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Macnamara JP, McCoy CW, Hendren NS, Tietze DC, Milburn NK, Dabas N, Mitrani RD, Goldberger JJ, Kirk KM, Shah JP, Best TM, Levine BD. The Cost of Return to Play Protocols in Collegiate Athletes Recovering from Coronavirus Disease 2019. Med Sci Sports Exerc 2022; 54:1051-1057. [PMID: 35220368 DOI: 10.1249/mss.0000000000002896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION/PURPOSE SARS-CoV-2 infection (COVID-19) can result in myocarditis. Protocols were developed to allow competitive athletes to safely return to play (RTP) after a COVID-19 infection, but the financial impact of these protocols is unknown. Our objective was to determine the differential cost of post-COVID-19 RTP protocols for competitive collegiate athletes. METHODS This multicenter retrospective cohort study of clinical evaluation of 295 athletes after COVID-19 infection was performed at four institutions with three RTP protocols. Costs were calculated using adjusted Center for Medicare and Medicaid Services pricing. All athletes underwent electrocardiogram and clinical evaluation. A tiered approach performed cardiac imaging and biomarker analysis for major symptoms. A universal transthoracic echocardiogram (TTE) approach performed TTE and biomarkers for all athletes. A universal exercise stress echocardiogram (ESE) approach performed ESE and biomarkers for all athletes. RESULTS The cost per athlete was $632.51 ± 651.80 ($44,908 total) in tiered group (n = 71), $1,072.30 ± 517.93 ($87,928 total) in the universal TTE group (n = 82), and $1357.38 ± 757.05 ($192,748 total) in the universal ESE group (n = 142) (P < 0.001). Extrapolated national costs for collegiate athletes would be $39 to 64 million higher for universal imaging approaches versus a tiered approach. Only seven athletes had probable/possible myocarditis with no significant difference between approaches. CONCLUSIONS Cardiac screening in collegiate athletes after COVID-19 infection resulted in significant cost to the health care system. A tiered-based approach was more economical, and a universal exercise echocardiogram group detected slightly more myocardial abnormalities by cardiac magnetic resonance imaging. The clinical consequences of these approaches are unknown.
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Affiliation(s)
| | | | - Nicholas S Hendren
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - David C Tietze
- Division of Sports Medicine, Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Nathaniel K Milburn
- Division of Sports Medicine, Department of Orthopedic Surgery, Penn Medicine, Philadelphia, PA
| | - Nitika Dabas
- Division of Cardiology, Department of Medicine, University of Miami, Coral Gables, FL
| | - Raul D Mitrani
- Division of Cardiology, Department of Medicine, University of Miami, Coral Gables, FL
| | - Jeffrey J Goldberger
- Division of Cardiology, Department of Medicine, University of Miami, Coral Gables, FL
| | - K Michele Kirk
- Division of Sports Medicine, Department of Orthopedic Surgery, John Peter Smith Health Network, Fort Worth, TX
| | - Jay P Shah
- Division of Sports Medicine, Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Thomas M Best
- Department of Orthopedics, UHealth Sports Medicine Institute, University of Miami, Coral Gables, FL
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2
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Bridge J, Fu L, Lin W, Xue Y, Lip GYH, Zheng Y. Artificial intelligence to detect abnormal heart rhythm from scanned electrocardiogram tracings. J Arrhythm 2022; 38:425-431. [PMID: 35785392 PMCID: PMC9237304 DOI: 10.1002/joa3.12707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/03/2022] [Accepted: 03/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background Electrocardiogram (ECG) interpretation is an integral part of the clinical ECG workflow; however, this process is often time‐consuming and labor‐intensive. We aim to develop a rapid, inexpensive means to detect abnormal ECGs using artificial intelligence (AI) from scanned ECG printouts. Methods The study included 1172 12‐lead ECG scans performed in 1172 individuals from a community in Guangzhou, China; 878 (74.9%) were diagnosed with sinus rhythm, and the remaining 294 (25.1%) with abnormal rhythms. A deep learning model consisting of a convolutional neural network based on InceptionV3 and a fully connected layer followed by a GEV activation was trained to classify scanned tracings as either normal or abnormal. Results In a hold‐out testing set, the model achieved a area under curve (AUC), sensitivity, specificity, PPV, and NPV of 0.932 (95% confidence interval [CI]: 0.890, 0.976), 0.816 (95% CI: 0.657, 0.923), 0.993 (95% CI: 0.959, 1.0), 0.969 (95% CI: 0.838, 0.999), and 0.950 (95% CI: 0.90, 0.980) respectively, when using a probability threshold of 0.5. When compared with a physiological expert, these results show comparable performance with a statistically significant increase in specificity and a non‐significant decrease in sensitivity at the 95% level. Conclusions We have developed a rapid, inexpensive, accurate means to detect abnormal ECGs using AI. Easy and accurate identification of such “abnormal” ECGs could allow the mass automated review of ECGs in community settings where abnormal ones could be flagged using AI for detailed clinical review by healthcare professionals.
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Affiliation(s)
- Joshua Bridge
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences University of Liverpool Liverpool UK
| | - Lu Fu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital Guangdong Academy of Medical Sciences Guangzhou China
| | - Weidong Lin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital Guangdong Academy of Medical Sciences Guangzhou China
| | - Yumei Xue
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital Guangdong Academy of Medical Sciences Guangzhou China
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK
| | - Yalin Zheng
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences University of Liverpool Liverpool UK
- Liverpool Centre for Cardiovascular Science University of Liverpool and Liverpool Heart & Chest Hospital Liverpool UK
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3
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Petek BJ, Baggish AL. Pre-participation Cardiovascular Screening in Young Competitive Athletes. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2021; 8:77-89. [PMID: 33552703 DOI: 10.1007/s40138-020-00214-5] [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] [Indexed: 12/14/2022]
Abstract
Purpose of Review The purpose of this review was to highlight the current recommendations, data, and limitations for methods of cardiovascular screening in athletes. Recent Findings While the history and physical (H&P) alone remains the cornerstone for preparticipation cardiovascular screening (PPCS) in athletes, the advent of modern electrocardiographic (ECG) screening criteria has drastically increased sensitivity and decreased false positive rates for screening. Advanced imaging techniques remain an important component of secondary testing after an athlete has an abnormal initial screening exam, however, the use of imaging for universal screening has not been rigorously tested to date. Current disqualification guidelines have now begun to emphasize shared decision making between the provider and athlete in situations of clinical equipoise. Summary All major medical and sporting societies recommend PPCS using a focused medical history and physical examination for all competitive athletes, but there remains controversy about the role of ECG and advanced imaging in PPCS. Future research should focus on the creation of a randomized trial that is powered for mortality that can truly assess the utility of PPCS in athletes.
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Affiliation(s)
| | - Aaron L Baggish
- Massachusetts General Hospital Cardiovascular Performance Program
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4
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Liu HW, Huang LW, Chiu SN, Lue HC, Wu MH, Chen MR, Wang JK. Cardiac Screening for High Risk Sudden Cardiac Death in School-Aged Children. ACTA CARDIOLOGICA SINICA 2020; 36:641-648. [PMID: 33235421 DOI: 10.6515/acs.202011_36(6).20200515a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Sudden cardiac death (SCD) is an uncommon but significant cause of death in the young. Citywide cardiac screening of school-aged children has been performed in Taipei since 1989. In this study, we investigate the efficacy of this screening method for identifying those at high risk of SCD. Methods This study analyzed the data from the results of cardiac screening for school-aged children in Taipei from 2003 to 2014. The cardiac screening included: Stage I, questionnaire surveys, simplified phonocardiography test and simplified electrocardiography (ECG) test; Stage II, physical examination and auscultation by a pediatric cardiologist for all children who had abnormal findings in stage I screening; Stage III, referral to a pediatric cardiologist for further examinations. Logistic regression and decision tree analyses were performed. Results A total of 566,447 students were screened, of whom 685 were identified as being at high risk of SCD. The most common causes of being at high risk of SCD included Wolff-Parkinson-White syndrome, long QT syndrome, cardiomyopathy and Marfan's syndrome. Using logistic regression analysis, the simplified ECG test was identified as being the most effective tool (odds ratio = 16.4, p < 0.001) and past history as the second most crucial factor (odds ratio = 3.95, p < 0.001) for detecting a high risk of SCD. Decision tree analysis showed that serial studies with a past history and the simplified ECG test could accurately identify those at high risk of SCD. Conclusions Questionnaire survey and simplified electrocardiography test-based cardiovascular screening in school-aged children can identify those at high risk of SCD.
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Affiliation(s)
- Hsiu-Wen Liu
- Department of Business Administration, Soochow University
| | | | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University
| | - Hung-Chi Lue
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University
| | - Ming-Ren Chen
- Department of Pediatrics, MacKay Memorial Hospital and Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University
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Cunningham A. COVID-19 and the School-based Mass Preparticipation Physical Evaluation: The Anvil That Broke the Camel's Back? Curr Sports Med Rep 2020; 19:284-285. [PMID: 32769663 DOI: 10.1249/jsr.0000000000000734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bratincsák A, Kimata C, Limm-Chan BN, Vincent KP, Williams MR, Perry JC. Electrocardiogram Standards for Children and Young Adults Using
Z
-Scores. Circ Arrhythm Electrophysiol 2020; 13:e008253. [DOI: 10.1161/circep.119.008253] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background:
Normative ECG values for children are based on relatively few subjects and are not standardized, resulting in interpersonal variability of interpretation. Recent advances in digital technology allow a more quantitative, reproducible assessment of ECG variables. Our objective was to create the foundation of normative ECG standards in the young utilizing
Z
-scores.
Methods:
One hundred two ECG variables were collected from a retrospective cohort of 27 085 study subjects with no known heart condition, ages 0 to 39 years. The cohort was divided into 16 age groups by sex. Median, interquartile range, and range were calculated for each variable adjusted to body surface area.
Results:
Normative standards were developed for all 102 ECG variables including heart rate; P, R, and T axis; R-T axis deviation; PR interval, QRS duration, QT, and QTc interval; P, Q, R, S, and T amplitudes in 12 leads; as well as QRS and T wave integrals. Incremental
Z
-score values between –2.5 and 2.5 were calculated to establish upper and lower limits of normal. Historical ECG interpretative concepts were reassessed and new concepts observed.
Conclusions:
Electronically acquired ECG values based on the largest pediatric and young adult cohort ever compiled provide the first detailed, standardized, quantitative foundation of traditional and novel ECG variables. Expression of ECG variables by
Z
-scores lends an objective and reproducible evaluation without interpreter bias that can lead to more confident establishment of ECG-disease correlations and improved automated ECG readings in high-volume cardiac screening efforts in the young.
Graphic Abstract:
A
graphic abstract
is available for this article.
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Affiliation(s)
- András Bratincsák
- Kapi’olani Medical Center for Women and Children, Hawaii Pacific Health, Honolulu, HI (A.B.)
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI (A.B., B.N.L.-C.)
| | - Chieko Kimata
- Patient Safety & Quality Services, Hawaii Pacific Health, Honolulu, HI (C.K.)
| | - Blair N. Limm-Chan
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI (A.B., B.N.L.-C.)
| | - Kevin P. Vincent
- Department of Bioengineering, University of California San Diego (K.P.V.)
| | - Matthew R. Williams
- Rady Children’s Hospital San Diego, CA (M.W., J.C.P)
- Department of Pediatrics, University of California San Diego (M.W., J.C.P)
| | - James C. Perry
- Rady Children’s Hospital San Diego, CA (M.W., J.C.P)
- Department of Pediatrics, University of California San Diego (M.W., J.C.P)
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Petek BJ, Baggish AL. Current controversies in pre-participation cardiovascular screening for young competitive athletes. Expert Rev Cardiovasc Ther 2020; 18:435-442. [PMID: 32594825 DOI: 10.1080/14779072.2020.1787154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Pre-participation cardiovascular screening (PPCS) in athletes is recommended by numerous medical and sporting societies. While there is consensus that young athletes should be screened prior to participation in competitive sports, there are on-going debates regarding the true incidence of sudden cardiac death (SCD), the most frequent causes of SCD, and the optimal methods for PPCS. AREAS COVERED This review focuses on the current evidence for the incidence of SCD, causes of SCD, and the pros and cons of a history and physical exam (H&P) and electrocardiogram (ECG) in PPCS of young competitive athletes. EXPERT OPINION With significant controversy surrounding PPCS in athletes, a large-randomized trial powered for mortality is needed to assess the utility of PPCS and to define the optimal screening methods to detect cardiovascular diseases that may lead to SCD in competitive athletes. Until a trial of this caliber is created, controversy will remain and heterogeneity in care will exist. Future research should also define the optimal timing and frequency of PPCS given age-related penetrance of certain diseases, create evidence-based history questionnaires, continue to optimize ECG screening criteria, and create more learning modules for ECG interpretation in athletes.
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Affiliation(s)
- Bradley J Petek
- Department of Medicine, Massachusetts General Hospital , Boston, MA, USA
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital , Boston, MA, USA
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8
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Abstract
PURPOSE OF REVIEW The optimal approach to screening young people to decrease the risk of sudden death remains unknown. It deserves the passionate attention that researchers, clinicians and families have given it. The new data from January 2018 to July 2019 are reviewed here. RECENT FINDINGS Cardiac findings associated with a risk of sudden death were reported in 0.4% of screened athletes. Well run programs continue report varying sensitivity for screening ECGs (between 86 and 100%). One major article reported a higher incidence of sudden death in young people than has been previously published (6.8/100 000 athletes). SUMMARY The rate of important findings in sophisticated screening programs is approximately 0.4%, suggesting that this is near the population rate of detectable disease in most athletic groups. ECGs are unquestionably capable of detecting disease that can be missed by history and physical, but the performance characteristics of ECGs continue to vary from study to study. In addition, the underlying cost and infrastructure of ECG and echocardiographic screening remains unaddressed by the recent literature. A few small studies have started to look at alternative technology approaches to ECG screening. VIDEO ABSTRACT.
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9
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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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10
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Abstract
Distinguishing between adaptive and maladaptive cardiovascular response to exercise is crucial to prevent the unnecessary termination of an athlete's career and to minimize the risk of sudden death. This is a challenging task essentially due to the substantial phenotypic overlap between electrical and structural changes seen in the physiological athletic heart remodeling and pathological changes seen in inherited or acquired cardiomyopathies. Stress testing is an ideal tool to discriminate normal from abnormal cardiovascular response by unmasking subtle pathologic responses otherwise undetectable at rest. Treadmill or bicycle electrocardiography, transthoracic echocardiography, and cardiopulmonary exercise testing are common clinical investigations used in sports cardiology, specifically among participants presenting with resting electrocardiographic abnormalities, frequent premature ventricular beats, or non-sustained ventricular arrhythmias. In this setting, as well as in cases of left ventricular hypertrophy or asymptomatic left ventricular dysfunction, stress imaging and myocardial tissue characterization by cardiovascular magnetic resonance show promise. In this review, we aimed to reappraise current diagnostic schemes, screening strategies and novel approaches that may be used to distinguish adaptive remodeling patterns to physical exercise from early phenotypes of inherited or acquired pathological conditions commanding prompt intervention.
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Sia CH, Dalakoti M, Tan BYQ, Lee ECY, Shen X, Wang K, Lee JS, Arulanandam S, Chow W, Yeo TJ, Yeo KK, Chua TSJ, Tan RS, Lam CSP, Chong DTT. A Population-wide study of electrocardiographic (ECG) norms and the effect of demographic and anthropometric factors on selected ECG characteristics in young, Southeast Asian males-results from the Singapore Armed Forces ECG (SAFE) study. Ann Noninvasive Electrocardiol 2019; 24:e12634. [PMID: 30707472 DOI: 10.1111/anec.12634] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/15/2018] [Accepted: 12/28/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Routine use of pre-participation electrocardiograms (ECGs) has been used by the Singapore Armed Forces, targeting early detection of significant cardiac diseases. We aim to describe the impact of demographic and anthropometric factors on ECG variables and establish a set of electrocardiographic reference ranges specific to a young male multiethnic Southeast Asian cohort. METHODS AND RESULTS Between November 1, 2009, and December 31, 2014, 144,346 young male conscripts underwent pre-participation screening that included a 12-lead ECG, demographic and anthropometric measurements. The Chinese population had the longest PR interval (146.7 ± 19.7 vs. 145.21 ± 19.2 in Malays vs. 141.2 ± 18.8 ms in Indians), QRS duration (94.5 ± 9.8 vs. 92.6 ± 9.7 in Malays vs. 92.5 ± 9.4 ms in Indians) and QTcB interval (408.3 ± 21.3 vs. 403.5 ± 21.6 in Malays vs. 401.2 ± 21.4 ms in Indians) (all p < 0.001). Body mass index (BMI) >25 kg/m2 and body fat >25% were independently associated with lower prevalence of increased QRS voltage on ECG. Systolic blood pressure of >140 mmHg or diastolic blood pressure of >90 mmHg independently increased the prevalence of increased QRS voltage on ECG. CONCLUSIONS Electrocardiographic parameters vary across different ethnicities and in comparison with international norms. In our population, diagnosis of increased QRS voltage by ECG is less prevalent with obesity and increased body fat. Further analysis of gold standard measurements for the diagnosis of LVH in our population is ongoing, to improve the accuracy of the ECG screening process.
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Affiliation(s)
- Ching-Hui Sia
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Mayank Dalakoti
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Benjamin Y Q Tan
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Edward C Y Lee
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Xiayan Shen
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Kangjie Wang
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Joshua S Lee
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Shalini Arulanandam
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore
| | - Weien Chow
- HQ Medical Corps, Singapore Armed Forces, Singapore, Singapore
| | - Tee Joo Yeo
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Terrance S J Chua
- Department of Cardiology, National Heart Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ru San Tan
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Carolyn S P Lam
- Department of Cardiology, National Heart Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Daniel T T Chong
- Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, Singapore, Singapore.,Department of Cardiology, National Heart Centre, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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Bierig SM, Arnold A, Einbinder LC, Armbrecht E, Burroughs T. Cardiovascular Ultrasound Combined With Non-invasive Screening for the Detection of Undiagnosed Cardiovascular Disease: A Literature Review. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479317737764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Non-invasive screenings have been widely utilized in the United States and worldwide to provide early identification of cardiovascular disease, allowing for earlier diagnosis and treatment. Screening sonography detects valve disease, cardiac dysfunction, and carotid disease in 5% to 20% of the population. This review discusses the current data regarding cardiovascular screening, the methodologies, and the resources required for performance of screenings. Cardiac and carotid sonography is highly accurate and discovers cardiovascular diseases that impact quality of life and risk of future events. Screenings are performed in a variety of settings and accuracy depends on the quality of personnel performing the non-invasive testing, the equipment utilized, and the personnel interpreting the studies. Despite the potential benefit for disease detection, population screening to detect cardiovascular disease is not widely supported by national organizations due to the theoretical cost of further testing and lack of cost versus benefit data. Additional studies are necessary to compare costs and benefits of non-invasive cardiovascular screening in the community setting.
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Affiliation(s)
| | | | | | - Eric Armbrecht
- Saint Louis University Center for Outcomes Research, Saint Louis, MO, USA
| | - Thomas Burroughs
- Saint Louis University Center for Outcomes Research, Saint Louis, MO, USA
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13
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Affiliation(s)
- Gaetano Thiene
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
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14
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Narayanan K, Bougouin W, Sharifzadehgan A, Waldmann V, Karam N, Marijon E, Jouven X. Sudden Cardiac Death During Sports Activities in the General Population. Card Electrophysiol Clin 2017; 9:559-567. [PMID: 29173402 DOI: 10.1016/j.ccep.2017.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Regular exercise reduces cardiovascular and overall mortality. Participation in sports is an important determinant of cardiovascular health and fitness. Regular sports activity is associated with a smaller risk of sudden cardiac death (SCD). However, there is a small risk of sports-related SCD. Sports-related SCD accounts for approximately 5% of total SCD. SCD among athletes comprises only a fraction of all sports-related SCD. Sport-related SCD has a male predominance and an average age of affliction of 45 to 50 years. Survival is better than for other SCD. This review summarizes links between sports and SCD and discusses current knowledge and controversies.
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Affiliation(s)
- Kumar Narayanan
- Paris Cardiovascular Research Center-INSERM U970 (PARCC), Paris, France; Cardiology Department, Maxcure Hospitals, Hitec City, Hyderabad 500081, India
| | - Wulfran Bougouin
- Paris Cardiovascular Research Center-INSERM U970 (PARCC), Paris, France; Paris Sudden Death Expertise Center (SDEC), European Georges Pompidou Hospital, 56 rue Leblanc, Paris 75987, France
| | - Ardalan Sharifzadehgan
- Paris Cardiovascular Research Center-INSERM U970 (PARCC), Paris, France; Paris Sudden Death Expertise Center (SDEC), European Georges Pompidou Hospital, 56 rue Leblanc, Paris 75987, France; Paris Descartes University, Rue de l'Ecole de Médecine, Paris 75006, France; Cardiology Department, European Georges Pompidou Hospital, 20, Rue Leblanc, Paris 75015, France
| | - Victor Waldmann
- Paris Cardiovascular Research Center-INSERM U970 (PARCC), Paris, France; Paris Sudden Death Expertise Center (SDEC), European Georges Pompidou Hospital, 56 rue Leblanc, Paris 75987, France; Paris Descartes University, Rue de l'Ecole de Médecine, Paris 75006, France; Cardiology Department, European Georges Pompidou Hospital, 20, Rue Leblanc, Paris 75015, France
| | - Nicole Karam
- Paris Cardiovascular Research Center-INSERM U970 (PARCC), Paris, France; Paris Sudden Death Expertise Center (SDEC), European Georges Pompidou Hospital, 56 rue Leblanc, Paris 75987, France; Paris Descartes University, Rue de l'Ecole de Médecine, Paris 75006, France; Cardiology Department, European Georges Pompidou Hospital, 20, Rue Leblanc, Paris 75015, France
| | - Eloi Marijon
- Paris Cardiovascular Research Center-INSERM U970 (PARCC), Paris, France; Paris Sudden Death Expertise Center (SDEC), European Georges Pompidou Hospital, 56 rue Leblanc, Paris 75987, France; Paris Descartes University, Rue de l'Ecole de Médecine, Paris 75006, France; Cardiology Department, European Georges Pompidou Hospital, 20, Rue Leblanc, Paris 75015, France.
| | - Xavier Jouven
- Paris Cardiovascular Research Center-INSERM U970 (PARCC), Paris, France; Paris Sudden Death Expertise Center (SDEC), European Georges Pompidou Hospital, 56 rue Leblanc, Paris 75987, France; Paris Descartes University, Rue de l'Ecole de Médecine, Paris 75006, France; Cardiology Department, European Georges Pompidou Hospital, 20, Rue Leblanc, Paris 75015, France
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Lampert R. ECG screening in athletes: differing views from two sides of the Atlantic. Heart 2017; 104:1037-1043. [PMID: 29101265 DOI: 10.1136/heartjnl-2016-309448] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/27/2017] [Accepted: 09/17/2017] [Indexed: 12/19/2022] Open
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Raukar N, Arciero E, Noyes A, Drezner J, Weiss J. Cardiovascular pre-participation screening in the young athlete: addressing concerns. PHYSICIAN SPORTSMED 2017; 45:365-369. [PMID: 28816570 DOI: 10.1080/00913847.2017.1363622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Neha Raukar
- a Department of Emergency Medicine, Division of Sports Medicine , Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Emily Arciero
- b Department of Pediatric Surgery , Massachusetts General Hospital , Boston , MA , USA
| | - Adam Noyes
- c Department of Cardiology , Warren Alpert Medical School of Brown University, Fellow , Providence , RI , USA
| | - Jonathan Drezner
- d University of Washington, Department of Family Medicine , Center for Sports Cardiology , Seattle , WA , USA
| | - Joseph Weiss
- e Department of Cardiology , Warren Alpert Medical School of Brown University , Providence , RI , USA
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Maillot N, Guenancia C, Yameogo NV, Gudjoncik A, Garnier F, Lorgis L, Chagué F, Cottin Y. Impact of the dynamic and static component of the sport practised for electrocardiogram analysis in screening athletes. Scand J Med Sci Sports 2017; 28:575-584. [PMID: 28730749 DOI: 10.1111/sms.12949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2017] [Indexed: 11/30/2022]
Abstract
To interpret the electrocardiogram (ECG) of athletes, the recommendations of the ESC and the Seattle criteria define type 1 peculiarities, those induced by training, and type 2, those not induced by training, to rule out cardiomyopathy. The specificity of the screening was improved by Sheikh who defined "Refined Criteria," which includes a group of intermediate peculiarities. The aim of our study was to investigate the influence of static and dynamic components on the prevalence of different types of abnormalities. The ECGs of 1030 athletes performed during preparticipation screening were interpreted using these three classifications. Our work revealed 62/16%, 69/13%, and 71/7% of type 1 peculiarities and type 2 abnormalities for the ESC, Seattle, and Refined Criteria algorithms, respectively(P<.001). For type 2 abnormalities, three independent factors were found for the ESC and Seattle criteria: age, Afro-Caribbean origin, and the dynamic component with, for the latter, an OR[95% CI] of 2.35[1.28-4.33] (P=.006) and 1.90[1.03-3.51] (P=.041), respectively. In contrast, only the Afro-Caribbean origin was associated with type 2 abnormalities using the Refined Criteria: OR[95% CI] 2.67[1.60-4.46] (P<.0001). The Refined Criteria classified more athletes in the type 1 category and fewer in the type 2 category compared with the ESC and Seattle algorithms. Contrary to previous studies, a high dynamic component was not associated with type 2 abnormalities when the Refined Criteria were used; only the Afro-Caribbean origin remained associated. Further research is necessary to better understand adaptations with regard to duration and thus improve the modern criteria for ECG screening in athletes.
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Affiliation(s)
- N Maillot
- Cardiology Department, University Hospital, Dijon, France
| | - C Guenancia
- Cardiology Department, University Hospital, Dijon, France.,LPPCM, INSERM UMR 866, Univ. Bourgogne Franche-Comté, Dijon, France
| | - N V Yameogo
- Cardiology Department, University Hospital, Dijon, France
| | - A Gudjoncik
- Cardiology Department, University Hospital, Dijon, France.,LPPCM, INSERM UMR 866, Univ. Bourgogne Franche-Comté, Dijon, France
| | - F Garnier
- Cardiology Department, University Hospital, Dijon, France
| | - L Lorgis
- Cardiology Department, University Hospital, Dijon, France.,LPPCM, INSERM UMR 866, Univ. Bourgogne Franche-Comté, Dijon, France
| | - F Chagué
- Cardiology Department, University Hospital, Dijon, France
| | - Y Cottin
- Cardiology Department, University Hospital, Dijon, France.,LPPCM, INSERM UMR 866, Univ. Bourgogne Franche-Comté, Dijon, France
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18
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Abstract
Sudden cardiac death (SCD) is a sudden and unexpected death caused by loss of heart of function. SCD may occur in any population, but when it occurs on the playing field in a young individual, communities worldwide are affected. Although these events are rare, media coverage of sudden cardiac arrests in young athletes have created the impression that these events are far more common than they appear. With a heightened awareness of SCD in young athletes, screening methods have been developed to try and prevent these events from occurring. The American Heart Associations (AHA) currently employs history and physical examination alone during the preparticipation physical exam (PPE), which clears a young athlete for participation in sports. There has been recent discussion on whether to include screening electrocardiogram (ECG) in the PPE especially after one study in Italy by Corrado et al. found that using routine ECG reduced the annual incidence of SCD by 90%. In this article we will discuss how effective the current screening recommendations are, whether routine ECG use should be included in the PPE and if it is cost effective, and review other screening modalities that may be useful in the detection of young athletes at risk for SCD.
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Affiliation(s)
- Christopher Schmehil
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Devika Malhotra
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
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19
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CARDIOVASCULAR SCREENING OF YOUNG ATHLETES: A REVIEW OF ECONOMIC EVALUATIONS. Int J Technol Assess Health Care 2017; 33:76-83. [DOI: 10.1017/s0266462317000162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objectives: Some experts have promoted preparticipative cardiovascular screening programs for young athletes and have claimed that such programs were cost-effective without performing a critical analysis of studies supporting this statement. In this systematic review, a critical assessment of economic evaluations on these programs is performed to determine if they really provide value for money.Methods: A systematic review of economic evaluations was performed on December 24, 2014. Web sites of health technology assessment agencies, the Cochrane database of systematic review, the National Health Service Economic Evaluation Database of the Cochrane Library, EMBASE, Medline, Psychinfo, and EconLit were searched to retrieve (reviews of) economic evaluations. No language or time restrictions were imposed and predefined selection criteria were used. Selected studies were critically assessed applying a structured data extraction sheet.Results: Five relevant economic evaluations were critically assessed. Results of these studies were mixed. However, those in favor of screening made (methodological) incorrect choices, of which the most important one was not taking into account a no-screening alternative as comparator. Compared with no screening, other strategies (history and physical examination or history and physical examination plus electrocardiogram) were not considered cost-effective.Conclusions: Results of primary economic evaluations should not be blindly copied without critical assessment. Economic evaluations in this field lack the support of robust evidence. Negative consequences of screening (false positive findings, overtreatment) should also be taken into account and may cause more harm than good. A mass screening of young athletes for cardiovascular diseases does not provide value for money and should be discouraged.
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20
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Mont L, Pelliccia A, Sharma S, Biffi A, Borjesson M, Brugada Terradellas J, Carré F, Guasch E, Heidbuchel H, La Gerche A, Lampert R, McKenna W, Papadakis M, Priori SG, Scanavacca M, Thompson P, Sticherling C, Viskin S, Wilson M, Corrado D, Lip GYH, Gorenek B, Blomström Lundqvist C, Merkely B, Hindricks G, Hernández-Madrid A, Lane D, Boriani G, Narasimhan C, Marquez MF, Haines D, Mackall J, Manuel Marques-Vidal P, Corra U, Halle M, Tiberi M, Niebauer J, Piepoli M. Pre-participation cardiovascular evaluation for athletic participants to prevent sudden death: Position paper from the EHRA and the EACPR, branches of the ESC. Endorsed by APHRS, HRS, and SOLAECE. Eur J Prev Cardiol 2016; 24:41-69. [DOI: 10.1177/2047487316676042] [Citation(s) in RCA: 146] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Lluís Mont
- Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Mats Borjesson
- Inst of Neuroscience and Physiology and Food, Nutrition and Sport Science and Östra University Hospital, Goteborg, Sweden
| | | | | | - Eduard Guasch
- Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | | | - André La Gerche
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | | | | | | | - Mauricio Scanavacca
- Instituto do Coração (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Bela Merkely
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | | | - Antonio Hernández-Madrid
- Unidad De Arritmias, Servicio De Cardiologia, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Deirdre Lane
- Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | | | - Manlio F Marquez
- Departamento de Electrocardiología, Instituto Nacional de Cardiologia Ignacio Chavez, Tlalpan, Mexico
| | - David Haines
- Department of Cardiovascular Medicine, Beaumont Health System, Royal Oak, MI, USA
| | - Judith Mackall
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | | | - Ugo Corra
- IRCCS Rehabilitation Medical Center, Cardiology Department, Salvatore Maugeri Foundation, Veruno, Italy
| | - Martin Halle
- Prevention and Sports Medicine, Technical University Munich, Munich, Germany
| | | | - Josef Niebauer
- Sports Medicine, Prevention & Rehabilitation, Paracelsus Medical University, Salzburg, Austria
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21
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Mont L, Pelliccia A, Sharma S, Biffi A, Borjesson M, Terradellas JB, Carré F, Guasch E, Heidbuchel H, Gerche AL, Lampert R, McKenna W, Papadakis M, Priori SG, Scanavacca M, Thompson P, Sticherling C, Viskin S, Wilson M, Corrado D, Lip GYH, Gorenek B, Lundqvist CB, Merkely B, Hindricks G, Hernández-Madrid A, Lane D, Boriani G, Narasimhan C, Marquez MF, Haines D, Mackall J, Marques-Vidal PM, Corra U, Halle M, Tiberi M, Niebauer J, Piepoli M. Pre-participation cardiovascular evaluation for athletic participants to prevent sudden death: Position paper from the EHRA and the EACPR, branches of the ESC. Endorsed by APHRS, HRS, and SOLAECE. Europace 2016; 19:139-163. [PMID: 27815371 DOI: 10.1093/europace/euw243] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Lluís Mont
- Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Mats Borjesson
- Inst of Neuroscience and Physiology and Food, Nutrition and Sport Science and Östra University Hospital, Göteborg, Sweden
| | | | | | - Eduard Guasch
- Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | | | - André La Gerche
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | | | | | | | - Mauricio Scanavacca
- Instituto do Coração (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Bela Merkely
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | | | - Antonio Hernández-Madrid
- Unidad De Arritmias, Servicio De Cardiologia, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Manlio F Marquez
- Departamento de Electrocardiología, Instituto Nacional de Cardiologia Ignacio Chavez, Tlalpan, Mexico
| | - David Haines
- Department of Cardiovascular Medicine, Beaumont Health System, Royal Oak, MI, USA
| | - Judith Mackall
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | | | - Ugo Corra
- IRCCS Rehabilitation Medical Center, Cardiology Department, Salvatore Maugeri Foundation, Veruno, Italy
| | - Martin Halle
- Prevention and Sports Medicine, Technical University Munich, Munich, Germany
| | | | - Josef Niebauer
- Sports Medicine, Prevention & Rehabilitation, Paracelsus Medical University, Salzburg, Austria
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22
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Electrocardiograms of Children and Adolescents Practicing Non-competitive Sports: Normal Limits and Abnormal Findings in a Large European Cohort Evaluated by Telecardiology. Sports Med 2016; 47:555-563. [DOI: 10.1007/s40279-016-0609-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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23
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Poirier P, Sharma S, Pipe A. The Atlantic Rift: Guidelines for Athletic Screening-Where Should Canada Stand? Can J Cardiol 2016; 32:400-6. [PMID: 27017148 DOI: 10.1016/j.cjca.2016.02.055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/15/2016] [Accepted: 02/15/2016] [Indexed: 11/19/2022] Open
Abstract
Sudden cardiac death (SCD) in a young seemingly healthy athlete is a tragic and often highly publicized event. Preparticipation screening aims to identify those affected by cardiovascular diseases who may be at higher risk of SCD during sports participation. There are conflicting recommendations from the American Heart Association and the European Society of Cardiology regarding screening electrocardiograms (ECGs) before participation in sports. The use of an ECG as a screening strategy has been questioned, with a large number of abnormal test results observed in athletes resulting from the electrocardiographic changes that occur in a highly trained individual overlapping with findings suggestive of a pathologic condition. An abnormal 12-lead ECG triggers further examinations, which are expensive given the low diagnostic yield of most abnormal electrocardiographic patterns. Universal screening of young athletes poses logistic and financial challenges. There are currently no Canadian guidelines regarding preparticipation screening of athletes. Screening of athletes ignores the much larger group of young nonathletes who participate in vigorous recreational activity and who collectively represent a population in which a much larger number of SCDs can be predicted to occur. While waiting for the best screening approach in Canada, increased awareness of and access to automated external defibrillators, along with training in cardiopulmonary resuscitation, can help reduce the number of SCDs. In some jurisdictions, electrocardiographic screening has been eschewed in favour of such an approach. Specific physician training in the field of sports cardiology with availability of experts throughout Canada may be a useful start. We provide suggestions and call for the development of Canadian guidelines by appropriate organizations.
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Affiliation(s)
- Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada; Faculty of Pharmacy, Université Laval, Québec City, Québec, Canada.
| | - Sanjay Sharma
- St George's University of London, London, United Kingdom
| | - Andrew Pipe
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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24
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Abstract
Although the occurrence of sudden cardiac death (SCD) in a young person is a rare event, it is traumatic and often widely publicized. In recent years, SCD in this population has been increasingly seen as a public health and safety issue. This review presents current knowledge relevant to the epidemiology of SCD and to strategies for prevention, resuscitation, and identification of those at greatest risk. Areas of active research and controversy include the development of best practices in screening, risk stratification approaches and postmortem evaluation, and identification of modifiable barriers to providing better outcomes after resuscitation of young SCD patients. Institution of a national registry of SCD in the young will provide data that will help to answer these questions.
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Affiliation(s)
- Michael Ackerman
- From Departments of Internal Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics; Divisions of Cardiovascular Diseases and Pediatric Cardiology; Windland Smith Rice Sudden Death Genomics Laboratory; Mayo Clinic, Rochester, MN (M.A.);Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa, City (D.L.A.); andDepartment of Cardiology, Boston Children's Hospital, MA (J.K.T.)
| | - Dianne L Atkins
- From Departments of Internal Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics; Divisions of Cardiovascular Diseases and Pediatric Cardiology; Windland Smith Rice Sudden Death Genomics Laboratory; Mayo Clinic, Rochester, MN (M.A.);Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa, City (D.L.A.); andDepartment of Cardiology, Boston Children's Hospital, MA (J.K.T.)
| | - John K Triedman
- From Departments of Internal Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics; Divisions of Cardiovascular Diseases and Pediatric Cardiology; Windland Smith Rice Sudden Death Genomics Laboratory; Mayo Clinic, Rochester, MN (M.A.);Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa, City (D.L.A.); andDepartment of Cardiology, Boston Children's Hospital, MA (J.K.T.).
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25
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Ghani S, Papadakis M, Kemp S, Zaidi A, Sheikh N, Gati S, Raju H, Smith A, Palmer C, Somauroo J, Sharma S. Results of a nationally implemented de novo cardiac screening programme in elite rugby players in England. Br J Sports Med 2016; 50:1338-1344. [PMID: 27340147 DOI: 10.1136/bjsports-2015-095902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIM Screening of young competitive athletes remains a contentious issue. In 2010, a nationwide cardiac screening for all elite rugby players was introduced in England. This provided a unique opportunity to prospectively assess the feasibility and cost-effectiveness of a de novo, ECG-based cardiac screening programme. METHODS Between 2010 and 2012, 1191 rugby players aged ≥14 years underwent cardiac screening with a health questionnaire, 12-lead ECG and a consultation with a cardiologist. The players with concerning findings on initial evaluation were offered on-site transthoracic echocardiogram (TTE). Athletes were referred for further investigations as deemed necessary. The overall cost of the screening programme was estimated. RESULTS After initial evaluation, 9.7% of athletes underwent on-site TTE; 8.2% underwent on-site TTE due to ECG anomalies and 1.4% underwent on-site TTE due to concerns on the questionnaire. After TTE, only 2.9% of the total cohort was referred for further evaluation. Two players were diagnosed with potentially serious conditions; one with Wolff-Parkinson-White, who resumed competition after catheter ablation, and one with hypertrophic cardiomyopathy, who withdrew from competition. During a mean follow-up of 52.8±5.5 months, none of the players who were reassured experienced any adverse cardiac events. The total cost of the screening programme was £59 875, which averaged to a cost of £50 per player or £29 938 per condition identified. Application of refined ECG criteria would reduce the ECG false-positive rate to 4.9%. CONCLUSIONS Preparticipation cardiac screening with 12-lead ECG is feasible. Refinement of the ECG criteria, the use of on-site TTE and expert setting can minimise the burden of unnecessary investigations and reduce costs.
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Affiliation(s)
- Saqib Ghani
- Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
| | - Michael Papadakis
- Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
| | | | - Abbas Zaidi
- Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
| | - Nabeel Sheikh
- Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
| | - Sabiha Gati
- Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
| | - Hariharan Raju
- Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
| | - Andy Smith
- Mid Yorkshire Hospital NHS Trust, Wakefield, UK.,RWC England 2015 Medical Advisory Group.,Premiership Rugby, Twickenham, UK
| | | | - John Somauroo
- Countess of Chester NHS Hospital Trust, UK.,Liverpool Heart and Chest NHS Hospital Trust, Liverpool, UK
| | - Sanjay Sharma
- Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
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26
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Gradually Understanding Sudden Cardiac Death ∗. J Am Coll Cardiol 2016; 67:2116-2117. [DOI: 10.1016/j.jacc.2016.03.476] [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: 02/29/2016] [Accepted: 03/01/2016] [Indexed: 11/17/2022]
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27
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Harmon KG, Drezner JA, O'Connor FG, Asplund C, Finnoff JT. Should Electrocardiograms Be Part of the Preparticipation Physical Examination? PM R 2016; 8:S24-35. [PMID: 26972265 DOI: 10.1016/j.pmrj.2016.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 01/07/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Kimberly G Harmon
- Sports Medicine Section, Departments of Family Medicine and Orthopaedics and Sports Medicine, University of Washington, Sports Medicine Center at Husky Stadium UW Medicine, Seattle, WA(∗)
| | - Jonathan A Drezner
- Sports Medicine Section, Departments of Family Medicine and Orthopaedics and Sports Medicine, University of Washington, Sports Medicine Center at Husky Stadium UW Medicine, Seattle, WA(†)
| | - Francis G O'Connor
- Military and Emergency Medicine, Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, MD(‡)
| | - Chad Asplund
- Athletic Medicine, Health Services Division, Georgia Southern University, Statesboro, GA(§)
| | - Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine, Rochester; and Mayo Clinic Sports Medicine Center, 600 Hennepin Ave, #310, Minneapolis, MN 55403(‖).
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28
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Smallman DP, Webber BJ, Mazuchowski EL, Scher AI, Jones SO, Cantrell JA. Sudden cardiac death associated with physical exertion in the US military, 2005–2010. Br J Sports Med 2015; 50:118-23. [DOI: 10.1136/bjsports-2015-094900] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2015] [Indexed: 12/19/2022]
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29
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Limitations of Current AHA Guidelines and Proposal of New Guidelines for the Preparticipation Examination of Athletes. Clin J Sport Med 2015; 25:472-7. [PMID: 25915146 DOI: 10.1097/jsm.0000000000000203] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the prevalence of athletes who screen positive with the preparticipation examination guidelines from the American Heart Association, the AHA 12-elements, in combination with 3 screening electrocardiogram (ECG) criteria. DESIGN Observational cross-sectional study. SETTING Stanford University Sports Medicine Clinic. PARTICIPANTS Total of 1596 participants, including 297 (167 male; mean age, 16.2 years) high school athletes, 1016 (541 male; mean age, 18.8 years) collegiate athletes, and 283 (mean age, 26.3 years) male professional athletes. MAIN OUTCOME MEASURES Athletes were screened using the 8 personal and family history questions from the AHA 12-elements. Electrocardiograms were obtained for all participants and interpreted using Seattle criteria, Stanford criteria, and European Society of Cardiology (ESC) recommendations. RESULTS Approximately one-quarter of all athletes (23.8%) had at least 1 positive response to the AHA personal and family history elements. High school and college athletes had similar rates of having at least 1 positive response (25.9% vs 27.4%), whereas professional athletes had a significantly lower rate of having at least 1 positive response (8.8%, P < 0.05). Females reported more episodes of unexplained syncope (11.4% vs 7.5%, P = 0.017) and excessive exertional dyspnea with exercise (11.1% vs 6.1%, P = 0.001) than males. High school athletes had more positive responses to the family history elements when compared with college athletes (P < 0.05). The percentage of athletes who had an abnormal ECG varied between Seattle criteria (6.0%), Stanford criteria (8.8%), and ESC recommendations (26.8%). CONCLUSIONS Many athletes screen positive under current screening recommendations, and ECG results vary widely by interpretation criteria. CLINICAL RELEVANCE In a patient population without any adverse cardiovascular events, the currently recommended AHA 12-elements have an unacceptably high rate of false positives. Newer screening guidelines are needed, with fewer false positives and evidence-based updates.
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30
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Chatard JC, Mujika I, Goiriena JJ, Carré F. Screening young athletes for prevention of sudden cardiac death: Practical recommendations for sports physicians. Scand J Med Sci Sports 2015; 26:362-74. [PMID: 26432052 DOI: 10.1111/sms.12502] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 12/13/2022]
Abstract
Regular intensive exercise in athletes increases the relative risk of sudden cardiac death (SCD) compared with the relatively sedentary population. Most cases of SCD are due to silent cardiovascular diseases, and pre-participation screening of athletes at risk of SCD is thus of major importance. However, medical guidelines and recommendations differ widely between countries. In Italy, the National Health System recommends pre-participation screening for all competitive athletes including personal and family history, a physical examination, and a resting 12-lead electrocardiogram (ECG). In the United States, the American College of Cardiology and the American Heart Association recommend a pre-participation screening program limited to the use of specific questionnaires and a clinical examination. The value of a 12-lead ECG is debated based on issues surrounding cost-efficiency and feasibility. The aim of this review was to focus on (i) the incidence rate of cardiac diseases in relation to SCD; (ii) the value of conducting a questionnaire and a physical examination; (iii) the value of a 12-lead resting ECG; (iv) the importance of other cardiac evaluations in the prevention of SCD; and (v) the best practice for pre-participation screening.
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Affiliation(s)
- J-C Chatard
- Laboratory of Exercise Physiology, Faculty of Medicine Jacques Lisfranc, University of Lyon-Saint-Etienne, Saint-Etienne, France
| | - I Mujika
- Department of Physiology, Faculty of Medicine and Odontology, University of the Basque Country, Leioa, Basque Country, Spain.,School of Kinesiology and Health Research Center, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - J J Goiriena
- Department of Physiology, Faculty of Medicine and Odontology, University of the Basque Country, Leioa, Basque Country, Spain
| | - F Carré
- Laboratory of Exercise Physiology, Faculty of Medicine, University of Rennes, Rennes, France
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31
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Burns KM, Encinosa WE, Pearson GD, Kaltman JR. Electrocardiogram in Preparticipation Athletic Evaluations among Insured Youths. J Pediatr 2015; 167:804-809.e1. [PMID: 26148663 PMCID: PMC4586399 DOI: 10.1016/j.jpeds.2015.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/15/2015] [Accepted: 06/04/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To retrospectively characterize electrocardiogram (ECG) use among preparticipation history and examinations (PPEs). STUDY DESIGN Using the 2005 to 2010 MarketScan insurance database, we identified subjects aged 5-21 years with either a PPE with an ECG or a PPE alone, excluding those with known cardiac diagnoses. We described cardiology referrals and subspecialty testing within 180 days and cardiac diagnoses within 1 year of the PPE, and the costs of testing in each group. RESULTS From 2005-2009, 503 304 PPEs occurred in 419 456 subjects, of which 8621 (2%) included an ECG. ECG use increased from 12-20 per 1000 PPEs from 2005-2009. Females, lower socioeconomic status, and rural settings were associated with fewer ECGs. Thirteen percent of PPEs with ECG and 0.5% of PPEs alone led to a cardiology referral. After PPEs with ECG, cardiac disease was identified in 18% (2% sports-limiting); after PPEs alone, cardiac disease was identified in 0.5% (0.03% sports-limiting). The PPE had a sensitivity of 44% and a specificity of 98.6% of identifying cardiac disease. The total reimbursement cost of PPEs plus testing was $80 396 464 ($160 per PPE). CONCLUSIONS These real-world data demonstrate that community providers selectively use the ECG as part of the PPE with a high rate of identification of cardiac disease. Mass ECG screening would need to be more efficient at identifying disease than this selective approach.
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Affiliation(s)
- Kristin M Burns
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD.
| | - William E Encinosa
- Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, MD
| | - Gail D Pearson
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Jonathan R Kaltman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
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Spatial/Frontal QRS-T Angle Predicts All-Cause Mortality and Cardiac Mortality: A Meta-Analysis. PLoS One 2015; 10:e0136174. [PMID: 26284799 PMCID: PMC4540436 DOI: 10.1371/journal.pone.0136174] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 07/31/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A number of studies have assessed the predictive effect of QRS-T angles in various populations since the last decade. The objective of this meta-analysis was to evaluate the prognostic value of spatial/frontal QRS-T angle on all-cause death and cardiac death. METHODS PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from their inception until June 5, 2014. Studies reporting the predictive effect of spatial/frontal QRS-T angle on all-cause/cardiac death in all populations were included. Relative risk (RR) was used as a measure of effect. RESULTS Twenty-two studies enrolling 164,171 individuals were included. In the combined analysis in all populations, a wide spatial QRS-T angle was associated with an increase in all-cause death (maximum-adjusted RR: 1.40; 95% confidence interval [CI]: 1.32 to 1.48) and cardiac death (maximum-adjusted RR: 1.71; 95% CI: 1.54 to 1.90), a wide frontal QRS-T angle also predicted a higher rate of all-cause death (maximum-adjusted RR: 1.71; 95% CI: 1.54 to 1.90). Largely similar results were found using different methods of categorizing for QRS-T angles, and similar in subgroup populations such as general population, populations with suspected coronary heart disease or heart failure. Other stratified analyses and meta-analyses using unadjusted data also generated consistent findings. CONCLUSIONS Spatial QRS-T angle held promising prognostic value on all-cause death and cardiac death. Frontal QRS-T angle was also a promising predictor of all-cause death. Given the good predictive value of QRS-T angle, a combined stratification strategy in which QRS-T angle is of vital importance might be expected.
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Cho JH, Selen MA, Kocheril AG. Screening of young competitive athletes for the prevention of sudden cardiac death with a wireless electrocardiographic transmission device: a pilot study. BMC Res Notes 2015; 8:342. [PMID: 26260154 PMCID: PMC4531846 DOI: 10.1186/s13104-015-1311-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/30/2015] [Indexed: 11/10/2022] Open
Abstract
Background The 12-lead electrocardiographic screening for the prevention of sudden cardiac death in young competitive athletes is not cost-effective and thus not routinely recommended. We investigate whether a less expensive wireless electrocardiographic transmission device can be used to screen for the prevention of sudden cardiac death in this population. Methods During pre-participation screening, twenty college football players underwent two electrocardiograms: a conventional 12-lead electrocardiogram and a wireless 9-lead electrocardiogram. We compared several electrocardiographic parameters (QRS duration, left ventricular hypertrophy using the Cornell voltage criteria and the Sokolow–Lyon criteria, ST deviation and corrected QT interval) to determine the correlation. Results The QRS duration, left ventricular hypertrophy using the Cornell voltage criteria and the Sokolow–Lyon criteria and corrected QT interval exhibited significant correlation between the two types of electrocardiograms (correlation coefficient 0.878, 0.630, 0.770 and 0.847, respectively with P values of 0.01, 0.003, 0.01 and 0.01, respectively). ST deviation in V1 was weakly correlated between the two types of electrocardiograms without statistical significance (correlation coefficient 0.360 with a P value of 0.119). Conclusions Our newly developed wireless 9-lead electrocardiogram demonstrated significant correlations with a conventional 12-lead electrocardiogram in terms of QRS duration, left ventricular hypertrophy and corrected QT interval.
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Affiliation(s)
- Jae Hyung Cho
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | - Mats A Selen
- Department of Physics, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
| | - Abraham G Kocheril
- Department of Cardiology, College of Medicine, University of Illinois at Urbana-Champaign, 101 West University Avenue, Champaign, IL, 61820, USA.
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ECG screening for SCD in young adults: Community volunteers can acquire higher quality ECGs than health professionals. J Electrocardiol 2015; 48:345-50. [DOI: 10.1016/j.jelectrocard.2015.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Indexed: 11/22/2022]
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Automated external defibrillator rescues among children with diagnosed and treated long QT syndrome. Heart Rhythm 2015; 12:776-81. [DOI: 10.1016/j.hrthm.2015.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Indexed: 11/23/2022]
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36
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Assanelli D, Levaggi R, Carré F, Sharma S, Deligiannis A, Mellwig KP, Tahmi M, Vinetti G, Aliverti P. Cost-effectiveness of pre-participation screening of athletes with ECG in Europe and Algeria. Intern Emerg Med 2015; 10:143-50. [PMID: 25164412 DOI: 10.1007/s11739-014-1123-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 07/31/2014] [Indexed: 10/24/2022]
Abstract
The aim of this study is to evaluate the cost-effectiveness of ECG in combination with family and personal history and physical examination in order to detect cardiovascular diseases that might cause sudden death in athletes. The study was conducted on a cohort of 6,634, mainly young professional and recreational athletes, 1,071 from Algeria and 5,563 from Europe (France, Germany and Greece). Each athlete underwent medical history, physical examination, and resting 12-lead ECG. 293 athletes (4.4 %), 149 in Europe (2.7 %) and 144 in Algeria (13.4 %) required further tests, and 56 were diagnosed with cardiovascular disease and thus disqualified. The cost-effectiveness ratio (CER) was calculated as the ratio between the cost of screening and the number of statistical life-years saved by the intervention. The estimated reduced risk of death deriving from treatment or disqualification resulted in the saving of 79.1 statistical life-years in Europe and 136.3 in Algeria. CER of screening was 4,071 purchasing-power-parity-adjusted US dollars ($PPP) in Europe and 582 $PPP in Algeria. The results of this study strongly support the utilisation of 12-lead ECG in the pre-participation screening of young athletes, especially in countries where secondary preventive care is not highly developed.
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Affiliation(s)
- Deodato Assanelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy,
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Vetter VL. Electrocardiographic screening of all infants, children, and teenagers should be performed. Circulation 2015; 130:688-97; discussion 697. [PMID: 25135125 DOI: 10.1161/circulationaha.114.009737] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Victoria L Vetter
- From The Children's Hospital of Philadelphia, and Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA.
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Tischer SG, Mattsson N, Storgaard M, Høfsten DE, Høst NB, Andersen LJ, Prescott E, Rasmusen HK. Results of voluntary cardiovascular examination of elite athletes in Denmark: Proposal for Nordic collaboration. Scand J Med Sci Sports 2015; 26:64-73. [DOI: 10.1111/sms.12405] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2014] [Indexed: 01/17/2023]
Affiliation(s)
- S. G. Tischer
- Department of Cardiology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - N. Mattsson
- Department of Cardiology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - M. Storgaard
- Sports Medical Team; Team Denmark; Brøndby Denmark
| | - D. E. Høfsten
- Department of Cardiology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - N. B. Høst
- Department of Cardiology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - L. J. Andersen
- Department of Cardiology; Roskilde Hospital; Roskilde Denmark
| | - E. Prescott
- Department of Cardiology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - H. K. Rasmusen
- Department of Cardiology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
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Yankelson L, Steinvil A, Adler A, Viskin S. Reply. J Am Coll Cardiol 2015; 65:408-409. [DOI: 10.1016/j.jacc.2014.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 10/21/2014] [Indexed: 11/30/2022]
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Schnell F, Riding N, O’Hanlon R, Axel Lentz P, Donal E, Kervio G, Matelot D, Leurent G, Doutreleau S, Chevalier L, Guerard S, Wilson MG, Carré F. Recognition and Significance of Pathological T-Wave Inversions in Athletes. Circulation 2015; 131:165-73. [DOI: 10.1161/circulationaha.114.011038] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background—
Pathological T-wave inversion (PTWI) is rarely observed on the ECG of healthy athletes, whereas it is common in patients with certain cardiac diseases. All ECG interpretation guidelines for use within athletes state that PTWI (except in leads aVR, III and V1 and in V1–V4 when preceded by domed ST segment in asymptomatic Afro-Caribbean athletes only) cannot be considered a physiological adaptation. The aims of the present study were to prospectively determine the prevalence of cardiac pathology in athletes presenting with PTWI, and to examine the efficacy of cardiac magnetic resonance in the work-up battery of further examinations.
Methods and Results—
Athletes presenting with PTWI (n=155) were investigated with clinical examination, ECG, echocardiography, exercise testing, 24h Holter ECG, and cardiac magnetic resonance. Cardiac disease was established in 44.5% of athletes, with hypertrophic cardiomyopathy (81%) the most common pathology. Echocardiography was abnormal in 53.6% of positive cases, and cardiac magnetic resonance identified a further 24 athletes with disease. Five athletes (7.2%) considered normal on initial presentation subsequently expressed pathology during follow-up. Familial history of sudden cardiac death and ST-segment depression associated with PTWI were predictive of cardiac disease.
Conclusions—
PTWI should be considered pathological in all cases until proven otherwise, because it was associated with cardiac pathology in 45% of athletes. Despite echocardiography identifying pathology in half of these cases, cardiac magnetic resonance must be considered routine in athletes presenting with PTWI with normal echocardiography. Although exclusion from competitive sport is not warranted in the presence of normal secondary examinations, annual follow-up is essential to ascertain possible disease expression.
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Affiliation(s)
- Frédéric Schnell
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Nathan Riding
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Rory O’Hanlon
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Pierre Axel Lentz
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Erwan Donal
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Gaelle Kervio
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - David Matelot
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Guillaume Leurent
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Stéphane Doutreleau
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Laurent Chevalier
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Sylvain Guerard
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Mathew G. Wilson
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - François Carré
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
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PérezRodon J, FranciscoPascual J, RivasGándara N, RocaLuque I, Bellera N, MoyaMitjans À. Cryptogenic Stroke And Role Of Loop Recorder. J Atr Fibrillation 2014; 7:1178. [PMID: 27957141 DOI: 10.4022/jafib.1178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 12/12/2014] [Accepted: 12/21/2014] [Indexed: 12/29/2022]
Abstract
Ischemic stroke is an important cause of morbidity and mortality when untreated. Identifying atrial fibrillation is important because atrial fibrillation ischemic related strokes are associated with an increased risk of disability and death compared with strokes of other etiologies and tend to recur without anticoagulation. However, atrial fibrillation detection can be difficult when it is asymptomatic and paroxistic and may be the underlying cause of some cryptogenic strokes or strokes of unknown origin. In this review, the different methods of cardiac monitoring to detect atrial fibrillation in patients with cryptogenic stroke are summarized, with a focus on loop recorder monitoring.
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Affiliation(s)
- Jordi PérezRodon
- Department of Cardiology, Hospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Spain
| | - Jaume FranciscoPascual
- Department of Cardiology, Hospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Spain
| | - Nuria RivasGándara
- Department of Cardiology, Hospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Spain
| | - Ivo RocaLuque
- Department of Cardiology, Hospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Spain
| | - Neus Bellera
- Department of Cardiology, Hospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Spain
| | - Àngel MoyaMitjans
- Department of Cardiology, Hospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Spain
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Lawless CE, Asplund C, Asif IM, Courson R, Emery MS, Fuisz A, Kovacs RJ, Lawrence SM, Levine BD, Link MS, Martinez MW, Matherne GP, Olshansky B, Roberts WO, Salberg L, Vetter VL, Vogel RA, Whitehead J. Protecting the Heart of the American Athlete. J Am Coll Cardiol 2014; 64:2146-71. [DOI: 10.1016/j.jacc.2014.08.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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43
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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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44
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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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YOUng Football Italian amateur players Remote electrocardiogram Screening with Telemedicine (YOU FIRST) study: preliminary results. Int J Cardiol 2014; 176:1257-8. [PMID: 25124997 DOI: 10.1016/j.ijcard.2014.07.195] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 07/27/2014] [Indexed: 01/02/2023]
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CZOSEK RICHARDJ, CNOTA JAMESF, KNILANS TIMOTHYK, PRATT JESSE, GUERRIER KARINE, ANDERSON JEFFREYB. Relationship between Echocardiographic LV Mass and ECG Based Left Ventricular Voltages in an Adolescent Population: Related or Random? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:1133-40. [DOI: 10.1111/pace.12416] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 02/06/2014] [Accepted: 04/01/2014] [Indexed: 11/30/2022]
Affiliation(s)
- RICHARD J. CZOSEK
- Division of Pediatric Cardiology; Department of Pediatrics; The Heart Institute; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - JAMES F. CNOTA
- Division of Pediatric Cardiology; Department of Pediatrics; The Heart Institute; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - TIMOTHY K. KNILANS
- Division of Pediatric Cardiology; Department of Pediatrics; The Heart Institute; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - JESSE PRATT
- Department of Biostatistics and Epidemiology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - KARINE GUERRIER
- Division of Pediatric Cardiology; Department of Pediatrics; The Heart Institute; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - JEFFREY B. ANDERSON
- Division of Pediatric Cardiology; Department of Pediatrics; The Heart Institute; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
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Abstract
Ensuring the safety of young athletes is a priority among health care providers. Controversy remains as to the best method of preparticipation screening. The American Academy of Pediatrics and the American Heart Association currently recommend screening with history and physical examination, without routine electrocardiogram or echocardiography. Meticulous conduction of a cardiac focused history and exam during the preparticipation evaluation can help identify those who may be at risk for sudden cardiac arrest. Understanding presenting signs of the most common cardiac diseases is useful in recognizing those in need of a directed cardiac evaluation before sports participation.
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Affiliation(s)
- James M Galas
- Division of Pediatric Cardiology, The Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, 3901 Beaubien Boulevard, Detroit, MI 48201-2119, USA.
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Electrocardiographic screening for hypertrophic cardiomyopathy and long QT syndrome: the drivers of cost-effectiveness for the prevention of sudden cardiac death. Pediatr Cardiol 2014; 35:323-31. [PMID: 24005901 DOI: 10.1007/s00246-013-0779-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 08/14/2013] [Indexed: 10/26/2022]
Abstract
It is universally recognized that the prevention of sudden cardiac death (SCD) in youth is an important public health initiative. The best approach remains uncertain. Many European and Asian countries support the use of electrocardiograms (ECGs). In the United States, this is highly controversial. Many debate its cost-effectiveness. We designed a comprehensive economic model of two of the most prevalent causes of SCD identifiable by ECG, hypertrophic cardiomyopathy (HCM) and long QT syndrome (LQTS), to determine the drivers of uncertainty in the estimate of cost-effectiveness. We compared the cost-effectiveness of screening with history and physical examination (H&P) plus ECG to the current United States standard, H&P alone, for the detection and treatment of HCM and LQTS. We used a Markov model on a theoretical cohort of healthy 12-year-olds over a 70-year time horizon from a societal perspective, employing extensive univariable and probabilistic sensitivity analyses, to determine drivers of costs and effectiveness. The incremental cost-effectiveness of adding ECGs to H&Ps was $41,400/life-year saved. The model was highly sensitive to the effect of identification and treatment of previously undiagnosed individuals with HCM; however, it was insensitive to many variables commonly assumed to be significant, including the costs of ECGs, echocardiograms, and genetic testing, as well as the sensitivity and specificity of ECGs. No LQTS-related parameters were significant. This study suggests that the key to determining the cost-effectiveness of ECG screening in the United States lies in developing a better understanding of disease progression in the previously undiagnosed HCM population.
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Investigation on cardiovascular risk prediction using physiological parameters. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2013; 2013:272691. [PMID: 24489599 PMCID: PMC3893863 DOI: 10.1155/2013/272691] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 09/23/2013] [Indexed: 12/11/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death worldwide. Early prediction of CVD is urgently important for timely prevention and treatment. Incorporation or modification of new risk factors that have an additional independent prognostic value of existing prediction models is widely used for improving the performance of the prediction models. This paper is to investigate the physiological parameters that are used as risk factors for the prediction of cardiovascular events, as well as summarizing the current status on the medical devices for physiological tests and discuss the potential implications for promoting CVD prevention and treatment in the future. The results show that measures extracted from blood pressure, electrocardiogram, arterial stiffness, ankle-brachial blood pressure index (ABI), and blood glucose carry valuable information for the prediction of both long-term and near-term cardiovascular risk. However, the predictive values should be further validated by more comprehensive measures. Meanwhile, advancing unobtrusive technologies and wireless communication technologies allow on-site detection of the physiological information remotely in an out-of-hospital setting in real-time. In addition with computer modeling technologies and information fusion. It may allow for personalized, quantitative, and real-time assessment of sudden CVD events.
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Gati S, Sheikh N, Ghani S, Zaidi A, Wilson M, Raju H, Cox A, Reed M, Papadakis M, Sharma S. Should axis deviation or atrial enlargement be categorised as abnormal in young athletes? The athlete's electrocardiogram: time for re-appraisal of markers of pathology. Eur Heart J 2013; 34:3641-8. [PMID: 24057078 DOI: 10.1093/eurheartj/eht390] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
AIMS The 2010 European Society of Cardiology (ESC) guidelines for electrocardiogram (ECG) interpretation in athletes are associated with a relatively high false positive rate and warrant modification to improve the specificity without compromising sensitivity. The aim of this study was to investigate whether non-specific anomalies such as axis deviation and atrial enlargement in isolation require further assessment in highly trained young athletes. METHOD AND RESULTS Between 2003 and 2011, 2533 athletes aged 14-35 years were investigated with 12-lead ECG and echocardiography. Electrocardiograms were analysed for non-training-related (Group 2) changes according to the 2010 ESC guidelines. Results were compared with 9997 asymptomatic controls. Of the 2533 athletes, 329 (13%) showed Group 2 ECG changes. Isolated axis deviation and isolated atrial enlargement comprised 42.6% of all Group 2 changes. Athletes revealed a slightly higher prevalence of these anomalies compared with controls (5.5 vs. 4.4%; P = 0.023). Echocardiographic evaluation of athletes and controls with isolated axis deviation or atrial enlargement (n = 579) failed to identify any major structural or functional abnormalities. Exclusion of axis deviation or atrial enlargement reduced the false positive rate from 13 to 7.5% and improved specificity from 90 to 94% with a minimal reduction in sensitivity (91-89.5%). CONCLUSION Isolated axis deviation and atrial enlargement comprise a high burden of Group 2 changes in athletes and do not predict underlying structural cardiac disease. Exclusion of these anomalies from current ESC guidelines would improve specificity and cost-effectiveness of pre-participation screening with ECG.
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Affiliation(s)
- Sabiha Gati
- St George's University of London, Cranmer Terrace, SW17 0RE, London SE5 9RS, UK
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