Preparticipation Cardiovascular Screening Research Articles

Pre participation cardiovascular screening in runners: Survey of athletes of the grand raid 2023 in reunion island

Pre participation cardiovascular screening in runners: Survey of athletes of the grand raid 2023 in reunion island

Prevalence and clinical significance of low QRS voltages in healthy individuals, athletes and patients with cardiomyopathy: implications for sports preparticipation cardiovascular screening.

Low QRS voltages (LQRSV), defined as a QRS amplitude from peak to nadir <0.5 mV in all limb leads, are an emerging diagnostic finding on the electrocardiogram (ECG). In healthy individuals and athletes, LQRSV are rare (2.2-4% of elite athletes, 0.5% of recreational athletes and 0.3% of sedentary individuals). LQRSV athletes commonly show ventricular arrhythmias (VAs) on exercise, and up to 40% of those with LQRSV and VAs have late gadolinium (LGE) on cardiac magnetic resonance (CMR). The prevalence of LQRSV in arrhythmogenic cardiomyopathy (ACM) ranges 17-40%, predicts left ventricular (LV) involvement, and is correlated with more extensive LGE replacement on CMR. In hypertrophic cardiomyopathy (HCM), LQRSV ranges 0.7% to 11%. LQRSV-HCM patients have more segments with LGE, despite relatively smaller LV mass, suggesting a more advanced clinical stage and a worse prognosis. In dilated cardiomyopathy (DCM), LQRSV range 6%-7%, but may be higher (36%) in certain genetic forms of DCM. On a follow-up, LQRSV are independently associated with incident cardiac events, such as sudden death, sustained ventricular arrhythmia, or appropriate internal cardioverter defibrillator discharge. In cardiac amyloid (CA), LQRSV range from 34% to 66% and demonstrate a negative prognostic value, with worse clinical outcomes regardless of underlying biologic, genetic, and clinical variables. In conclusion, LQRSV deserve careful consideration for exclusion of arrhythmogenic substrates in healthy individuals, athletes, and patients. While additional research is needed, it is reasonable that LQRSV should trigger clinical investigation to exclude underlying diseases at risk of life-threatening arrhythmias.

Causes of sudden cardiac arrest and death and the diagnostic yield of sport preparticipation screening in children

ObjectiveEvidence on the increased risk of sports-related sudden cardiac arrest and death (SCA/D) and the potential benefit of cardiovascular preparticipation screening (PPS) in children is limited. We assessed the burden...

Abstract 12668: Prevalence of Phenotypic Hypertrophic Cardiomyopathy Among Students Referred for Sport Pre-Participation Cardiovascular Screening

Background: Although rare, sudden cardiac death (SCD) is a tragic event for young sports participants and has catastrophic impact on the community. Hypertrophic cardiomyopathy (HCM) is a leading cause of SCD in sports. Comprehensive initial pre-participation physical evaluation (CIPPE) is mandated for middle school, and junior and senior high school students by Pennsylvania Interscholastic Athletic Association (PIAA) primarily for reducing potential sports-related injuries and SCD. Prospective data has been limited in this age group in regard to the prevalence of HCM. Methods: Between 2015 and 2023, we prospectively screened 424 students [age 10-21 (15±2) years, 60% male, 64% Caucasian) referred for cardiovascular disease pre-participation screening based on at least one positive response on the 14-point AHA questionnaire during CIPPE. Evaluation included 12-lead ECG and rhythm strip (100%), transthoracic echo (96.4%), ambulatory heart rhythm monitor (3.8%), treadmill exercise ECG (14.5%), stress echo (2.1%), and cardiac MRI (0.9%). Results: Overall, 1 (0.24%) student was diagnosed with definitive and two were diagnosed with probable HCM [Table-1]. Conclusion: In this prospective cohort of middle school and junior and senior high school students with at least one positive response to the 14-point AHA questionnaire, 1 (0.24%) had definitive and 2 (0.47%) had probable phenotypic HCM.

The cardiac preparticipation sports evaluation.

Sudden cardiac death (SCD) is the leading cause of death in young athletes during sports participation. Preparticipation cardiovascular screening aims to identify those at an increased risk of SCD. This review aims to provide a background of SCD in young athletes, to discuss the various screening recommendations of major medical societies, and to review recent evidence and current practice. Numerous studies have evaluated various preparticipation screening practices, particularly regarding the inclusion of ECG as part of an initial evaluation to identify conditions with an increased risk of SCD. Some analyses have shown ECG inclusion to provide increased screening sensitivity and specificity, though others have shown no benefit when compared with evaluation with history and physical examination alone. Furthermore, in countries for which more extensive screening protocols have been employed, postimplementation statistics have not shown a significant decrease in SCD. SCD in young athletes primarily results from underlying cardiac disease. Various preparticipation screening recommendations exist globally, with the common goal of decreasing the rates of SCD by identifying youth at risk during sports participation. Current guidelines in the United States support universal preparticipation evaluation using history and physical examination, with cardiology referral if abnormalities are identified.

Return-to-Play for Elite Athletes With Genetic Heart Diseases Predisposing to Sudden Cardiac Death

BackgroundPeople diagnosed with genetic heart diseases (GHDs) associated with sudden cardiac death (SCD) have historically been restricted from competitive sports. Recent data documenting return-to-play (RTP) experiences following shared decision making (SDM) suggest that cardiac event rates for athletes with a GHD are lower than previously described, thereby suggesting an opportunity to reconsider this paradigm. ObjectivesThe purpose of this study was to evaluate clinical outcomes among National Collegiate Athletic Association Division I university and professional athletes diagnosed with a GHD. MethodsA multicenter retrospective analysis was performed to examine demographics, clinical characteristics, RTP outcomes, and cardiac events among elite athletes with a GHD. ResultsA total of 76 elite (66%, Division I, 34% professional) athletes (age 19.9 ± 5 years, 28% women) diagnosed with a GHD (hypertrophic cardiomyopathy [53%], long QT syndrome, long QT syndrome [26%]) comprise this cohort. Most athletes were asymptomatic (48 of 76, 63%) before diagnosis and had their GHD detected during routine preparticipation cardiovascular screening. Most athletes (55 of 76, 72%) were initially disqualified from their sport but subsequently opted for unrestricted RTP after comprehensive clinical evaluation and SDM. To date, (mean follow-up 7 ± 6 years), only 1 exercise-related (1.3%) and 2 nonexercise-related GHD-associated adverse cardiac events occurred. There have been no fatalities during follow-up. ConclusionsThis is the first study describing the experience of athletes with a known SCD-predisposing GHD who are competing at the elite level. After careful evaluation, risk stratification, and tailoring of their GHD therapy, RTP following SDM appears associated with low, nonfatal events rates at elite levels of sport.

Readability of the current preparticipation cardiovascular screening questionnaires: Are they suitable for athletes?

Abstract Funding Acknowledgements Type of funding sources: None. Background Pre-participation screening (PPS) is now implemented by the majority of the leading sporting organisations around the globe, where the presence of the personal symptoms and family history questionnaire has to date been constant among all. The leading cardiology and sporting bodies of the AHA, ESC, IOC and FIFA all however independently publish, and advocate altered variations of the form, which are not validated, and based on expert opinion alone. Purpose The National Institute of Health (NIH) recommend questionnaires be written at a reading age of between 11-14 years. To date the readability and suitability of commonly used PPS questionnaires has not been investigated; thus, it was our aim to assess the readability of several PPS questionnaires from the leading sporting and cardiology organisations. Methods Readability analysis was performed on the PPS questionnaires from the leading sporting and cardiology organisations 1) AHA; 2) The PPE monograph; 3) ESC; 4) FIFA; 5) IOC. To assess the readability of the questionnaires, several formulae were applied, using multiple regression equations to predict the reading ability needed to understand the given text. The readability formula used were the Flesch Kincaid, Flesch Reading Ease, New Dale-Chall, SMOG scale, FORCAST, Coleman-Liau, and the Gunning Fog scale. Results Readability analysis demonstrated that the PPS questionnaires had an average reading age of between 14 and 18 years, resulting in all falling outside the NIH recommended reading age. The best performing questionnaire in terms of readability was the IOC questionnaire (average 13.7 years). The questionnaire with the highest reading age was the AHA 14-step (18.4 years), where 34.3% of the total words within the questionnaire were considered difficult according to the New Dale-Chall list. Questions relating to symptoms were considered easier to comprehend than family history questions. This was also exemplified by percentage of "unfamiliar" words, with symptoms questions having an average of 19.4%, while family history questions having an average of 27.3%. Within the sub analysis of individual questions, chest pain, syncope and palpitations were questions documented by all organisations, however the wording of these showed notable variation, with an average 7.5-year difference in reading age between questionnaires. Conclusion The readability of the current PPS questionnaires exceed the NIH recommended reading age of 11-14 years. Readability is an integral part of health literacy, and should a question be too difficult for an athlete to comprehend, this misunderstanding may lead to them rejecting the questionnaire or providing an inaccurate response. The PPS questionnaire remains a mainstay within the screening process, yet more research needs to be conducted to establish athlete comprehension and tailor future questionnaires towards this, with the goal of improving specificity and sensitivity.

Right ventricle adaptation to high intensity training assessed by cardiac magnetic resonance in olympic athletes

Abstract Funding Acknowledgements Type of funding sources: None. Background Several determinants affect cardiac remodelling in athletes, including sport discipline, body size and sex. Recently, interest in myocardial deformation (MD) imaging as reliable functional index is growing. Available MD data are usually derived by echocardiography and mostly related to the evaluation of the left ventricle. Data on right ventricle (RV) deformation assessed by CMR are lacking and, currently, specific reference values in athletes have not been explored. Purpose To assess RV deformation in a cohort of Olympic athletes and to evaluate possible inter-individual differences related to type of sport and sex. Methods A cohort of Olympic athletes with unremarkable cardiovascular pre-participation screening tests was enrolled. A group of sedentary individuals was also enrolled for comparison. All subjects underwent CMR without contrast. Cine-images were post-processed to assess RV volume, ejection fraction (EF) and MD by computing global longitudinal strain (GLS) by feature-tracking software. Athletes were divided in subgroups based on sex, ESC sport classification and RV enlargement (RVEDV/LVEDV&amp;gt;1 or ≤1). Results 265 Olympic athletes (15% skill, 19% power, 25% mixed, 41% endurance; 58% male) and 21 sedentary controls were enrolled. Endurance athletes showed the greatest RV remodeling in terms of volumes (Table). No differences in RV-EF were found comparing athletes of different sport categories, but between athletes and sedentary controls. Median value of RV-GLS of the whole athletic cohort was -23 (-21, -25). There were no significant differences among the different sport disciplines other than endurance vs. sedentary controls for RV-GLS. Female athletes showed higher values of RV-GLS when compared with males. When examined with regard to presence of RV enlargement, no differences were observed (Figure). Conclusion Endurance athletes showed the greatest right ventricle remodelling in terms of RV volumes and function. Specifically, they showed the highest values of RV volumes and the lowest values of RV-GLS of the entire athlete’s population, but still within the normal range. Female athletes had higher RV-GLS values when compared with males. No difference was observed between athletes with dilated RV compared to non-dilated RV.

Native T1 and T2 mapping by CMR in a cohort of olympic athletes: does sport discipline make difference?

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac Magnetic Resonance (CMR) represents the gold standard for morpho-functional assessment and for myocardial tissue characterization. Although Mapping technique provided added value to tissue characterization, data on Mapping in athletes are still scarce and differences between sport disciplines have not been evaluated. Purpose To compare T1 and T2 Mapping values between Olympic Athletes engaged in different types of sport and a control group of sedentary subjects. Methods A group of Olympic athletes with unremarkable cardiovascular pre-participation screening prior the Olympic games underwent CMR without contrast administration. A group of sedentary subjects was enrolled as a control group. Cine, native T1 and T2 Mapping were analyzed. Athletes were divided in different sports categories according to the ESC classification. Results 265 Olympic athletes (15% skill, 19% power, 25% mixed, 41% endurance - 58% male) and 21 controls were enrolled. Comparing athletes of different sport categories and sedentary controls, endurance presented the lowest value of T1 Mapping. T2 Mapping was slightly higher in endurance athletes but were within normal limits (referred to local normal range) (Table). Compared with males, female athletes had higher values of T1 native myocardial Mapping [956 (934-981) vs 941 (926-963); p=0,004], while there were no significant differences regarding T2 Mapping values (p=0,874) (Figure). Conclusion T1 was lower and T2 Mapping slightly higher athletes engaged in endurance compared to other sport disciplines and sedentary controls. Female athletes showed higher T1 native myocardial Mapping compared with males, while T2 Mapping did not show differences.

Sudden cardiac death in the young: An update for NPs.

NPs can identify risk for sudden cardiac death in children during physical exams to prevent tragedy. The updated American Academy of Pediatrics 2021 policy statement on this issue provides guidance on using a combination of elements to determine and manage risk, including the organization's own 4-question screening tool, the American Heart Association 14-Element Preparticipation Cardiovascular Screening of Young Competitive Athletes, personal history, family history, physical exam, ECG, and cardiology referral as indicated.

Value of screening for the risk of sudden cardiac death in young competitive athletes.

This study aimed to report the long-term findings of the Italian programme of cardiovascular preparticipation screening (PPS) in young, competitive athletes. The study assessed the diagnostic yield for diseases at risk of sudden cardiac death (SCD), the costs of serial evaluations, and the long-term outcomes of PPS in a large population of Italian children (age range, 7-18 years). The PPS was repeated annually and included medical history, physical examination, resting electrocardiogram, and stress testing; additional tests were reserved for athletes with abnormal findings. Over an 11-year study period, 22 324 consecutive children [62% males; mean age, 12 (interquartile range, 10-14) years at first screening] underwent a total of 65 397 annual evaluations (median 2.9/child). Cardiovascular diseases at risk of SCD were identified in 69 children (0.3%) and included congenital heart diseases (n = 17), channelopathies (n = 14), cardiomyopathies (n = 15), non-ischaemic left ventricular scar with ventricular arrhythmias (n = 18), and others (n = 5). At-risk cardiovascular diseases were identified over the entire age range and more frequently in children ≥12 years old (n = 63, 91%) and on repeat evaluation (n = 44, 64%). The estimated cost per diagnosis was 73 312€. During a follow-up of 7.5 ± 3.7 years, one child with normal PPS findings experienced an episode of resuscitated cardiac arrest during sports activity (event rate of 0.6/100.000 athletes/year). The PPS programme led to the identification of cardiovascular diseases at risk of SCD over the whole study age range of children and more often on repeat evaluations. Among screened children, the incidence of sport-related cardiac arrest during long-term follow-up was low.

The International Criteria for Electrocardiogram Interpretation in Athletes: Common Pitfalls and Future Directions.

Preparticipation cardiovascular screening (PPCS) in young athletes is performed to detect conditions associated with sudden cardiac death. Many medical societies and sports governing bodies support the addition of a 12-lead electrocardiogram (ECG) to the history and physical to improve PPCS sensitivity. The current standard for ECG interpretation in athletes, the International Criteria, was developed to distinguish physiologic from pathologic ECG findings in athletes. Although application of the International Criteria has reduced the PPCS false-positive rate, interpretative challenges and potential areas of improvement remain. This review provides an overview of common pitfalls and future directions for ECG interpretation in athletes.

Risks of the Athletic Field Revisited: Report of Unusual Occurrences of Cardiac Arrest and Sudden Death in Professional Soccer Players

BackgroundSudden deaths in competitive athletes are highly visible but potentially preventable events that generate great interest amongst the cardiovascular community and general public. MethodsInternet searches were performed using a combination of keywords and operators to produce search results for sudden death or cardiac arrest on the field in professional soccer players. ResultsWe identified 35 male professional soccer players (mean age 26 ± 5 years) who experienced collapse and cardiac arrest on the field (most during matches) in Europe from December 2002 to February 2022 with 63% in the last 6 years. Twenty-five have died on the field or later in a hospital despite cardiopulmonary resuscitation. Of the 10 survivors, eight were implanted with cardioverter-defibrillators for secondary (n = 6) or primary (n = 2) prevention and returned to full competition; five of the 8 required successful device therapy during matches or training. ConclusionsCardiac arrest and sudden death can occur not uncommonly in professional athletes highly trained over decades and participating at an elite sports level. Our observations also underscore the importance of targeted preparticipation cardiovascular screening, and availability of external defibrillators on the playing field.

Late gadolinium enhancement of the hinge point is a common finding in asymptomatic ELITE athletes

Abstract Funding Acknowledgements Type of funding sources: None. Background Late gadolinium enhancement (LGE) demonstrates regional differences in myocardial extracellular volume, such as seen in myocardial fibrosis, and is associated with diverse cardiac diseases and is a predictive factor for sudden cardiac death. Earlier findings suggest an LGE prevalence of 7% in endurance athletes of varying age and exercise exposure. However, findings for (potentially benign) LGE indices in athletes performing at elite-level are lacking. Purpose To establish a specific baseline for LGE findings on CMR in apparently healthy, elite-level athletes. Methods We performed a cross-sectional assessment of hinge point late gadolinium enhancement (HP-LGE) in elite athletes (national-, international-, Olympic-, Paralympic-level or comparable). All athletes were asymptomatic and examined during pre-participation cardiovascular screening. Each underwent CMR using 3 Tesla- (Philips) or 1½ Tesla- (Siemens) MRI-scanners including short-axis cine imaging, LGE, and T1-mapping. CMR data were analysed using cvi42, statistical analyses using R. Athletes with HP-LGE were compared to athletes without HP-LGE. Results We screened 210 athletes, 34% female, with a mean age (±SD) of 28±7 and body surface area (BSA) of 2.0±0.2 m2 participating in road cycling (n=38), field hockey (n=28), water polo (n=27), soccer (n=21), rowing (n=18), swimming (n=13), track cycling (n=12), tennis (n=10), sailing (n=10), para-cycling (n=7), and miscellaneous (n=26) sports. We observed indexed end-diastolic volumes (EDVi) of 119±20 and 123±20 ml/m2, stroke volumes 131±33 and 127±37 ml, and ejection fractions of 56±5 and 54±6 %, in the left- (LV) and right ventricle (RV), respectively. Eighty-four (40%) athletes had HP-LGE. Proportionally, fewer female athletes had HP-LGE as compared with men (24 vs 41 %, p=0.014). Athletes with HP-LGE had greater LV- and RV EDVi (123±20 and 127±20 ml/m2 vs. 117±19 and 120±19 ml/m2, p=0.02 and p=0.01; for LV and RV, respectively), lower RV ejection fractions (53±5 vs. 55±6, p-value 0.04), smaller estimated global extra cellular volumes of the LV (24 vs 25 %, p=0.01). There were no differences in indexed LV- and RV end-systolic volumes, LV- and RV stroke volumes, LV ejection fraction and indexed wall mass, global native-, or contrast-enhanced T1 times in athletes with and without HP-LGE. Conclusion Late gadolinium enhancement in the hinge point is present in 40% of asymptomatic elite athletes. Athletes with HP-LGE were more frequently men, had higher LV- and RV EDVi, suggesting an association with ventricular volumes. Our findings in asymptomatic, elite athletes, with normal ventricular function and T1 times, suggest that HP-LGE could be a sign of physiological sports adaptation instead of an early sign of pathology. Further studies are warranted to investigate if HP-LGE is associated with long-term cardiac changes or the development of cardiac pathology.

Cost-effectiveness of the cardiovascular pre-participation screening in children practicing sport

Abstract Funding Acknowledgements Type of funding sources: None. Introduction In Italy, preparticipation screening of competitive athletes is mandatory. The age at which pre-participation screening (PPS) should start is established by each sport federation and it is sometimes under 10 years old. The aim of this study is to detect both PPS efficacy and cost in paediatric age and to define the cut-off age from which it is more cost-effective. Methods We retrospectively enrolled 25251 athletes aged ≤15 to evaluate the prevalence of cardiovascular (CV) diseases and cost-effectiveness ratio who underwent PPS from 2011 to 2020. In addition, we retrospectively studied a subgroup of 1307 competitive athletes aged 7-15 who underwent PPS from January 2019 to February 2020 for an in-depth analysed regarding costs. Cardiovascular preparticipation screening included first-line investigations (history, physical examination, resting ECG and exercise testing) and further examinations in case of abnormalities at first-line tests. Results In the period 2010-2020, 66 athletes were permanently disqualified for a CV disease (0,11%), 26 for a CV disease at risk of sudden cardiac death (0.05%), with a prevalence of 0.15% over 12 years old versus 0.01% under 12 (p&amp;lt;0.001). In the cost analysis subgroup, second-line investigations were prescribed to 5% of athletes because of abnormalities at first line tests: 1 was disqualified for a CV disease (0,07%). The cost for each athlete was 69,80€. Between 2011 and 2020, 58185 PPS were carried out. The overall cost of PPS was about €4 million, the cost for each diagnosis of any CV disease was 61.535€, and for each CV disease at risk of sudden cardiac death was 156.204€. Conclusion The cost-effectiveness of PPS before competitive sports in the pediatric age is lower than reported for older athletes in previously published studies. According to our data, starting PPS before 12 years of age does not appear to be justified.

Hemodynamic forces in olympic athletes assessed by cardiac magnetic resonance: a new non-invasive screening tool?

Abstract Funding Acknowledgements Type of funding sources: None. Background Non-invasive evaluation of left ventricular hemodynamic forces (HDFs) by Cardiac Magnetic Resonance (CMR) is a promising tool to improve systolic and diastolic evaluation. No data are available on athletic population. Purpose To provide the range of normal values of HDFs in Olympic athletes and to evaluate the possible influence of different sport categories. Methods A group of Olympic athletes evaluated prior the Olympic games with unremarkable cardiovascular pre-participation screening tests underwent CMR without contrast administration. A group of sedentary subjects was enrolled as a control group. Cine-images were post-processed by a feature-tracking based software to estimate HDFs. HDFs were measured in apex-base (AB) and latero-septal (LS) directions, over the entire heartbeat, in systole and diastole. Athletes were divided in subgroups according to ESC sport classification for comparison. They were also divided according to the ejection fraction (EF ≤ or &amp;gt;53%). Results 93 elite athletes (33% power, 33% mixed, 33% endurance) were enrolled. HDFs in AB and LS direction were 20.5%± 4.3 and 2.9%± 0.7 in the entire heartbeat, 32.6% ± 7 and 3.6%± 1 in systole, 11%± 4.1 and 2.3%± 0.8 in diastole. Comparing athletes of different sport category and sedentary controls no significant differences were found between groups (Table). Comparing athletes with ejection fraction (EF) £ 53% and &amp;gt; 53%, the former showed lower values of AB-HDFs assessed in the entire heartbeat and in systole (18.9 ± 4.6 % vs 20.9 ± 4.1; p= 0.024 and 29.6 ± 6.3 vs 33.3 ± 7; p= 0.024, respectively), but within the normal range. Conclusion We provide normal range for HDFs assessed by CMR in elite athletes and no differences were observed between sedentary controls and athletes involved in different sport categories. Comparing athletes with low-normal and normal ejection fraction, the former showed lower values of AB-HDFs but within the normal range.

Left ventricle myocardial deformation in olympic athletes assessed by cardiac magnetic resonance: does the sex and discipline matter?

Abstract Funding Acknowledgements Type of funding sources: None. Background Sport induces structural and functional cardiac adaptation with different entity related to several factors including type of training and gender. Cardiovascular Magnetic Resonance (CMR) is the gold standard for morpho-functional evaluation of athletes’ heart and commonly relies on ventricular volume, wall thickness and ejection fraction (EF) assessment. Data on myocardial deformation (MD) are limited to echocardiography and are scarce. Purpose To assess MD in Olympic athletes and to evaluate the possible influence of sport categories and gender. Methods A group of Olympic athletes evaluated prior the Olympic games with unremarkable cardiovascular pre-participation screening tests underwent CMR without contrast administration. A group of sedentary subjects was enrolled as a control group. Cine-images were post-processed for volume and function evaluation and to assess global longitudinal strain (GLS) and global circumferential strain (GCS) by feature-tracking software. Athletes were divided in subgroups according to ESC sport classification. Male and female athletes were compared. Athletes were also divided based on EF (≤53% or &amp;gt;53%). Results 93 elite athletes (33% power, 33% mixed, 33% endurance) and 18 controls were enrolled. No differences in terms of EF were observed, while endurance athletes showed the greater LV remodeling (Table). GLS and GCS values of the entire population were -22.5±2.7% and -30.7±3.4%, respectively. No significant differences were found comparing athletes of different sport categories and sedentary controls for GLS (p= 0.940) and GCS (p=0.072). Female athletes showed higher GLS compared to male (-23.5±2.8% vs-21.9±2.8%, p=0.002) but not differences in terms of GCS (-31.5±3.1% vs-30.2±3.5%, p=0.076). Athletes with EF≤53% had lower GLS values compared with those with &amp;gt;53% but within normal limits (Figure). Conclusion No differences were observed in MD assessed by CMR between different sport categories and controls. Female athletes showed higher longitudinal but not circumferential strain compared with male. Athletes with lower EF presented lower values of strain but within normal range with the potentiality to be used as a tool for differential diagnosis between normal adaptation and disease.

Review on Cardiorespiratory Complications after SARS-CoV-2 Infection in Young Adult Healthy Athletes

This review analyzes scientific data published in the first two years of the COVID-19 pandemic with the aim to report the cardiorespiratory complications observed after SARS-CoV-2 infection in young adult healthy athletes. Fifteen studies were selected using PRISMA guidelines. A total of 4725 athletes (3438 males and 1287 females) practicing 19 sports categories were included in the study. Information about symptoms was released by 4379 (93%) athletes; of them, 1433 (33%) declared to be asymptomatic, whereas the remaining 2946 (67%) reported the occurrence of symptoms with mild (1315; 45%), moderate (821; 28%), severe (1; 0%) and unknown (809; 27%) severity. The most common symptoms were anosmia (33%), ageusia (32%) and headache (30%). Cardiac magnetic resonance identified the largest number of cardiorespiratory abnormalities (15.7%). Among the confirmed inflammations, myocarditis was the most common (0.5%). In conclusion, the low degree of symptom severity and the low rate of cardiac abnormalities suggest that the risk of significant cardiorespiratory involvement after SARS-CoV-2 infection in young adult athletes is likely low; however, the long-term physiologic effects of SARS-CoV-2 infection are not established yet. Extensive cardiorespiratory screening seems excessive in most cases, and classical pre-participation cardiovascular screening may be sufficient.

ACSM-AMSSM Call to Action: Adapting Preparticipation Cardiovascular Screening to the COVID-19 Pandemic.

Preparticipation cardiovascular screening, designed to identify cardiovascular pathology responsible for sudden unexpected death, is recommended by all major professional medical organizations overseeing the clinical care of competitive athletes. Data from several large, prospective, cohort studies indicate that cardiac imaging findings consistent with inflammatory heart disease following COVID-19 infection are more common than most forms of heart disease associated with sudden death during exercise. This call-to-action document is intended to provide recommendations about how routine preparticipation cardiovascular screening for young competitive athletes - which has the capacity to detect both COVID-19 cardiovascular complications and pathology unrelated to infection - should be altered to account for recent scientific advances.

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

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.