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Sewry N, Schwellnus M, Borjesson M, Swanevelder S, Jordaan E. Pre-race screening and stratification predicts adverse events-A 4-year study in 29585 ultra-marathon entrants, SAFER X. Scand J Med Sci Sports 2020; 30:1205-1211. [PMID: 32187395 DOI: 10.1111/sms.13659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/17/2020] [Accepted: 03/10/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pre-race screening and risk stratification in recreational endurance runners may predict adverse events (AEs) during a race. AIM To determine if pre-race screening and risk stratification predict AEs during a race. METHODS A total of 29 585 participants (Male 71.1%, average age = 42.1 years; Female 28.9%, average age = 40.2 years) at the Two Oceans ultra-marathon races (56 km) completed a pre-race medical screening questionnaire and were risk stratified into four pre-specified groups [very high risk (VHR; existing cardiovascular disease-CVD:3.2%), high risk (HR; risk factors for CVD:10.5%), intermediate risk (IR; existing other chronic disease, medication use or injury:53.3%), and low risk (LR:33.0%)]. Race starters, finishers, and medical encounters (ME) were recorded. Did-not-start (DNS) rate (per 1000 entrants that did-not-start), did-not-finish (DNF) rate (per 1000 starters that did-not-finish), AE rate [per 1000 starters that either DNF or had an ME], and ME rate (per 1000 starters with an ME) were compared across risk categories. RESULTS Adverse events were significantly higher (per 1000 starters; 95%CI) in the VHR (68.9; 52.4-89.9:P = .0407) compared with the LR (51.3; 46.5-56.7). The DNS rate was significantly different between the IR (190.3; 184.0-196.9) and LR (207.4; 199.2-216.0: P = .0011). DNF rates were not different in the VHR (56.4; 41.9-75.9) compared to LR (44.2; 39.7-49.1: P = .1295), and ME rate was also not different between risk categories, however, VHR (12.9; 7.0-23.9) was approaching significance compared to LR (6.9; 5.2-9.1: P = .0662). CONCLUSION Pre-race medical screening and risk stratification may identify athletes at higher risk of AEs. Further studies should be performed in larger cohorts to clarify the role of pre-race medical screening in reducing AEs in endurance runners.
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Affiliation(s)
- Nicola Sewry
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,International Olympic Committee (IOC) Research Centre, Cape Town, South Africa
| | - Martin Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,International Olympic Committee (IOC) Research Centre, Cape Town, South Africa.,Emeritus Professor of Sport and Exercise Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mats Borjesson
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, Göteborg University, Gothenburg, Sweden.,Center for Health and Performance, Göteborg University, Gothenburg, Sweden.,Sahlgrenska University Hospital/Östra, Göteborg, Sweden
| | - Sonja Swanevelder
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Esme Jordaan
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa.,Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa
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Mavrogeni SI, Tsarouhas K, Spandidos DA, Kanaka-Gantenbein C, Bacopoulou F. Sudden cardiac death in football players: Towards a new pre-participation algorithm. Exp Ther Med 2019; 17:1143-1148. [PMID: 30679986 PMCID: PMC6327574 DOI: 10.3892/etm.2018.7041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/22/2018] [Indexed: 11/06/2022] Open
Abstract
Athletic pre-participation screening is essential for minimizing the risk for sudden cardiac death (SCD) in athletes participating in either competitive or leisure sporting activities. The primary causes of SCD in young athletes (<35 years of age) include hypertrophic cardiomyopathy, congenital anomalies of the coronary artery and arrhythmogenic right ventricular cardiomyopathy. Other abnormalities, such as malignant arrhythmia due to blunt trauma to the chest (commotio cordis), myocarditis, valvular disease, aortic rupture (in Marfan syndrome) and ion channelopathies (catecholaminergic polymorphic ventricular tachycardia, Brugada syndrome, long or short QT syndrome), also contribute to a lesser degree to SCD. Currently, clinical assessment, electrocardiogram (ECG) and echocardiography are the cornerstones of the pre-participation athletic evaluation. However, their low sensitivity raises queries as regards the need for the application of more sophisticated modalities, such as cardiovascular magnetic resonance (CMR). CMR offers precise biventricular assessment and is greatly reproducible without the inherent limitations of echocardiography; i.e., low quality of images due to the lack of appropriate acoustic window or operator's experience. Furthermore, myocardium replacement fibrosis, indicative of patients' increased risk for future cardiac events, can be effectively detected by late gadolinium enhanced (LGE) images, acquired 15 min post-contrast injection. Finally, diffuse myocardial fibrosis not identified by LGE, can also be detected by pre-contrast (native) T1, post-contrast T1 mapping and extracellular volume images, which provide detailed information about the underlying pathophysiologic background. Therefore, CMR is recommended in all football players with a positive family or personal history of syncope or SCD, abnormal/doubtful ECG or echocardiogram.
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Affiliation(s)
- Sophie I Mavrogeni
- Onassis Cardiac Surgery Center, 17674 Athens, Greece.,Exercise Physiology and Sports Medicine Clinic, Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 11527 Athens, Greece
| | - Konstantinos Tsarouhas
- Exercise Physiology and Sports Medicine Clinic, Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 11527 Athens, Greece.,Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece
| | - Demetrios A Spandidos
- Department of Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Christina Kanaka-Gantenbein
- Exercise Physiology and Sports Medicine Clinic, Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 11527 Athens, Greece.,First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 11527 Athens, Greece
| | - Flora Bacopoulou
- Exercise Physiology and Sports Medicine Clinic, Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 11527 Athens, Greece
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Schwellnus M, Swanevelder S, Derman W, Borjesson M, Schwabe K, Jordaan E. Prerace medical screening and education reduce medical encounters in distance road races: SAFER VIII study in 153 208 race starters. Br J Sports Med 2018; 53:634-639. [DOI: 10.1136/bjsports-2018-099275] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2018] [Indexed: 01/09/2023]
Abstract
ObjectivesTo examine the efficacy and feasibility of an online prerace medical screening and educational intervention programme for reducing medical complications in long-distance races.MethodsThis was an 8-year observational study of medical encounter rates among 153 208 Two Oceans race starters (21.1 and 56 km) in South Africa. After the first 4-year control (CON) period, we introduced an online prerace medical screening (based on European pre-exercise screening guidelines) and an automated educational intervention programme. We compared the incidence of medical encounters (per 1000 starters; all and serious life threatening) in the CON versus the 4-year intervention (INT) period.ResultsIn comparison to the CON period (2008–2011: 65 865 starters), the INT period (2012–2015: 87 343 starters) had a significantly lower incidence (adjusted for age group, sex, race distance) of all medical encounters by 29% (CON=8.6 (7.9–9.4); INT=6.1 (5.6–6.7), p<0.0001), in the 21.1 km race by 19% (CON=5.1 (4.4–5.9); INT=4.1 (3.6–4.8), p=0.0356) and in the 56 km race by 39% (CON=14.6 (13.1–16.3); INT=9.0 (7.9–10.1), p<0.0001). Serious life-threatening encounters were significantly reduced by 64% (CON=0.6 (0.5–0.9); INT=0.2 (0.1–0.4); p=0.0003) (adjusted for age group and sex). Registration numbers increased in the INT period (CON=81 345; INT=106 743) and overall % race starters were similar in the CON versus INT period. Wet-bulb globe temperature was similar in the CON and INT periods.ConclusionAll medical encounters and serious life-threatening encounters were significantly lower after the introduction of a prescreening and educational intervention programme, and the programme was feasible.
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Schwabe K, Schwellnus M, Swanevelder S, Jordaan E, Derman W, Bosch A. Leisure athletes at risk of medical complications: outcomes of pre-participation screening among 15,778 endurance runners - SAFER VII. PHYSICIAN SPORTSMED 2018; 46:405-413. [PMID: 30052116 DOI: 10.1080/00913847.2018.1505569] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE International guidelines for pre-participation screening of masters/leisure athletes to identify those that require medical assessment exist, but have not been implemented in mass-community based sports events. We determined the prevalence of runners who, according to these guidelines, would require a medical assessment before participating in a distance running event. METHODS Participants of the 2012 Two Oceans races (21.1 and 56 km) in South Africa (n = 15,778) completed an online pre-race medical screening questionnaire using European pre-participation screening guidelines. We determined the prevalence of runners that would require a pre-race medical assessment, based on risk factors, symptoms, and disease. RESULTS The pre-participation "self assessment of risk" screening identified 4,941 runners (31.3%; 95% CI 30.6-32.0) that would need to undergo a full pre-participation medical assessment prior to running, if the current pre-participation screening guidelines are applied. Although musculoskeletal complaints and prescription medication use were the main triggers for a medical assessment, 16.8% (n = 2657) runners should undergo medical evaluation for suspected cardiac disease based on the questionnaire results: 3.4% (n = 538) reporting existing CVD (very high risk) and 13.4% (n = 2119) reporting multiple CVD risk factors (high risk). Other possible risk factors were reported as follows: history of chronic diseases (respiratory = 13.1%, gastro-intestinal = 4.3%, nervous system = 3.8%, metabolic/endocrine = 3.5%, allergies = 13.9%); chronic prescription medication = 14.8%, used medication before or during races = 15.6%; past history of collapse during a race = 1.4%. CONCLUSIONS Current guidelines identified that > 30% runners would require a full medical assessment before race participation - mainly linked to runners reporting musculoskeletal conditions. We suggest a revision of guidelines and propose that pre-race screening should be considered to identify runners with a "very high," "high," and "intermediate risk" for medical complications during exercise. Pre-race screening and educational intervention could be implemented to reduce medical complications during exercise.
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Affiliation(s)
- Karen Schwabe
- a Division of Exercise Science & Sports Medicine, Department of Human Biology, Faculty of Health Sciences , University of Cape Town , Cape Town , South Africa
| | - Martin Schwellnus
- b Sport, Exercise Medicine and Lifestyle Institute (SEMLI) and Section Sports Medicine, Faculty of Health Sciences , University of Pretoria , Pretoria , South Africa.,c International Olympic Committee (IOC) Research Centre , Pretoria , South Africa.,d Faculty of Health Sciences , University of Cape Town , Cape Town , South Africa
| | - Sonja Swanevelder
- e Biostatistics Unit , South African Medical Research Council , Cape Town , South Africa
| | - Esme Jordaan
- e Biostatistics Unit , South African Medical Research Council , Cape Town , South Africa.,f Statistics and Population Studies Department , University of the Western Cape , Cape Town , South Africa
| | - Wayne Derman
- c International Olympic Committee (IOC) Research Centre , Pretoria , South Africa.,g Institute for Sport and Exercise Medicine, Faculty of Medicine & Health Sciences , University of Stellenbosch , Stellenbosch , South Africa
| | - Andrew Bosch
- a Division of Exercise Science & Sports Medicine, Department of Human Biology, Faculty of Health Sciences , University of Cape Town , Cape Town , South Africa
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Salehi S, Moradi Shahpar F, Norouzi G, Ghazalian F, Poursaid Esfehani M, Abedi Yekta AH. Prevalence of Cardiovascular Disorders Among Iranian Elite Athletes. Asian J Sports Med 2016; 7:e35826. [PMID: 27625762 PMCID: PMC5003308 DOI: 10.5812/asjsm.35826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 02/07/2016] [Accepted: 03/06/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Athletes' health is an important issue and for promoting it, pre-participation examination (PPE) is widely performed by responsible bodies around the world. OBJECTIVES This study was to determine prevalence of cardiovascular disorders among athletes participating in the Asian games and answering the question whether the electrocardiogram (ECG) is a necessary part of pre-participation examination (PPE) for prevention of sudden cardiac death. MATERIALS AND METHODS All athletes participated at Asian games came to sports medicine federation for a PPE including a comprehensive questionnaire, physical examination and ECG. In this retrospective study all profiles of 338 athletes have been studied as well as their electrocardiograms. Multiple logistic regressions as well as Firth's bias reduction were used with R statistical software and SPSS. For predicting the changes in ECG, receiver operating characteristic (ROC) curve has done. RESULTS Among 388 athletes, 80 (20.6%) were female and 308 (79.4%) male with mean age of 23.2 + 8 years. Nine athletes (2.3%) were smokers, 28 of them (7.2%) experienced chest pain and discomfort, 45 of them (13.3%) had palpitations and 28 (7.2%) had history of anemia. Study of their electrocardiograms showed that long Q-T interval was not seen for anyone, but evidence of left ventricular hypertrophy was seen in 12 (3.1%), inverted T wave in 6 (1.5%), and right bundle branch block in 45 (13.3%). CONCLUSIONS PPE provides very important information of athletes' health. This study has shown that there was not any significant relation between current examination and electrocardiogram changes but regarding the ECG changes we recommend it as a routine part of PPE.
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Affiliation(s)
- Shahin Salehi
- Imam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Farhad Moradi Shahpar
- Physical Education Department, University of Isfahan, Isfahan, IR Iran
- Iran Sports Medicine Federation, Tehran, IR Iran
| | | | - Farshad Ghazalian
- Department of Physical Education, Science and Research Branch, Islamic Azad University, Tehran, IR Iran
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Veloso HH, Hasslocher-Moreno AM, Mediano MFF. Chagas heart disease in professional athletes from endemic countries: A notorious case calls attention for its identification and stratification. Int J Cardiol 2016; 207:115-6. [DOI: 10.1016/j.ijcard.2016.01.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/05/2016] [Indexed: 11/27/2022]
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Abstract
The rigorous cardiovascular (CV) demands of sport, combined with training-related cardiac adaptations, render the athlete a truly unique CV patient and sports cardiology a truly unique discipline. Cardiologists are advised to adopt a systematic approach to the CV evaluation of athletes, taking into consideration the individual sports culture, sports-specific CV demands, CV adaptations and their appearance on cardiac testing, any existing or potential interaction of the heart with the internal and external sports environment, short- and long-term CV risks, and potential effect of performance-enhancing agents and antidoping regulations. This article outlines the systematic approach, provides a detailed example, and outlines contemporary sports cardiology core competencies.
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Affiliation(s)
- Christine E Lawless
- Sports Cardiology Consultants LLC, 360 West Illinois Street, #7D, Chicago, IL 60654, USA; Department of Nutrition and Health Sciences, University of Nebraska, Lincoln, 110 Ruth Leverton Hall, Lincoln, NE 68583-0806, USA.
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Leischik R, Dworrak B, Foshag P, Strauss M, Spelsberg N, Littwitz H, Horlitz M. Pre-participation and follow-up screening of athletes for endurance sport. J Clin Med Res 2015; 7:385-92. [PMID: 25883700 PMCID: PMC4394910 DOI: 10.14740/jocmr2129w] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 12/17/2022] Open
Abstract
Physical activity increases life expectancy and sport is a priori not harmful. Exhausted sporting activity (e.g. endurance running, triathlon, cycling or competitive sport) can lead under individual conditions to negative cardiac remodelling (pathological enlargement/function of cardiac cavities/structures) or in worst case to cardiac arrhythmias and sudden cardiac death (SCD). This individually disposition can be genetically determined or behaviourally/environmentally acquired. Overall competitive young male athletes suffer five-fold higher than non-competitive athletes from sudden death and athletes aged over 30 bear a potential for arrhythmias, atrial fibrillation or a 20-fold higher possibility for SCD as female athletes. Patients with diabetes, coronary disease, obesity or hypertension require different special managements. Screening of cardiorespiratory health for sport activities has a lot of faces. Basically there is a need for indicated examinations or possible preventive measures inside or outside of pre-competition screening. The costs of screening compared to expenditure of whole effort for sporting activities are acceptable or even negligible, but of course dependent on national/regional settings. The various causes and possibilities of screening will be discussed in this article as basic suggestion for an open discussion beyond national borders and settings.
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Affiliation(s)
- Roman Leischik
- Faculty of Health, School of Medicine, University Witten/Herdecke, Germany
| | - Birgit Dworrak
- Faculty of Health, School of Medicine, University Witten/Herdecke, Germany
| | - Peter Foshag
- Faculty of Health, School of Medicine, University Witten/Herdecke, Germany
| | - Markus Strauss
- Faculty of Health, School of Medicine, University Witten/Herdecke, Germany
| | - Norman Spelsberg
- Faculty of Health, School of Medicine, University Witten/Herdecke, Germany
| | - Henning Littwitz
- Faculty of Health, School of Medicine, University Witten/Herdecke, Germany
| | - Marc Horlitz
- Faculty of Health, School of Medicine, University Witten/Herdecke, Germany
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Berge HM, Isern CB, Berge E. Blood pressure and hypertension in athletes: a systematic review. Br J Sports Med 2015; 49:716-23. [DOI: 10.1136/bjsports-2014-093976] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2014] [Indexed: 12/18/2022]
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Maron BJ, Friedman RA, Kligfield P, Levine BD, Viskin S, Chaitman BR, Okin PM, Saul JP, Salberg L, Van Hare GF, Soliman EZ, Chen J, Matherne GP, Bolling SF, Mitten MJ, Caplan A, Balady GJ, Thompson PD. Assessment of the 12-Lead ECG as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12–25 Years of Age). Circulation 2014; 130:1303-34. [DOI: 10.1161/cir.0000000000000025] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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12
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Maron BJ, Friedman RA, Kligfield P, Levine BD, Viskin S, Chaitman BR, Okin PM, Saul JP, Salberg L, Van Hare GF, Soliman EZ, Chen J, Matherne GP, Bolling SF, Mitten MJ, Caplan A, Balady GJ, Thompson PD. Assessment of the 12-lead electrocardiogram as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 years of age): a scientific statement from the American Heart Association and the American College of Cardiology. J Am Coll Cardiol 2014; 64:1479-514. [PMID: 25234655 DOI: 10.1016/j.jacc.2014.05.006] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Higgins JP, Andino A. Soccer and Sudden Cardiac Death in Young Competitive Athletes: A Review. JOURNAL OF SPORTS MEDICINE (HINDAWI PUBLISHING CORPORATION) 2013; 2013:967183. [PMID: 26464886 PMCID: PMC4590894 DOI: 10.1155/2013/967183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 01/08/2013] [Indexed: 01/02/2023]
Abstract
Sudden cardiac death (SCD) in young competitive athletes (<35 years old) is a tragic event that has been brought to public attention in the past few decades. The incidence of SCD is reported to be 1-2/100,000 per year, with athletes at a 2.5 times higher risk. Soccer is the most popular sport in the world, played by people of all ages. However, unfortunately it is cardiovascular diseases such as hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy that have subtly missed screening and claimed the lives of soccer stars such as Marc Vivien Foe and Antonio Puerta during live action on the field and on an internationally televised stage. This paper covers the physiological demands of soccer and the relationship between soccer and SCD. It also reviews the most common causes of SCD in young athletes, discusses the current guidelines in place by The Fédération Internationale de Football Association (FIFA) for screening among professional soccer players, and the precautions that have been put in place to prevent SCD on the field in professional soccer.
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Affiliation(s)
- John P. Higgins
- Exercise Physiology, Memorial Hermann-Texas Medical Institute, The University of Texas Health Science Center at Houston, 6431 Fannin, Houston, TX 77030, USA
- Lyndon B. Johnson General Hospital, The University of Texas Medical School at Houston, UT Annex-Room 104, 5656 Kelley Street Houston, TX 77026, USA
| | - Aldo Andino
- The University of Texas Medical School at Houston, 6431 Fannin, Houston, TX 77030, USA
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