Sudden Cardiac Death In Sport Research Articles

Etiology, Epidemiology And Methods Of Preventing Sudden Death Of Cardiac Origin In Sports

Introduction: Numerous epidemiological studies have consistently shown an association between moderate aerobic exercise and decreased risk of coronary heart disease (CHD) and death, and even a small amount of exercise provides a significant reduction in risk compared to a sedentary lifestyle Objective: The aim of this study was to identify the etiology, epidemiology and prevention of sudden cardiac death in sports. Methodology: The methodology used was a literature review. The research was carried out by means of an electronic search for scientific articles published on the Scielo (Scientific Electronic Library Online) and Lilacs (Latin American Health Sciences Literature) and Pubmed websites. The health terminologies consulted in the Health Sciences descriptors (DeCS/BIREME) were used; the etiology, epidemiology and ways of preventing sudden cardiac death in sports practices. Discussion: An important distinction must be made between hypertrophic cardiomyopathy and “athlete's heart syndrome”. In this syndrome, intense physical training leads to various morphological and physiological alterations, especially left ventricular hypertrophy. Conclusion: The complete health safety of athletes consists of periodic pre-participation clinical assessment as well as emergency measures, mainly in competition venues, consisting of the availability of health professionals

AI-based heart monitoring: the FIFPRO player pilot study

Abstract Background The implementation of remote global heart screening and monitoring services in professional players is essential as it allows: (1) efficient and rapid identification of cardiac abnormalities ensuring their safety and health; (2) standardizing the quality of medical heart checkups in low-resource regions to promote health equity; (3) prioritizing diversity in data collection to aid in the research and prevention of sudden cardiac death in sports. Purpose To demonstrate the feasibility of a global standardized heart screening program for professional footballers by leveraging an artificial intelligence platform to efficiently identify cardiac patterns from Holter’s records. In this study, we presented the most prevalent cardiac patterns, the patterns that prompted further assessment by the cardiologist, and an example of a typical research question exploring the effect of age on the prevalence of cardiac patterns. Methods The pilot study included 100 players from 9 different countries: Australia, Botswana, Bulgaria, Ghana, Greece, Indonesia, Panama, Spain and the UK. Holter data (Bittium Faros 180) were acquired in real-life monitoring from 24h to 48h including training sessions. Electrocardiograms were analyzed through an AI platform with a deep learning-based methodology to detect over 20 cardiac patterns. Medical team reviewed labels of detected cardiac patterns to validate and further train the AI algorithm. Thereafter cardiologists reviewed the cardiac patterns to determine whether further cardiac assessment was required. Results 145 sessions were recorded, with 100 players having one session and 45 players having two sessions. The mean age was 27.5 years (minimum 15, maximum 41), with 31 female players. The median duration of the Holter session was 25.1 hours. Table 1 presents the most frequently detected cardiac patterns: low density premature atrial complex, mild sinus bradycardia and low density premature ventricular complex in over 50% of the players. 18 players were identified with abnormalities requiring further study. 14 presented altered cardiac patterns (6 with negative T-waves, 5 with intraventricular conduction delay, 2 with QRS low voltage and 1 with P wave enlargement) and 3 presented premature ventricular complexes during exercise or high density. 1 was excluded because of inadequate clinical information. Regarding the effect of age, players with mild sinus bradycardia, premature ventricular complex, pause (2-3 seconds) or 2-degree atrioventricular block were found to be significantly older than players without those patterns (Figure 1). Conclusion This is the first global AI-based platform to obtain standardized heart screening program in professional athletes remotely. This study has been validated using diverse data from groups on 5 continents. This approach is beneficial to promote health equity in screening and monitoring of possible cardiomyopathies and channelopathies in order to prevent sudden cardiac death.Table 1Figure 1

Disorders of connective tissue metabolism, which can affect injuries and other risks during sports and physical culture

The purpose of the article: to carry out a theoretical analysis of scientific literature data on disorders of connective tissue metabolism, in particular connective tissue dysplasia, which can cause increased injuries and other negative health consequences when performing physical activity of various types. The article briefly describes changes in the structural elements and metabolism of connective tissue, which can lead to disruption of its basic functions. More often, such changes, according to scientific literature, are described by the term “connective tissue dysplasia” and characterize a variety of all manifestations on the part of most organs and systems of the body. The presence of dysplastic changes in the connective tissue can serve as a prerequisite for the development of many morpho-functional changes, maladaptive changes and the development of pathological conditions in the body of athletes and people involved in physical culture. Against the background of manifestations of connective tissue dysplasia, dislocations, subluxations of joints, episodic arthralgias, tendinitis, bursitis, epicondylitis, tunnel syndrome, protrusions of intervertebral discs, various skeletal deformities, varicose disease of the lower extremities, decreased aerobic productivity, and cases of sudden cardiac death in sports often occur. Thus, timely detection of markers of connective tissue dysplasia will make it possible to rationally select (plan) physical activity in order to prevent cases of injury and the development of other pathological conditions in people involved in physical culture and sports.

Development of the NOCSAE Standard to Reduce the Risk of Commotio Cordis.

Commotio cordis, sudden cardiac death (SCD) caused by relatively innocent impact to the chest, is one of the leading causes of SCD in sports. Commercial chest protectors have not been demonstrated to mitigate the risk of these SCDs. To develop a standard to assess chest protectors, 4 phases occurred. A physiological commotio cordis model was utilized to assess variables that predicted for SCD. Next, a surrogate model was developed based on data from the physiological model, and the attenuation in risk was assessed. In the third phase, this model was calibrated and validated. Finally, National Operating Committee on Standards for Athletic Equipment adopted the standard and had an open review process with revision of the standard over 3 years. Of all variables, impact force was the most robust at predicting SCD. Chest wall protectors which could reduce the force of impact to under thresholds were predicted to reduce the risk of SCD. The correlation between the experimental model and the mechanical surrogate ranged from 0.783 with a lacrosse ball at 30 mph to 0.898 with a baseball at 50 mph. The standard was licensed to National Operating Committee on Standards for Athletic Equipment which initially adopted the standard in January 2018, and finalized in July 2021. An effective mechanical surrogate based on physiological data from a well-established model of commotio cordis predicts the reduction in SCD with chest protectors. A greater reduction in force provides a great degree of protection from commotio cordis. This new National Operating Committee on Standards for Athletic Equipment standard for chest protectors should result in a significant reduction in the risk of commotio cordis on the playing field.

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 Role of the Electrocardiogram (ECG) In the Screening and Prevention of Sudden Cardiac Death in Sports

The Role of the Electrocardiogram (ECG) In the Screening and Prevention of Sudden Cardiac Death in Sports Abstract: Athletes carry a higher risk for sports-related sudden cardiac death compared to the general population. The majority of these athletes suffer from an undiagnosed heart disease. Since physical activity is an essential trigger for sudden cardiac death in individuals with undiagnosed, usually hereditary, heart disease, sports can lead to sudden cardiac death in these athletes. Different heart diseases lead to sudden cardiac death at different ages during sports. The electrocardiogram (ECG) is an important screening tool to identify individuals of all ages with heart disease that are associated with sports-related sudden cardiac death. These individuals can then be treated and lives can be saved.

Sudden cardiac death in sports

Problem and objective: To inform about the incidence, causes and prevention measures of sudden cardiac death in sports. Methods: A literature search was performed (PubMed, Web of Science, Researchgate) using the terms sudden cardiac death (SCD), sudden cardiac arrest (SCA), sudden death, cardiopulmonary resuscitation, sport, exercise and athlete. Observational studies, systematic reviews and meta-analyses that examined SCD/SCA during exercise or up to one hour afterwards in recreational, competitive or elite athletes were considered. Results: Of 6350 study titles and abstracts 11 full-text studies were included in this clinical review. When the incidence was calculated based on multiple sports, it varied between populations and ranged from 0.1 to 2.9/100,000 athlete-years (AY). The incidence was highest in male professional basketball players, with 19/100,000 AY. The most frequent cause of SCD/SCA in athletes >35 years was coronary artery disease (CAD), while in younger athletes the predominating underlying pathologies (autopsy-negative sudden unexplained death, myocarditis, cardiomyopathies, coronary artery anomalies and premature CAD) differed by region. The most effective screening tool for cardiovascular disease in athletes is the ECG. Survival after CPR is substantially influenced by the use of an automated external defibrillator (AED). Discussion: SCD/SCA in athletes is a rare but very tragic event. Incidence rates in athletes differ among populations, studies, and sports. Some degree of underreporting can be assumed as there is no mandatory reporting of sports-related SCD/SCA in most countries and few scientific registries exist. Potentially, primary screening measures could be adapted to the regionally different causes of SCD/SCA. In addition, training athletes and staff in the use of an AED is paramount to improving survival rates.

The athlete's ECG : What is normal or abnormal?

The electrocardiogram (ECG) has become amobile and cost-effective routine assessment tool to risk stratify leisure-time and professional athletes during preparticipation screening. A central goal is the reduction of sudden cardiac death in sports through early recognition of the most prevalent underlying cardiac pathologies, e.g., hereditary cardiomyopathies or primary arrhythmias. Continuous evolution of the first ECG criteria for athletes, presented in 2010 by the European Society of Cardiology (ESC), has helped to improve the specificity of the criteria to both detect cardiac pathologies in early stages and differentiate from physiologic adaptation of the athlete's heart. Thus, the risk of false-positive findings and erroneous stigmatizations of athletes has been successfully reduced. This review article intends to trace back the changes of the ECG criteria in the light of agrowing body of scientific evidence over the last 15years, to present the key messages of the current International ECG criteria from 2017 and to identify some of the remaining challenges that wait to be answered by physicians in the field of sports medicine and sports cardiology.

Prevention of Sudden Death in Sports: A Global and Multidisciplinary Observatory for Scientific Research and Knowledge Transfer (PREMUBID).

The health benefits of sports and exercise training are well known. However, an acute bout of exercise transiently increases the risk of sudden cardiac death (SCD). To minimize the cardiovascular risks of exercise, more insight into the prevention and causes of SCD is needed. The observatory for the prevention of sudden death in sports, PREMUBID, was created with the aim of fostering research to assess the benefits and risks of exercise at different volumes and intensities and to get insight into the underlying mechanisms of potentially cardiac (mal) adaptations. The observatory gathers researchers from a wide range of disciplines working at institutions in Europe and North America. The guiding principles of PREMUBID are to broaden the understanding of SCD in sports, strengthening collaborative research across the globe, and to develop, implement and evaluate robust pre-participation screening and emergency care strategies to further reduce the number of fatal cardiac events in sport events. During the inaugural meeting of the observatory, members and affiliated researchers discussed possibilities to initiate collaborative research projects and to exchange staff and students to share information and practices to prevent SCD. The final goal is to translate the obtained knowledge to understandable messages for the general population and healthcare workers to ensure that the population at large benefits from it. The PREMUBID consortium aims to produce novel knowledge and insights in SCD prevention, in order to maximize the health benefits associated with acute and long-term exercise training.

Left ventricular myocardial remodeling in playing sports athletes

The article presents the results of an echocardiographic study of 64 male playing sports athletes (basketball and football). The results of the study showed that up to the age of 19 in playing sports athletes, only normal geometry of the left ventricle is observed. With age and, accordingly, with an increase in the experience of playing sports, the number of eccentric and concentric remodeling and eccentric and concentric myocardial hypertrophy increases statistically. The percentage of concentric myocardial hypertrophy (pathological remodeling) was 6.5 %, 12.5 % and 7.7 % in the groups 19–25 years old, 26–30 years old and 31 and older, respectively, which must be taken into account when taking measures to prevent overtraining and sudden cardiac death in sports.

World netball cardiac screening guidelines.

Sudden cardiac adverse events remain an area of concern in sport. The precise risk for netball athletes is unknown but the annual incidence of sudden cardiac death in sports is reported at 0.5-2 cases in 100 000 young competitive athletes between the ages of 12-35 years. Cardiac screening in the sport and exercise medicine context aims at identifying pathologies associated with catastrophic events when combined with physical activity. There is an ongoing debate relating to the standardisation of the pre-participatory medical assessment (PPMA). World Netball (WN) commissioned a cardiac screening policy (13 March 2022). The minimum PPMA recommended by World Netball is a history, physical examination, and a resting 12-lead electrocardiogram (ECG). ECGs should be interpreted in accordance with athlete-specific ECG interpretation criteria. Expansion of sports cardiology experience and infrastructure, in combination with universal emergency response planning for sudden cardiac arrest, is intended to safeguard athlete health and player welfare in WN.

Is the Preparticipation Physical Examination Replacing the Annual Well Child Examination among Student Athletes?

The goal of the preparticipation physical examination (PPE) is to promote health and safety during competition by screening athletes for injuries and illness. Historically it has been reported that the PPE may be the only medical evaluation that many student athletes receive. Our objective was to evaluate whether student athletes who have participated in our PPEs also receive routine well child care. In addition, we investigated parental perspectives regarding what should be included during the PPE. A 29-question survey was distributed to parents of student athletes during 6 PPE sessions sponsored and hosted at local school districts. Descriptive statistics were used to characterize and summarize the data set. A total of 288 surveys were completed. All our student athletes had a primary care provider (100%), with the overwhelming majority of student athletes (90.9%) having both a well child examination and a PPE annually. Approximately 89% of parents believed that electrocardiograms prevented sudden cardiac death in sports. The majority of parents believed the PPE was an appropriate setting to discuss mental health and substance abuse. The majority of student athletes complete both a well child examination and a PPE annually. Parents believe screening electrocardiograms are effective in preventing sudden cardiac death and that the PPE can prevent injuries from occurring. Parents also believe the PPE can serve as an opportunity to discuss mental health and substance abuse, which is consistent with the most recent PPE monogram. An educational handout should be provided to parents regarding the goals of the PPE.

Are Trainers Prepared on Basic Life Support stages? Qualitative Survey of the Knowledge of Sports Club Coaches in Trieste on the Sudden Cardiac Death in Sport

Are Trainers Prepared on Basic Life Support stages? Qualitative Survey of the Knowledge of Sports Club Coaches in Trieste on the Sudden Cardiac Death in Sport

Utility of genetic testing in athletes.

Athletes are some of the fittest members of our society, yet paradoxically carry an increased risk of sudden cardiac death (SCD). The athlete's underlying risk of SCD in sports may be increased due to a number of underlying structural, arrhythmic and inherited cardiac conditions (ICCs). There are also physiological adaptations, which occur in the cardiovascular system in athletes as a result of high‐level athletic activity and may be misinterpreted as pathology. Differentiation of “athlete's heart” from heart disease may be challenging due to the effects of exercise on the electrical and structural cardiac remodeling. Features such as prolongation of the QT interval, left ventricular hypertrophy and cavity dilatation, create significant overlap between physiology and inherited channelopathies and cardiomyopathies. Most inherited cardiac conditions have an underlying genetic basis to disease and genetic testing in an athlete can have diagnostic, prognostic and therapeutic implications, including guiding exercise recommendations. Therefore, genetic testing can be a useful diagnostic tool when used carefully and appropriately by a trained cardio‐genetics expert.

P306Echocardiographic criteria of left ventricular non-compaction cardiomyopathy in black athletes from homogenous ethnic descent

Abstract Background To prevent sudden cardiac death in sports, pre-competition medical assessment aims to detect underlying cardiac diseases as electrical disorders or cardiomyopathies. Due to a large diagnostic grey-zone, Left Ventricular Non-Compaction Cardiomyopathy (LVNC) is an entity quite challenging to diagnose, particularly in athletes from Afro-Caribbean descent. Purpose The aim of the study was to assess the currently established echocardiographic diagnostic criteria for LVNC in a cohort of adolescent African football players of relatively homogenous ethnic descent. Methods The study took place in the West-African sub-Saharan country of Gabon were the ethnic background of its population is relatively homogenous. The competitive football players underwent cardiac screening, including personal and family history, physical examination, 12-lead resting ECG and transthoracic echocardiography, that particularly assessed the three currently established diagnostic echocardiographic criteria to diagnose LVNC (Jenni-, Chin- and Stöllberger-Criteria). Results The mean age of the 210 male athletes was 18.6 years (range 18–22). Family history revealed sudden or unexplained death in 17%. Most of the cases concerned athletes without an echocardiographic LVNC pattern. Clearly suspicious ECG findings were unexpectedly rare, with T-wave inversions in 7 athletes (3.3%) and ST-segment depression in 1 athlete (0.5%). All ECG changes but two were seen in athletes with positive echocardiographic criteria for LVNC. The number of athletes exhibiting at least one of the established echocardiographic criteria for LVNC was very high (n=83, 39.5%). All of these 83 athletes were positive for the Chin criteria (100%), while 41 athletes showed positive criteria for Stöllberger (49.3%, 19.5% overall) and 21 for Jenni (25.3%, 4.8% overall) criteria. In not less than 17 athletes all three currently established diagnostic criteria were positive (20.5%, 8.1% overall). The LV systolic function was normal in all athletes. Conclusions In adolescent African football players from relatively homogenous ethnic background, the prevalence of positive echocardiographic diagnostic criteria for LVNC is unexpectedly high. Almost 40% of the athletes fulfill at least one of the established diagnostic criteria. Thus, these established criteria should not be used routinely for a population of black athletes. The estimation, which of the three diagnostic sets may be the most accurate is not conclusive, however, it is remarkable that the “Chin” criteria were positive in all players with LVNC pattern, while the “Jenni” criteria were positive in only 25%. In 8.1% of the overall cohort all three diagnostic criteria were positive, making these athletes most likely to have the definite diagnosis. At a nine year follow-up there were no adverse or fatal events reported. More studies, which should integrate cardiac MRI, are needed to improve diagnostic accuracy of these morphologic findings.

Sudden Cardiac Death in Sports: Why Its Prevalence is So Different by Gender?

Abstract Sports competition can be a trigger to fatal arrhythmias in predisposed individuals, leading to sudden cardiac death. Athletes have 2.8 fold more risk of sudden cardiac death than non-athletes. However, female athletes seem to have some cardiac protection, dying suddenly much less than men during sports. Although the mechanisms for this protection have not been well established until now, hormonal, genetic and molecular factors may play a role in it. The so-called “fair sex” might harbour the key for sudden cardiac death prevention.

Regional differences of sudden cardiac death in sports. Experiences from German and Swiss registries

Sudden death of an athlete is the most devastating medical event in sports. While accidents account for more than 50% of these cases, sudden cardiac deaths (SCD) are less frequent (approx. 15%), but the leading medical cause of deaths. The risk depends on age, sex, ethnicity, type of sport and sport level. There are large variations in the methods of registration of SCD in recreational and competitive sports. This must be taken into account when interpreting reported incidences and causes. High data quality in registries is a prerequisite for meaningful preventive strategies (e.g. ECG screening and safety at sports facilities). This review summarises important results from two national registries on sports-related SCD and shows their potential impact on preventive strategies.

Iznenadna srčana smrt - mere prevencije i preporuke za bavljenje fizičkom aktivnošću

Physical activity provides many well-documented health benefits, while physical inactivity is a leading risk factor for cardiovascular morbidity and mortality. In order to achieve these benefits, one must expose himself to relatively moderate physical activity. However, many athletes and recreationists go beyond these limits and engage in higher level of physical activity. Occasionally, intense physical activity is associated with sudden death in individuals with concealed heart disease. Despite the media attention provided by such accident, the reputation of physical activity remains intact, as most deaths can be explained by a basic cardiac abnormality where exercise is only the trigger of a fatal arrhythmia, not the actual cause of death. The paradox is that athletes with these abnormalities show identical performance in the form of minute heart volume compared to healthy individuals. In athletes younger than 35, congenital heart disease, especially hypertrophic cardiomyopathy and congenital coronary artery abnormalities, are the leading cause of sudden cardiac death, while most athletes older than 35 die due to atherosclerotic changes in the coronary arteries. Pre-competition screening with apparently healthy individuals is the only way to prevent sudden cardiac death in sports. When diagnosing a specific condition of the cardiovascular system, it is necessary to determine the risk of sudden cardiac death associated with continued physical activity and competitive sports activity, and to define clear disqualification criteria for each athlete individually.

PO215 Prevalence and Predictors of White Coat Hypertension Among Newly-Diagnosed Hypertensive In a Tertiary Health Centre In Nigeria

The annual incidence of sudden cardiac death (SCD) in athletes is significantly lower than the general population. However, when SCD occurs in an athlete during sporting event or training, it sends shockwaves in the society and raises questions about cardiovascular effects of sports and exercise. This document reviews the causes and mechanism of SCD in sports and exercise in young and older athletes. In the Indian context, we suggest a ‘pre-participation screening’ of young and older athletes and consider a ‘supervised, graded exercise regime’ for the uninitiated, older sports participant. Finally, the document proposes medical infrastructure required to successfully revive a victim of sudden cardiac arrest during a sporting event.

Sudden Cardiac Death in Sports: Not a Fatality!

Abstract Sudden cardiac death in sports is still controversial. Despite being a rare event, the death of an apparently healthy young athlete causes a major impact on the media. On the other hand, for being a rare event, it is clearly undervalued. Sports preparticipation cardiological assessment is one of the most effective preventive medical actions for professional and amateur endurance athletes. The regular and supervised practice of physical exercise does not kill. We believe that deaths are triggered by excessive physical training and use of drugs, in individuals with not diagnosed or undervalued heart diseases. It is necessary to make health professionals and athletes aware of the athletes' physiological limits, in addition to preparing the athletes properly when they try to overcome human limits.