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Ujvári A, Fábián A, Lakatos B, Tokodi M, Ladányi Z, Sydó N, Csulak E, Vágó H, Juhász V, Grebur K, Szűcs A, Zámodics M, Babity M, Kiss O, Merkely B, Kovács A. Right Ventricular Structure and Function in Adolescent Athletes: A 3D Echocardiographic Study. Int J Sports Med 2024; 45:473-480. [PMID: 38301728 PMCID: PMC11150038 DOI: 10.1055/a-2259-2203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
The aim of this study was to characterize the right ventricular (RV) contraction pattern and its associations with exercise capacity in a large cohort of adolescent athletes using resting three-dimensional echocardiography (3DE). We enrolled 215 adolescent athletes (16±1 years, 169 males, 12±6 hours of training/week) and compared them to 38 age and sex-matched healthy, sedentary adolescents. We measured the 3DE-derived biventricular ejection fractions (EF). We also determined the relative contributions of longitudinal EF (LEF/RVEF) and radial EF (REF/RVEF) to the RVEF. Same-day cardiopulmonary exercise testing was performed to calculate VO2/kg. Both LV and RVEFs were significantly lower (athletes vs. controls; LVEF: 57±4 vs 61±3, RVEF: 55±5 vs 60±5%, p<0.001). Interestingly, while the relative contribution of radial shortening to the global RV EF was also reduced (REF/RVEF: 0.40±0.10 vs 0.49±0.06, p<0.001), the contribution of the longitudinal contraction was significantly higher in athletes (LEF/RVEF: 0.45±0.08 vs 0.40±0.07, p<0.01). The supernormal longitudinal shortening correlated weakly with a higher VO2/kg (r=0.138, P=0.044). Similarly to the adult athlete's heart, the cardiac adaptation of adolescent athletes comprises higher biventricular volumes and lower resting functional measures with supernormal RV longitudinal shortening. Characteristic exercise-induced structural and functional cardiac changes are already present in adolescence.
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Affiliation(s)
- Adrienn Ujvári
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Alexandra Fábián
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Lakatos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Tokodi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Nóra Sydó
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Emese Csulak
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Hajnalka Vágó
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Vencel Juhász
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Kinga Grebur
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Andrea Szűcs
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márk Zámodics
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Máté Babity
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Orsolya Kiss
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Surgical Research and Techniques, Semmelweis University, Budapest, Hungary
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Evans L, Hutt K. Sudden Cardiac Death in Dancers and Athletes: Time for Increased Cardiac Screening? J Dance Med Sci 2024; 28:132-138. [PMID: 37864364 DOI: 10.1177/1089313x231203052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Background: Young athletes are thought to be models of peak physical condition, capable of exceptional physical accomplishments. However approximately 64 UK athletes aged 12 to 35 will die each year from a phenomenon known as Sudden Cardiac Death (SCD). SCD can be defined as an unexpected death as a result of abrupt loss of cardiac function within an hour of symptom onset. Undiagnosed heart conditions such as arrhythmias are often found to be the cause of SCD. Advantageous physical attributes found in athletes' hearts can complicate diagnoses as hearts with inherited conditions can appear physiologically similar to hearts adapted to strenuous exercise. Growing research surrounding SCD within sporting populations aims to decrease mortality rates however there is an absence of study specifically into SCD in dance. Within sport, the topic of cardiac screening has generated widespread controversy which is fueled by a lack of empirical evidence. There is currently no international consensus of pre participation cardiac screening methods within dance or sport, potentially leaving many dancers and athletes at risk. Methods: As part of this study, existing material surrounding the topics of SCD and cardiac screening in athletes and dancers was gathered. All existing studies at the time of writing in relation to cardiac screening in athletes and dancers were collected and analysed in order to compare results and evaluate the methodological limitations.This process aimed to identify gaps in current knowledge and research to inform future study. Results: This article aimed to analyze the epidemiology of SCD within sport and dance and to make recommendations for pre-participation screening within dance institutions. The study highlights the need to increase awareness of SCD within the dance community and determine appropriate screening approaches depending on context and setting.
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Affiliation(s)
- Lola Evans
- London Contemporary Dance School, London, UK
| | - Kim Hutt
- London Studio Centre, London, UK
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Sanghera G, Hormaza V, Dadlani GH. Progress in pediatric cardiology chest pain for the pediatric primary care provider. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shah K, Pandya A, Kotwani P, Saha S, Desai C, Tyagi K, Saxena D, Puwar T, Gaidhane S. Cost-Effectiveness of Portable Electrocardiogram for Screening Cardiovascular Diseases at a Primary Health Center in Ahmedabad District, India. Front Public Health 2021; 9:753443. [PMID: 34926378 PMCID: PMC8678108 DOI: 10.3389/fpubh.2021.753443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background: District Health Authority in Ahmedabad, Gujarat has introduced Project Lifeline, 12-lead portable ECG devices across all primary health centers (PHC) in the district to screen cardiac abnormalities among high-risk and symptomatic adults for providing primary management and proper timely referral. The prime purpose of the study was to assess the cost-effectiveness of portable ECG for the screening of cardiovascular diseases (CVD) among high-risk and symptomatic adults at the PHC in Ahmedabad, Gujarat. Methods: Cost-effective analysis was conducted using a societal perspective. An incremental costing approach was adapted, and cost-effectiveness analysis was done using a decision-analytic model. We surveyed 73 patients who screened positive for cardiac abnormality, documented the type of ECG abnormalities, and diagnosed CVD. The program cost was obtained from the implementers. Transition probabilities were derived from primary data supported by expert opinion for the intervention arm, while a systematic search of the literature was undertaken to derive transition probabilities for the control arm. Results: The ECG screening at PHC saves 2.90 life years at an incremental cost of 89.97 USD (6657.47 INR), yielding a cost-effectiveness ratio of 31.07 USD (2,299.06 INR) per life-year saved, which is below the willingness to pay threshold. The budget impact analysis was also performed. Results are sensitive to the relative risk reduction associated with the non-participation and the cost of initial screening. Conclusion: Cost-effectiveness analysis clearly shows that the facility to screen cardiac abnormality at the PHC level is highly recommended for high-risk adults and symptomatic cases.
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Affiliation(s)
- Komal Shah
- Regional Resource Centre for Health Technology Assessment, Indian Institute of Public Health, Gandhinagar, India
| | - Apurvakumar Pandya
- Regional Resource Centre for Health Technology Assessment, Indian Institute of Public Health, Gandhinagar, India
| | - Priya Kotwani
- Regional Resource Centre for Health Technology Assessment, Indian Institute of Public Health, Gandhinagar, India
| | - Somen Saha
- Regional Resource Centre for Health Technology Assessment, Indian Institute of Public Health, Gandhinagar, India
| | - Chintan Desai
- District Panchayat, Department of Health, Ahmedabad, India
| | - Kirti Tyagi
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | - Deepak Saxena
- Regional Resource Centre for Health Technology Assessment, Indian Institute of Public Health, Gandhinagar, India
| | - Tapasvi Puwar
- Regional Resource Centre for Health Technology Assessment, Indian Institute of Public Health, Gandhinagar, India
| | - Shilpa Gaidhane
- Department of Medicine, J. N. Medical College, Datta Meghe Institute of Medical Sciences, Wardha, India
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Ousaka D, Hirai K, Sakano N, Morita M, Haruna M, Hirano K, Yamane T, Teraoka A, Sanou K, Oozawa S, Kasahara S. Initial evaluation of a novel electrocardiography sensor-embedded fabric wear during a full marathon. Heart Vessels 2021; 37:443-450. [PMID: 34519873 PMCID: PMC8438904 DOI: 10.1007/s00380-021-01939-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/03/2021] [Indexed: 10/27/2022]
Abstract
Sudden cardiac accident (SCA) during a marathon is a concern due to the popularity of the sport. Preventive strategies, such as cardiac screening and deployment of automated external defibrillators have controversial cost-effectiveness. We investigated the feasibility of use of a new electrocardiography (ECG) sensor-embedded fabric wear (SFW) during a marathon as a novel preventive strategy against SCA. Twenty healthy volunteers participated in a full marathon race. They were equipped with a SFW hitoe® with a transmitter connected via Bluetooth to a standard smartphone for continuous ECG recording. All data were stored in a smartphone and used to analyze the data acquisition rate. The adequate data acquisition rate was > 90% in 13, 30-90% in 3, and < 10% in 4 runners. All of 4 runners with poorly recorded data were female. Inadequate data acquisition was significantly associated with the early phase of the race compared with the mid phase (P = 0.007). Except for 3 runners with poor heart rate data, automated software calculation was significantly associated with manual analysis for both the mean (P < 0.001) and maximum (P = 0.014) heart rate. We tested the feasibility of continuously recording cardiac data during a marathon using a new ECG sensor-embedded wearable device. Although data from 65% of runners were adequately recorded, female runners and the early phase of the race tended to have poor data acquisition. Further improvements in device ergonomics and software are necessary to improve ability to detect abnormal ECGs that may precede SCA.
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Affiliation(s)
- Daiki Ousaka
- Department of Pharmacology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, 700-8558, Japan
| | - Kenta Hirai
- Department of Pediatric Cardiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, 700-8558, Japan
| | - Noriko Sakano
- Department of Biomedical Informatics, Okayama University Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama, 700-8558, Japan
| | - Mizuki Morita
- Department of Biomedical Informatics, Okayama University Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama, 700-8558, Japan
| | - Madoka Haruna
- Department of Clinical Laboratory, Okayama University Hospital, Okayama, 700-8558, Japan
| | - Kazuya Hirano
- Department of Biomedical Informatics, Okayama University Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama, 700-8558, Japan
| | - Takahiro Yamane
- Department of Biomedical Informatics, Okayama University Graduate School of Interdisciplinary Science and Engineering in Health Systems, Okayama, 700-8558, Japan
| | - Akira Teraoka
- Teraoka Memorial Hospital, Hiroshima, 729-3103, Japan
| | | | - Susumu Oozawa
- Department of Clinical Safety, Okayama University Hospital, Okayama, 700-8558, Japan
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, 700-8558, Japan.
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Le HM, Downey BC, Lanois CJ, Miller PE, Stein CJ, Kerkhof DL, Corrado GD. Comparison of the Limb-lead Electrocardiogram to the 12-Lead Electrocardiogram for Identifying Conditions Associated with Sudden Cardiac Death in Youth Athletes. Am J Cardiol 2021; 152:146-149. [PMID: 34237610 DOI: 10.1016/j.amjcard.2021.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/19/2022]
Abstract
The optimal screening strategy to prevent sudden cardiac death (SCD) in athletes remains unknown. Pre-participation screening with electrocardiogram (ECG) remains controversial. The utility and accuracy of limb-lead (LL) ECG alone in identifying cardiac abnormalities associated with SCD has not been studied. This study was a comparative secondary data analysis, comparing the interpretation accuracy of 4 physicians evaluating publicly available ECGs of the most common cardiac conditions associated with SCD in athletes. Each physician interpreted a total of 100 ECGs: 50 normal ECGs (25 LL and 25 standard 12L) and 50 abnormal ECGs (25 LL and 25 standard 12L). The agreement between LL ECGs and 12L ECGs was assessed by Cohen's kappa coefficient and the accuracy of identifying an abnormal ECG was compared across LL and 12L ECGs using a chi-squared test. Inter-rater reliability was assessed by estimating the Fleiss's kappa coefficient. The sensitivity of LL ECG and 12L ECG was identical at 86%. The specificity of LL ECG was 75% (95% CI = 65% to 83%) and 12L ECG was 82% (95% CI = 73% to 89%). Substantial agreement was seen between LL ECG and 12L ECG interpretation across all readers (k = 0.63; 95% CI = 0.49 to 0.77). Interpretation accuracy was 81% (95% CI = 74% to 86%) and 84% (95% CI 78% to 89%) using LL ECG and 12L ECG, respectively (p = 0.43). In conclusion, the accuracy, sensitivity, and specificity were high and comparable for both LL ECG and 12L ECG in identifying cardiovascular conditions associated with SCD. Agreement between LL ECG and 12L ECG was substantial.
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MESH Headings
- Arrhythmogenic Right Ventricular Dysplasia/complications
- Arrhythmogenic Right Ventricular Dysplasia/diagnosis
- Arrhythmogenic Right Ventricular Dysplasia/physiopathology
- Athletes
- Brugada Syndrome/complications
- Brugada Syndrome/diagnosis
- Brugada Syndrome/physiopathology
- Cardiomyopathy, Dilated/complications
- Cardiomyopathy, Dilated/diagnosis
- Cardiomyopathy, Dilated/physiopathology
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/physiopathology
- Cardiovascular Diseases/complications
- Cardiovascular Diseases/diagnosis
- Cardiovascular Diseases/physiopathology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Electrocardiography/methods
- Humans
- Long QT Syndrome/complications
- Long QT Syndrome/diagnosis
- Long QT Syndrome/physiopathology
- Mass Screening
- Myocarditis/complications
- Myocarditis/diagnosis
- Myocarditis/physiopathology
- Wolff-Parkinson-White Syndrome/complications
- Wolff-Parkinson-White Syndrome/diagnosis
- Wolff-Parkinson-White Syndrome/physiopathology
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Affiliation(s)
- Hung M Le
- Boston Children's Hospital, Department of Orthopedics, Division of Sports Medicine, Boston, Massachusetts.
| | - Brian C Downey
- Tufts Medical Center, Division of Cardiology, Boston, Massachusetts
| | - Corey J Lanois
- Boston Children's Hospital, Department of Orthopedics, Division of Sports Medicine, Boston, Massachusetts
| | - Patricia E Miller
- Boston Children's Hospital, Department of Orthopedics, Division of Sports Medicine, Boston, Massachusetts
| | - Cynthia J Stein
- Boston Children's Hospital, Department of Orthopedics, Division of Sports Medicine, Boston, Massachusetts
| | | | - Gianmichel D Corrado
- Boston Children's Hospital, Department of Orthopedics, Division of Sports Medicine, Boston, Massachusetts; Northeastern University, Boston, Massachusetts
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Carré F, Schnell F. ECG in the athlete, QRS voltage value never matters, really? Eur J Prev Cardiol 2020; 27:1539-1541. [DOI: 10.1177/2047487320920045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- François Carré
- Univ Rennes 1, CHU Rennes, Inserm, LTSI - UMR 1099, France
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Orchard JJ, Neubeck L, Orchard JW, Puranik R, Raju H, Freedman B, La Gerche A, Semsarian C. ECG-based cardiac screening programs: Legal, ethical, and logistical considerations. Heart Rhythm 2019; 16:1584-1591. [DOI: 10.1016/j.hrthm.2019.03.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Indexed: 01/02/2023]
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