anomalies de connexion des artères coronaires : connaissances et questions

Some anomalous connections of the coronary arteries may be associated with a risk of sudden cardiac death. In opposite with others cardiac diseases at risk of sudden cardiac death, the relationship between these congenital abnormalities and the risk of sudden cardiac death are not well understood. A correction of the anomaly is generally indicated after an aborted sudden cardiac death. Primary prevention strategy after the discovery of an anomaly at risk is debated. Even if the absolute risk of sudden death is very low, a pre-participation screening in young athletes may be discussed due to a non-rare incidence.

Cardiovascular pre-participation screening in young athletes: Recommendations of the Association of European Paediatric Cardiology - CORRIGENDUM.

Cardiovascular pre-participation screening in young athletes: Recommendations of the Association of European Paediatric Cardiology - CORRIGENDUM.

Highlights From the Circulation Family of Journals.

Highlights From the Circulation Family of Journals.

Cardiovascular pre-participation screening in young athletes: Recommendations of the Association of European Paediatric Cardiology.

Sudden death in young competitive athletes can be avoided by implementation of pre-participation screening programmes. A screening programme should be performed only by trained physicians and should include the athlete's personal and family history, physical examination results, and the readings from a 12-lead-electrocardiogram. The athlete should undergo this screening programme every second year to detect progressive diseases. In addition, the programme should include detailed instructions to the athletes to pause training during infections in order to prevent sudden death due to myocarditis.

Cardiovascular Preparticipation Screening in Young Athletes: Looking Through One Lens.

Cardiovascular Preparticipation Screening in Young Athletes: Looking Through One Lens.

Optimizing QT Interval Measurement for the Preparticipation Screening of Young Athletes

Sudden cardiac death is the leading cause of death in athletes. Long QT syndrome (LQTS) is one of the most common cardiogenetic diseases that can lead to sudden cardiac death and is identified by QT interval prolongation on an ECG. Recommendations for QT monitoring in athletes are adopted from nonathlete populations. To improve screening, ECG data of athletes are assessed to determine a more appropriate method for QT interval estimation. ECG (CardeaScreen) data were collected from June 2010 to March 2015. ECG data with HR greater than 100 bpm were excluded. Fiducial points of outliers were manually corrected if the QRS onset or the T wave offset was misidentified. A model of best fit was determined and compared across four QT correction factors. Classification analysis was used to compare the Bazett's corrected QT interval to the 99th percentile of uncorrected QT interval. High school (n = 597), college (n = 1207), and professional athletes (n = 273) (N = 2077) were analyzed. Mean age was 19 ± 3.5 yr. QT interval varied by cohort (HS = 388 ± 30, Col = 410 ± 33, Pro = 407 ± 27, p < 0.0001). A nonlinear power function with a cubic exponent of -0.349 fit the data the best (R = 0.64). Of the four common correction factors, Fridericia had the lowest residual dependence to HR (m = -0.10). With standard screening, 75% of athletes within the top 1% for QT interval were not identified for further investigation for LQTS. Up to 75% of athletes possessing an uncorrected QT interval greater than 99% of the population are not identified for investigation for LQTS using the recommended criteria. We propose a new method of risk stratification that replaces QT interval correction. Further study is needed to establish QT interval distributions and risk thresholds in athletes.

151 Preventing Sudden Cardiac Death in the Young: Results form a Population-Based Screening Program in the UK: Abstract 151 Table 1

Purpose Sudden cardiac death (SCD) in the young is commonly attributed to inherited cardiac conditions, a considerable proportion of which can be detected during life. To prevent such tragedies, learned sporting and scientific bodies recommend pre-participation screening in young athletes. However, most SCDs in the young are likely to occur in non-competitive athletes. The aim of this study was to report the results of a population screening program in the UK. Methods During 2012, 12000 individuals, aged between 14 and 35 years, were screened, irrespective of athletic activity. Screening was performed at a cost of £35/individual and comprised of a health questionnaire, 12-lead ECG and consultation with a cardiologist. Individuals with abnormalities underwent a transthoracic echocardiogram on the day or were referred for further evaluation. Follow-up data were obtained through self-reported patient questionnaires. Results Of the 12,000 individuals screened (which included 13% elite athletes), 9.4% underwent echocardiography on the day. Ultimately, 323 (2.7%) individuals were referred for further assessment, 231 responded to the questionnaire and 189 had completed their follow-up investigations. Individuals were subjected to an average of 1.6 further investigations (ECHO 31%, 24-hour ECG monitor 30%, exercise test 22%, MRI 12%, other 5%). A cardiac pathology or findings necessitating regular follow-up were identified in 31 (16%) of the 189 individuals (Table 1). Conclusion Our results indicate that a large-scale population screening program based to similar methodology to the European Society of Cardiology recommendations is feasible. Our low referral rate indicates that young individuals with potentially sinister conditions can be identified at a relative low additional cost and investigation burden to the National health system.

ECG in preparticipation screening of young athletes

Introduction: The aim of the ECG in preparticipation screening of young athletes is detection of potential disorders in asymptomatic young athletes. Objective: The objective of the study was to determine the freqency and type of ECG changes observed during preparticipation screening of young athletes. Method: The research included analysis of ECG tests recorded during the regular preparticipation screening of 219 young athletes, aged from 9 to 19 years, predominantly male, who were engaged in 7 different sport disciplines. Standard ECG was recorded at least 24 hours after strenuous physical activity. ECG analysis was performed according to the European Society of Cardiology (ESC) recommendations for the interpretation of 12-lead ECG in the athletes, with corrections related to the inversion of T wave. Results: ECG was perfectly normal in 103 (47%), and ECG changes were noticed in 116 (53%) of the athletes. In 51.6% of examined athletes, ECG changes were of the common type, reflecting adaptation of the heart to regular exercises, and only in 1,4% athletes vwere founded ECG changes that are not consistent with training. The most common (32% of the total examinees) was incomplete right bundle branch block (RBBB). Sinus bradycardia was present in 12,8% of the athletes, and early repolarization at 7,8%. T wave inversion without clinical significance was observed in 4,1% of athlets. Isolated increase in QRS complex voltage was observed in 3,6%, while the first degree AV block was present in 0,5% of the athletes. ECG changes unrelated to training were recorded in 1,4% of athletes. Significant T wave inversion was observed in 0,9% and pre-excitation (Wolf-Parkinson-White syndrom) in 0,5% of the athletes. Conclusion: Preparticipation screening ECG test revealed ECG changes in 51,6% of young athletes. The vast majority of changes are of common, physiological type, that neither requires further investigation, nor termination of active participation in sports. In our study, in one athlete ECG changes required termination of sport activities, and two athletes continued active participation in sports, after additional testing.

Cost-effectiveness of pre-participation screening of athletes with ECG in Europe and Algeria.

The aim of this study is to evaluate the cost-effectiveness of ECG in combination with family and personal history and physical examination in order to detect cardiovascular diseases that might cause sudden death in athletes. The study was conducted on a cohort of 6,634, mainly young professional and recreational athletes, 1,071 from Algeria and 5,563 from Europe (France, Germany and Greece). Each athlete underwent medical history, physical examination, and resting 12-lead ECG. 293 athletes (4.4 %), 149 in Europe (2.7 %) and 144 in Algeria (13.4 %) required further tests, and 56 were diagnosed with cardiovascular disease and thus disqualified. The cost-effectiveness ratio (CER) was calculated as the ratio between the cost of screening and the number of statistical life-years saved by the intervention. The estimated reduced risk of death deriving from treatment or disqualification resulted in the saving of 79.1 statistical life-years in Europe and 136.3 in Algeria. CER of screening was 4,071 purchasing-power-parity-adjusted US dollars ($PPP) in Europe and 582 $PPP in Algeria. The results of this study strongly support the utilisation of 12-lead ECG in the pre-participation screening of young athletes, especially in countries where secondary preventive care is not highly developed.

EFFECTIVENESS OF CARDIAC SCREENING INCLUSIVE OF ECG IN YOUNG ATHLETES

BackgroundThe primary objective of pre-participation screening in athletes is the detection of potentially lethal cardiac conditions. The American Heart Association (AHA) recommends a directed history and physical examination. The added...

Raising awareness of the need for cardiac pre-participation screening in young athletes

Regular physical exercise confers many health benefits which are well known. However a small proportion of athletes are at risk due to undiagnosed cardiac conditions which increase their risk of exercise-related sudden cardiac death. Many authors now recommend pre-participation screening of all athletes undergoing regular athletic activity. This article describes the experience of working with a professional football club and the charity Cardiac Risk in the Young (CRY) to perform cardiac screening for their 14–16 year-old squad. The authors do not discuss the full complexity of issues surrounding screening, but do acknowledge the importance of adherence to national criteria recommendations.

Preparticipation Screening of Young Athletes: Why Still Open Questions on Performing an Electrocardiogram?

Sudden cardiac death of a young athlete has a tremendous impact on the public attentiveness and the medical community as well, because it is hardly acceptable that trained and healthy individuals might die suddenly. Over the last years, questions have arisen on whether this occurrence could be prevented by a proper medical screening. This article deals with some aspects of ECG-implementation in preparticipation screening protocols.

Transient loss of consciousness in young adults

Transient loss of consciousness (TLOC) is prevalent among young adults and frequently has a benign prognosis. However, when associated with certain clinical profiles it may herald serious cardiac disease [1–6]. Despite this, routine assessment through questionnaires has only been routinely performed during pre-participation screening of young athletes [7–9]. Epidemiological aspects like gender differences, role of occupational factors and prevalence of warning signs suggestive of adverse conditions still remain to be elucidated.

Value Of Routine X-rays Of The Lumbar Spine In Orthopedic Preparticipation Screening

BACKGROUND: Considering orthopedic preparticipation screening in athletes of disciplines with high lumbar spine loads, it is unclear whether routinely performed x-rays of the lumbar spine are of additional value in detecting pathologies. Furthermore, it has to be discussed if findings lead to a limitation of eligibility for competitive sports or if medical follow-up examinations and specific training are required. PURPOSE: To analyze radiographic findings of either routinely performed or indicated x-rays of the lumbar spine during preparticipation examinations in young athletes with sport specific loads of the lumbar spine. METHODS: Radiographic findings of the lumbar spine in 325 children (12.2 ± 0.6 years; 173 boys, 152 girls) of an elite sport school were analyzed. Findings were categorized into: 0 = inconspicuous; 1 = findings without clinical relevance (e.g. side deviation, spina bifida occulta); 2 = findings requiring follow-up examinations, physical therapy or specific training (e.g. scoliosis, unilateral spondylolysis); and 3 = findings limiting sports eligibility (spondylolisthesis, spinal instability). Data were analyzed using the Chi Square test and the Fisher Exact test. RESULTS: X-rays were performed in 325 cases. In 21 athletes lumbar pain in history or clinical findings in examination led to additional radiographs. Radiographs were inconspicuous in 285 (88 %), without clinical relevance in 13 (4 %), needed to be controlled in 11 (3 %) and led to a limited sports eligibility in 16 (5 %) children. Findings in 9 of 21 (43 %) indicated and in 18 of 304 (6 %) routinely performed radiographs were classified into grades 2 and 3 (p<0.01). Spondylolisthesis or spinal instability were found in 2 indicated (11 %) and 14 routine x-rays (5 %; p>0.05). CONCLUSION: X-rays of the lumbar spine without any clinical indication have to be questioned in preparticipation screening of young athletes.