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Golubjatnikov M, Walker A. Endurance Sporting Events. Emerg Med Clin North Am 2024; 42:581-596. [PMID: 38925776 DOI: 10.1016/j.emc.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Endurance sports encompass a broad range of events from marathons and triathlons to ultramarathons, long-distance cycling, skiing, and swimming. As these events have experienced a surge in popularity, we have a greater need to understand the associated medical risks. This article reviews the history of endurance races, reviews the most critical and common causes of cardiovascular, heat, electrolyte, and musculoskeletal injuries/illnesses, and discusses considerations for medical directors/personnel associated with such events.
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Affiliation(s)
- Matt Golubjatnikov
- St Joseph's Medical Center, 1800 N California Street, Stockton, CA 95204, USA
| | - Anne Walker
- St Joseph's Medical Center, 1800 N California Street, Stockton, CA 95204, USA.
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Scarneo-Miller SE, Hosokawa Y, Drezner JA, Hirschhorn RM, Conway DP, Elkins GA, Hopper MN, Strapp EJ. National Athletic Trainers' Association Position Statement: Emergency Action Plan Development and Implementation in Sport. J Athl Train 2024; 59:570-583. [PMID: 38918009 PMCID: PMC11220767 DOI: 10.4085/1062-6050-0521.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
OBJECTIVE An emergency action plan (EAP) is a written document detailing the preparations and on-site emergency response of health care professionals and other stakeholders to medical emergencies in the prehospital setting. The EAP is developed to address any type of catastrophic injury response and should not be condition specific. The objective of this National Athletic Trainers' Association position statement is to provide evidence-based and consensus-based recommendations for developing and implementing an EAP for sports settings. METHODS These recommendations were developed by a multidisciplinary expert panel that performed (1) a comprehensive review of existing EAP evidence, (2) a modified Delphi process to define consensus recommendations, and (3) a strength of recommendation taxonomy determination for each recommendation. RESULTS An EAP is an essential tool designed to facilitate emergency preparedness and an efficient, coordinated emergency response during an athletic event. A comprehensive EAP should consider modes to optimize patient outcomes, the various stakeholders needed to develop the plan, the factors influencing effective implementation of the EAP, and the roles and responsibilities to ensure a structured response to a catastrophic injury. CONCLUSIONS These evidence-informed recommendations outline the necessary steps for emergency planning and provide considerations for the immediate management of patients with catastrophic injuries. Increasing knowledge and implementation of the EAP to manage patients with catastrophic injuries improves the overall response and decreases errors during an emergency.
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Smith C, Sewry N, Nolte K, Swanevelder S, Engelke N, van Kamp C, Jordaan E, Schwellnus M. Do five screening tools identify the same number of runners who require pre-exercise medical clearance? SAFER XXXIV. PHYSICIAN SPORTSMED 2024; 52:77-83. [PMID: 36722299 DOI: 10.1080/00913847.2023.2176161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/30/2023] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Currently, there are five international screening tools that are recommended to identify individuals who require pre-exercise medical clearance to reduce the risk of medical encounters during exercise. Therefore, the aim was to determine the percentage of race entrants who are advised to obtain pre-exercise medical clearance and the observed agreement between these five different international pre-exercise medical screening tools. METHODS In all, 76,654 race entrants from the Two Oceans Marathon (2012-2015) that completed an online pre-race screening questionnaire. Five pre-exercise medical screening tools (American Heart Association (AHA), pre-2015 American College of Sport Medicine (ACSM), post-2015 ACSM, Physical Activity Readiness Questionnaire (PAR-Q), and the European Association of Cardiovascular Prevention and Rehabilitation (EACPR)) were retrospectively applied to all participants. The % (95%CI) race entrants requiring medical clearance identified by each tool and the observed agreement between tools (%) was determined. RESULTS The % entrants requiring medical clearance varied from 6.7% to 33.9% between the five tools: EACPR (33.9%; 33.5-34.3); pre-2015 ACSM (33.9%; 33.5-34.3); PAR-Q (23.2%; 22.9-23.6); AHA (10.0%; 9.7-10.2); post-2015 ACSM (6.7%; 6.5-6.9). The observed agreement was highest between the pre-2015 ACSM and EACPR (35.4%), for pre-2015 ACSM and PAR-Q (24.8%), PAR-Q and EACPR (24.8%), and lowest between the post-2015 ACSM and AHA (4.1%). CONCLUSION The percentage of race entrants identified to seek medical clearance (and observed agreement) varied considerably between pre-exercise medical screening tools. Further research should determine which tool has the best predictive ability in identifying those at higher risk of medical encounters during exercise.
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Affiliation(s)
- Chanel Smith
- Division of Biokinetics and Sports Science, Department of Physiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Nicola Sewry
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- International Olympic Committee (IOC) Research Centre, Pretoria, South Africa
| | - Kim Nolte
- Division of Biokinetics and Sports Science, Department of Physiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Sonja Swanevelder
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Nina Engelke
- Department of Statistics and Actuarial Science, Stellenbosch University, Stellenbosch, South Africa
| | - Calvin van Kamp
- Department of Statistics and Actuarial Science, Stellenbosch University, Stellenbosch, South Africa
| | - Esme Jordaan
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
- Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa
| | - Martin Schwellnus
- Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- International Olympic Committee (IOC) Research Centre, Pretoria, South Africa
- Sport and Exercise Medicine, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa
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Stumph JD, Cornwell WK, Rosenberg MA, Khodaee M. Profound First-Degree Atrioventricular Block in a High-Level Basketball Athlete. Sports Health 2023:19417381231210297. [PMID: 37946461 DOI: 10.1177/19417381231210297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
First-degree atrioventricular (AV) block (PR interval >200 ms) is commonly observed among screening electrocardiogram (ECG) in athletes. Profound first-degree AV block (PR interval >400 ms) and Mobitz type I (Wenckebach) second-degree AV block are generally uncommon and often require further workup on a case-by-case basis, particularly when there is concern for a structural cardiac abnormality. In this case, we present an example of an asymptomatic profound first-degree AV block with Mobitz type I (Wenckebach) second-degree AV block. Transthoracic echocardiogram and stress echocardiogram were unremarkable and the patient was cleared to participate in sports without any restriction. Physicians managing athletes should be aware of ECG features that require additional evaluation and cardiology consultation.
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Affiliation(s)
- Justin D Stumph
- OhioHealth, Primary Care Sports Medicine, Columbus, Ohio, USA
| | - William K Cornwell
- University of Colorado Anschutz Medical Campus, Department of Medicine-Cardiology, Aurora, Colorado, USA
- University of Colorado Anschutz Medical Campus, Clinical Translational Research Center, Aurora, Colorado, USA
| | - Michael A Rosenberg
- University of Colorado Anschutz Medical Campus, Department of Medicine-Cardiology, Aurora, Colorado, USA
| | - Morteza Khodaee
- University of Colorado School of Medicine, Department of Family Medicine and Orthopedics, Denver, Colorado, USA
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Rey RT, Pezalla AE. Parents, Pain, and Over-the-Counter Medicine: Athletes' Perceived Alternatives to Prescription Opioid Misuse. Healthcare (Basel) 2023; 11:2671. [PMID: 37830708 PMCID: PMC10572744 DOI: 10.3390/healthcare11192671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
Youth athletes are often prescribed opioids after sustaining sport-related injuries, and because of their age, warrior-like culture in sport, and the desire to perform at the highest level, they are at risk for opioid misuse. Due to the nature of sport, youth athletes are at a greater risk to misuse opioids, and although it does not always predict misuse in adults, it is almost always a precursor among those addicted to opioids in adulthood. This crisis has been classified by the National Center for Health Statistics at the Centers for Disease Control and Prevention as an epidemic, resulting in over a hundred deaths a day and has cost over a billion dollars. To better understand athletes' experiences and use of opioids, the current study uses in-depth, semi-structured interviews with 35 current athletes and highlights their lived experiences with opioid use. Qualitative, line-by-line coding revealed three main themes: the protective role of parents, the teaching potential of athletes' own pain, and the easy access to over-the-counter medication and supplements that allow athletes to address their pain or enhance their performance. The results highlight that youth athletes may not misuse opioids to the extent previously predicted by past research and provide insight into the opioid epidemic from a youth sporting perspective.
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Affiliation(s)
- Rikishi T. Rey
- Department of Communication, Clemson University, Clemson, SC 29634, USA
| | - Anne E. Pezalla
- Department of Psychology, Macalester College, St Paul, MN 55105, USA;
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Bryde R, Martinez MW, Emery MS. Exercise recommendations for patients with hypertrophic cardiomyopathy. Prog Cardiovasc Dis 2023; 80:53-59. [PMID: 37201741 DOI: 10.1016/j.pcad.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 05/20/2023]
Abstract
Individuals with hypertrophic cardiomyopathy (HCM) have historically been advised to limit exercise and sports participation to mild-intensity activities due to concerns for sudden cardiac arrest (SCA). However, more contemporary data have shown SCA is rare in patients with HCM and emerging data is shifting towards support for the safety of exercise in this patient population. Recent guidelines endorse exercise in patients with HCM after a comprehensive evaluation and shared-decision making with an expert provider.
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Affiliation(s)
- Robyn Bryde
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL, USA
| | - Matthew W Martinez
- Department of Cardiovascular Medicine, Atlantic Health, Morristown Medical Center, Morristown, NJ, USA; Sports Cardiology and Hypertrophic Cardiomyopathy, Morristown Medical Center, Morristown, NJ, USA
| | - Michael S Emery
- Sports Cardiology Center, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
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Riding NR, Dorobantu DM, Williams CA, Stuart G, Fritsch P, Wilson MG, Mossialos E, Pieles G. Protecting the stars of tomorrow: do international cardiovascular preparticipation screening policies account for the paediatric athlete? A systematic review and quality appraisal. Br J Sports Med 2023; 57:371-380. [PMID: 36332982 DOI: 10.1136/bjsports-2022-105659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE (1) Identify and review current policies for the cardiovascular screening of athletes to assess their applicability to the paediatric population and (2) evaluate the quality of these policy documents using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. DESIGN Systematic review and quality appraisal of policy documents. DATA SOURCES A systematic search of PubMed, MEDLINE, Scopus, Web of Science, SportDiscus and CINAHL. ELIGIBILITY CRITERIA FOR SELECTING STUDIES An article was included if it was a policy/position statement/guideline/consensus or recommendation paper relating to athletes and cardiovascular preparticipation screening. RESULTS AND SUMMARY Of the 1630 articles screened, 13 met the inclusion criteria. Relevance to paediatric athletes was found to be high in 3 (23%), moderate in 6 (46%) and low in 4 (31%), and only 2 provide tailored guidance for the athlete aged 12-18 years. A median 5 related citations per policy investigated solely paediatric athletes, with study designs most commonly being retrospective (72%). AGREEII overall quality scores ranged from 25% to 92%, with a median of 75%. The lowest scoring domains were rigour of development; (median 32%) stakeholder involvement (median 47%) and Applicability (median 52%). CONCLUSION Cardiac screening policies for athletes predominantly focus on adults, with few providing specific recommendations for paediatric athletes. The overall quality of the policies was moderate, with more recent documents scoring higher. Future research is needed in paediatric athletes to inform and develop cardiac screening guidelines, to improve the cardiac care of youth athletes.
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Affiliation(s)
- Nathan R Riding
- Bristol Medical School, University of Bristol, Bristol, UK.,Institute of Sport and Exercise Health (ISEH), University College London, London, UK
| | - Dan-Mihai Dorobantu
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, UK.,Population Health Sciences, University of Bristol, Bristol, UK.,Congenital Heart Unit, Bristol Royal Hospital for Children and Heart Institute, Bristol, UK
| | - Craig A Williams
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, UK
| | - Graham Stuart
- Congenital Heart Unit, Bristol Royal Hospital for Children and Heart Institute, Bristol, UK.,National Institute for Health Research Cardiovascular Biomedical Research Centre, Bristol Heart Institute, Bristol, UK
| | | | - Mathew G Wilson
- Institute of Sport and Exercise Health (ISEH), University College London, London, UK.,Athlete Health and Performance Research Centre and the Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Elias Mossialos
- Department of Health Policy, London School of Economics, London, UK
| | - Guido Pieles
- Institute of Sport and Exercise Health (ISEH), University College London, London, UK .,Athlete Health and Performance Research Centre and the Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Altman J, Rambarat CA, Hamburger R, Dasa O, Dimza M, Kelling M, Clugston JR, Handberg EM, Pepine CJ, Edenfield KM. Relationship between arm span to height ratio, aortic root diameter, and systolic blood pressure in collegiate athletes. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 25:100242. [PMID: 38510494 PMCID: PMC10946030 DOI: 10.1016/j.ahjo.2022.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/12/2022] [Indexed: 03/22/2024]
Abstract
Study objective Sudden cardiac death is the most common cause of non-traumatic death in collegiate athletes. Marfan syndrome poses a risk for sudden cardiac death secondary to aortic root dilation leading to aortic dissection or rupture. Arm span to height ratio (ASHR) > 1.05 has been proposed as a screening tool for Marfan syndrome in pre-participation examinations (PPE) for collegiate athletes but limited data exists on the association between ASHR and aortic root diameter (ARD). This study examines the relationship between ASHR and ARD and assesses for predictors of ARD. Design Retrospective chart review. Setting National Collegiate Athletic Association Division I University. Participants 793 athletes across thirteen sports between 2012 and 2022 evaluated with PPE and screening echocardiogram. Interventions Not applicable. Main outcome measures (1) Relationships between ASHR, SBP, BSA, and ARD amongst all athletes as well as stratified by ASHR >1.05 or ≤1.05 using univariate analysis. (2) Predictors of ARD using multivariate analysis using linear regression. Results 143 athletes (18 %) had ASHRs > 1.05. Athletes with ASHR > 1.05 had higher ARD (2.99 cm) than athletes with ASHR ≤ 1.05 (2.85 cm). Weak correlations were noted between ASHR, ARD, and SBP. Multivariate analysis showed that BSA, male sex, and participation in swimming were predictors of ARD. ASHR was not predictive of ARD in regression analysis. Conclusions These findings showed a tendency towards higher ARD in athletes with ASHR >1.05 but this observation was not statistically significant in multivariate analysis.
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Affiliation(s)
- Joshua Altman
- University of Florida College of Medicine, Department of Emergency Medicine, Department of Orthopaedic Surgery and Sports Medicine, Gainesville, FL, United States of America
| | - Cecil A. Rambarat
- University of Florida College of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Gainesville, FL, United States of America
| | - Robert Hamburger
- University of Florida College of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Gainesville, FL, United States of America
| | - Osama Dasa
- University of Florida, College of Public Health and Health Professions, Gainesville, FL, United States of America
| | - Michelle Dimza
- University of Florida College of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Gainesville, FL, United States of America
| | - Matthew Kelling
- University of Florida College of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Gainesville, FL, United States of America
| | - James R. Clugston
- University of Florida College of Medicine, Department of Community Health and Family Medicine, Gainesville, FL, United States of America
| | - Eileen M. Handberg
- University of Florida College of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Gainesville, FL, United States of America
| | - Carl J. Pepine
- University of Florida College of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Gainesville, FL, United States of America
| | - Katherine M. Edenfield
- University of Florida College of Medicine, Department of Community Health and Family Medicine, Gainesville, FL, United States of America
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Iso Y, Kitai H, Ichimori K, Kubota M, Tsujiuchi M, Nagumo S, Toshida T, Yonechi T, Ebato M, Suzuki H. Cardiac Structure and Cardiorespiratory Fitness in Young Male Japanese Rugby Athletes. J Cardiovasc Dev Dis 2023; 10:jcdd10010012. [PMID: 36661907 PMCID: PMC9861008 DOI: 10.3390/jcdd10010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/21/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
Limited data are available on athlete's heart for rugby athletes. This study aimed to investigate cardiac structure and its relationship with cardiorespiratory fitness in young Japanese rugby athletes. A prospective cross-sectional study using echocardiography and cardiopulmonary exercise testing (CPET) was conducted on 114 male collegiate rugby players. There was a higher prevalence of increased left ventricular (LV), atrial, and aortic dimensions in the young athletes than that in previously published reports, whereas the wall thickness was within the normal range. Anthropometry and CPET analyses indicated that the forwards and backs presented muscular and endurance phenotypes, respectively. Indexed LV and aortic dimensions were significantly larger in the backs than in the forwards, and the dimensions significantly correlated with oxygen uptake measured by CPET. On the four-tiered classification for LV hypertrophy, abnormal LV geometry was found in 16% of the athletes. Notably, the resting systolic blood pressure was significantly higher in athletes with concentric abnormal geometry than in the other geometry groups, regardless of their field positions. Japanese young athletes may exhibit unique phenotypes of cardiac remodeling in association with their fitness characteristics. The four-tiered LV geometry classification potentially offers information regarding the subclinical cardiovascular risks of young athletes.
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Affiliation(s)
- Yoshitaka Iso
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan
- Division of Cardiology, Showa University Fujigaoka Rehabilitation Hospital, Yokohama 227-8518, Japan
- Correspondence: ; Tel.: +81-45-971-1151
| | - Hitomi Kitai
- Department of Clinical Pathology and Laboratory, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan
- Department of Physical Therapy, Showa University School of Nursing and Rehabilitation Sciences, Yokohama 226-8555, Japan
| | - Keiko Ichimori
- Department of Clinical Pathology and Laboratory, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan
| | - Megumi Kubota
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan
- Division of Cardiology, Showa University Fujigaoka Rehabilitation Hospital, Yokohama 227-8518, Japan
| | - Miki Tsujiuchi
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan
- Division of Cardiology, Showa University Fujigaoka Rehabilitation Hospital, Yokohama 227-8518, Japan
| | - Sakura Nagumo
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan
- Division of Cardiology, Showa University Fujigaoka Rehabilitation Hospital, Yokohama 227-8518, Japan
| | - Tsutomu Toshida
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan
| | - Toru Yonechi
- Faculty of Sport Science, Nippon Sport Science University, Yokohama 227-0033, Japan
| | - Mio Ebato
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan
| | - Hiroshi Suzuki
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama 227-8501, Japan
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Abstract
Individuals with HCM have historically been held from participation in sports beyond mild-intensity exercise. Exercise improves functional capacity and indices of cardiac function even in those with HCM. Emerging data have demonstrated the safety of exercise in individuals with HCM. Improvement in risk stratification and a shared decision-making approach has led to a guideline endorsement for HCM providers to develop an informed plan for exercise and competitive athletics among the HCM population.
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Affiliation(s)
- Matthew W Martinez
- Department of Cardiovascular Medicine, Atlantic Health, Morristown Medical Center, Morristown, NJ 07960, USA; Sports Cardiology and Hypertrophic Cardiomyopathy.
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Dean PN, Pugh K, Statuta SM, MacKnight JM. The Importance of Surrounding the Athlete's Heart with a Team. Clin Sports Med 2022; 41:357-368. [PMID: 35710266 DOI: 10.1016/j.csm.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Providing medical care for an athlete can be challenging in many aspects. One specific aspect is the athlete's cardiovascular system. Athletic training and physical activity certainly can improve cardiovascular health, but it can also cause cardiac adaptations and place athletes at risk for sudden cardiac arrest. When an athlete has cardiac symptoms, a concerning family history, abnormal cardiac testing, or an underlying cardiac condition, a wide range of professionals are needed to appropriately care for the athlete under evaluation.
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Affiliation(s)
- Peter N Dean
- Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia School of Medicine, UVA Children's Hospital Battle Building, 1204 West Main Street, Charlottesville, VA 22903, USA.
| | - Kelli Pugh
- University of Virginia, McCue Center, Room 112, 290 Massie Road, Charlottesville, VA 22904, USA
| | - Siobhan M Statuta
- Department of Family Medicine and Physical Medicine and Rehabilitation, University of Virginia School of Medicine, PO Box 800729, 1415 Jefferson Park Avenue- McKim Hall 3152, Charlottesville, VA 22908, USA
| | - John M MacKnight
- Internal Medicine & Orthopaedic Surgery, University of Virginia School of Medicine, University Physicians Clinic, UVA Health System, Box 800671, Charlottesville, VA 22908, USA
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Evaluation of a Preparticipation Cardiovascular Screening Program Among 1,686 National Collegiate Athletic Association Division I Athletes: Comparison of the Seattle, Refined, and International Electrocardiogram Screening Criteria. Clin J Sport Med 2022; 32:306-312. [PMID: 32487874 DOI: 10.1097/jsm.0000000000000858] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 04/06/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To: (1) analyze the results of 5 years of preparticipation cardiac screening including 12-lead electrocardiogram (ECG) of National Collegiate Athletic Association (NCAA) Division I athletes; and (2) assess the rates of ECG screening abnormalities and false-positive rates among 3 ECG screening criteria. DESIGN Retrospective chart review. SETTING National Collegiate Athletic Association Division I University. PARTICIPANTS One thousand six hundred eighty-six first-year athletes presenting for their preparticipation examination including 12-lead resting ECG. INTERVENTIONS At the completion of the study period, all ECGs were retrospectively reviewed using the Seattle, Refined, and International Criteria. MAIN OUTCOME MEASURES (1) Prevalence of pathologic cardiac conditions identified by screening; and (2) number of ECG screening abnormalities by criteria. RESULTS Three athletes (0.2%) were found to have conditions that are associated with sudden cardiac death. Retrospective review of ECGs using Seattle, Refined, and International criteria revealed an abnormal ECG rate of 3.0%, 2.1%, and 1.8%, respectively. International criteria [odds ratios (OR), 0.58; P = 0.02] demonstrated a lower false-positive rate compared with the Seattle criteria. There was no significant difference in false-positive rates between the Seattle and Refined (OR, 0.68; P = 0.09) or the International and Refined criteria (OR, 0.85; P = 0.5). CONCLUSIONS There was a low rate of significant cardiac pathology in this population, and no athletes were permanently restricted from play as a result of screening. Our results suggest that the International criteria have the lowest false-positive rate of athlete-specific ECG criteria, and thus, it is the preferred method for preparticipation ECG screening in NCAA athletes.
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A Deep Learning and Clustering Extraction Mechanism for Recognizing the Actions of Athletes in Sports. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:2663834. [PMID: 35371202 PMCID: PMC8970900 DOI: 10.1155/2022/2663834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/11/2022] [Accepted: 03/01/2022] [Indexed: 12/24/2022]
Abstract
In sports, the essence of a complete technical action is a complete information structure pattern and the athlete's judgment of the action is actually the identification of the movement information structure pattern. Action recognition refers to the ability of the human brain to distinguish a perceived action from other actions and obtain predictive response information when it identifies and confirms it according to the constantly changing motion information on the field. Action recognition mainly includes two aspects: one is to obtain the required action information based on visual observation and the other is to judge the action based on the obtained action information, but the neuropsychological mechanism of this process is still unknown. In this paper, a new key frame extraction method based on the clustering algorithm and multifeature fusion is proposed for sports videos with complex content, many scenes, and rich actions. First, a variety of features are fused, and then, similarity measurement can be used to describe videos with complex content more completely and comprehensively; second, a clustering algorithm is used to cluster sports video sequences according to scenes, eliminating the need for shots in the case of many scenes. It is difficult and complicated to detect segmentation; third, extracting key frames according to the minimum motion standard can more accurately represent the video content with rich actions. At the same time, the clustering algorithm used in this paper is improved to enhance the offline computing efficiency of the key frame extraction system. Based on the analysis of the advantages and disadvantages of the classical convolutional neural network and recurrent neural network algorithms in deep learning, this paper proposes an improved convolutional network and optimization based on the recognition and analysis of human actions under complex scenes, complex actions, and fast motion compared to post-neural network and hybrid neural network algorithm. Experiments show that the algorithm achieves similar human observation of athletes' training execution and completion. Compared with other algorithms, it has been verified that it has very high learning rate and accuracy for the athlete's action recognition.
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14
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Ebadi AA. Student athlete ECGs: Case examples of normal and abnormal sport physical ECGs and when you should refer your patient for cardiology evaluation. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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15
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Prevalence of Elevated Blood Pressure and Risk Factors for Hypertension in College Athletes. Clin J Sport Med 2022; 32:e74-e82. [PMID: 34184859 DOI: 10.1097/jsm.0000000000000876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/23/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the prevalence and risk factors for hypertension (HTN) in college athletes using the new (≥130/80 mm Hg) versus prior (≥140/90 mm Hg) US hypertension guidelines. DESIGN Retrospective cohort study. SETTING Eleven Pacific-12 Conference institutions. PARTICIPANTS Of the 8602 athletes enrolled in the primary study, 4977 (57.9%) met inclusion criteria. Athletes were included in the study if age <30 and blood pressure (BP), baseline demographics (age, weight, height, sex, and race), and primary sport were available. INDEPENDENT VARIABLES Age, sex, race, height, weight, body mass index, and primary sport. MAIN OUTCOME MEASURES Elevated BP of ≥130/80 mm Hg and/or ≥140/90 mm Hg. RESULTS Normal BP (<130/80) was present in 3214 (64.6%) athletes and 1763 (35.4%) had BP ≥ 130/80, including 460 (9.2%) with BP ≥ 140/90. Male athletes had a higher prevalence of BP ≥ 130/80 (46.7% vs 21.5%; P < 0.001) and BP ≥ 140/90 (14.2% vs 3.1%; P < 0.001) compared to female athletes. Independent risk factors from multivariate analyses for BP ≥ 130/80 included: older age (odds ratio [OR] = 1.05, 95% confidence interval [CI] 1.00-1.11, P = 0.04), male sex (OR = 1.97, 95% CI 1.65-2.35, P < 0.001), heavier weight (OR = 1.03, 95% CI 1.02-1.03, P < 0.001), and baseball as the primary sport (OR = 1.47, 95% CI 1.14-1.90, P < 0.01). Independent risk factors for BP ≥ 140/90 mm Hg included: male sex (OR = 3.54, 95% CI 2.55-4.97, P < 0.001) and heavier weight (OR = 1.03, 95% CI 1.02-1.04, P < 0.001). CONCLUSIONS In a large, diverse cohort of matriculating college athletes from multiple institutions, over one-third presented with elevated BP ≥ 130/80 mm Hg, which was more common in older male athletes with larger body size and baseball players.
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Grubic N, Hill B, Phelan D, Baggish A, Dorian P, Johri AM. Bystander interventions and survival after exercise-related sudden cardiac arrest: a systematic review. Br J Sports Med 2021; 56:410-416. [PMID: 34853034 DOI: 10.1136/bjsports-2021-104623] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the provision of bystander interventions and rates of survival after exercise-related sudden cardiac arrest (SCA). DESIGN Systematic review. DATA SOURCES MEDLINE, EMBASE, PubMed, CINAHL, SPORTDiscus, Cochrane Library and grey literature sources were searched from inception to November/December 2020. STUDY ELIGIBILITY CRITERIA Observational studies assessing a population of exercise-related SCA (out-of-hospital cardiac arrests that occurred during exercise or within 1 hour of cessation of activity), where bystander cardiopulmonary resuscitation (CPR) and/or automated external defibrillator (AED) use were reported, and survival outcomes were ascertained. METHODS Among all included studies, the median (IQR) proportions of bystander CPR and bystander AED use, as well as median (IQR) rate of survival to hospital discharge, were calculated. RESULTS A total of 29 studies were included in this review, with a median study duration of 78.7 months and a median sample size of 91. Most exercise-related SCA patients were male (median: 92%, IQR: 86%-96%), middle-aged (median: 51, IQR: 39-56 years), and presented with a shockable arrest rhythm (median: 78%, IQR: 62%-86%). Bystander CPR was initiated in a median of 71% (IQR: 59%-87%) of arrests, whereas bystander AED use occurred in a median of 31% (IQR: 19%-42%) of arrests. Among the 19 studies that reported survival to hospital discharge, the median rate of survival was 32% (IQR: 24%-49%). Studies which evaluated the relationship between bystander interventions and survival outcomes reported that both bystander CPR and AED use were associated with survival after exercise-related SCA. CONCLUSION Exercise-related SCA occurs predominantly in males and presents with a shockable ventricular arrhythmia in most cases, emphasising the importance of rapid access to defibrillation. Further efforts are needed to promote early recognition and a rapid bystander response to exercise-related SCA.
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Affiliation(s)
- Nicholas Grubic
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada .,Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Braeden Hill
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Dermot Phelan
- Sports Cardiology Center, Atrium Health Sanger Heart and Vascular Institute, Charlotte, North Carolina, USA
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paul Dorian
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Amer M Johri
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
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17
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Armstrong TA, Neil ER, Pennington AM, Mair KEF, Eberman LE. Athletic Trainers' Perceptions of Accessibility to Necessary Resources for Those Working Per Diem Services. J Athl Train 2021; 56:112-122. [PMID: 33259595 DOI: 10.4085/1062-6050-0095.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT As the demand for athletic training services has grown, the per diem athletic training setting has expanded to fulfill this need. Per diem services are provided by athletic trainers (ATs) who are hired as independent contractors for short time periods. These service opportunities help to increase access to care for medically underserved populations; however, due to the transient nature of the work, the quality of care may be compromised. OBJECTIVE To examine current practices in per diem services and evaluate ATs' accessibility to resources. DESIGN Cross-sectional study. SETTING Online survey. PATIENTS OR OTHER PARTICIPANTS A total of 448 participants responded (access rate = 9.57%), of whom 210 were ineligible (46.9%). Of those who were eligible, 192 participants completed the entire tool (completion rate = 80.7%, age = 38 ± 12 years, years certified = 14 ± 11, years providing per diem services = 8 ± 8). MAIN OUTCOME MEASURE(S) The survey comprised 3 sections: (1) demographics, (2) accessibility to resources and influence on patient care, and (3) domains of athletic training while providing per diem services. Resources assessed included those that are relevant to ATs practicing in accordance with the Board of Certification "Standards of Professional Practice." The final instrument included approximately 30 questions (depending on display logic) and took an average of 12 minutes to complete. RESULTS Of the 11 primary resources assessed, participants had limited accessibility to 6. Critical resources related to informatics, legalities, and health care delivery were often not available, were seen as unimportant to providing medical services, or both. CONCLUSIONS Participants indicated varied perceptions about the need for and access to these resources. Yet such resources contribute to the creation of a safe infrastructure for providing medical services and should be part of the routine dialogue regarding independent contracting.
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Abstract
ABSTRACT Introduction: The study and collection of athletes’ heart function index parameters and the correct and reasonable evaluation of body functions can effectively adjust training plans and avoid athletes’ bodily exhaustion. Objective: To study the diagnosis of myocardial injury by cardiovascular monitoring in athletes from two aspects: extraction of characteristic parameters of heart function and research of signal processing. Methods: The heart function intelligent evaluation algorithm was studied by using multi-source information fusion, and embedded technology; miniature sensors were used as well. Results: The incidence of severe ventricular arrhythmia was lower in both groups. The incidence of sinus arrhythmia and intermittent second degree I atrioventricular block in the high-intensity group was significantly higher than that in the control group. The number of atrial and ventricular premature beats was lower in the control group, but increased significantly in the high-intensity group. Conclusions: This study applied the theory of multi-source information fusion to carry out representative research on the intelligent monitoring and evaluation of the heart function of elite athletes, centering on the application requirements of the heart function monitoring of elite athletes. Level of evidence II; Therapeutic studies - investigation of treatment results.
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Affiliation(s)
| | - Chang Sun
- Qiqihar Institute of Engineering, China
| | - Jie Bai
- Qiqihar Medical University, China
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19
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Guía ESC 2020 sobre cardiología del deporte y el ejercicio en pacientes con enfermedad cardiovascular. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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20
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Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, Collet JP, Corrado D, Drezner JA, Halle M, Hansen D, Heidbuchel H, Myers J, Niebauer J, Papadakis M, Piepoli MF, Prescott E, Roos-Hesselink JW, Graham Stuart A, Taylor RS, Thompson PD, Tiberi M, Vanhees L, Wilhelm M. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J 2021; 42:17-96. [PMID: 32860412 DOI: 10.1093/eurheartj/ehaa605] [Citation(s) in RCA: 728] [Impact Index Per Article: 242.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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21
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Braillon A. Electrocardiographic screening in athletes: Another French exception? Presse Med 2021; 50:104054. [PMID: 33711723 DOI: 10.1016/j.lpm.2020.104054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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22
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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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23
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Austin AV, Owens DS, Prutkin JM, Salerno JC, Ko B, Pelto HF, Rao AL, Siebert DM, Carrol JS, Harmon KG, Drezner JA. Do 'pathologic' cardiac murmurs in adolescents identify structural heart disease? An evaluation of 15 141 active adolescents for conditions that put them at risk of sudden cardiac death. Br J Sports Med 2021; 56:88-94. [PMID: 33451997 DOI: 10.1136/bjsports-2019-101718] [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] [Accepted: 12/16/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed whether the presence and character of a cardiac murmur in adolescents were associated with structural heart disease that confers risk of sudden cardiac death (SCD). METHODS We performed a retrospective analysis of 15 141 adolescents age 12-19 who underwent a heart screen with history, physical examination and ECG. Participants with any screening abnormality underwent an echocardiogram for the assessment of structural heart disease. Murmurs were classified as physiological or pathological according to standard clinical criteria, and participants with murmurs were compared with a comparison group without murmurs. The primary outcome was echocardiogram-detected structural heart disease associated with SCD. RESULTS 905 participants with a cardiac murmur (mean age 15.8; 58% male) and 4333 participants without a murmur (comparison group; mean age 15.8; 55% male) had an echocardiogram to detect structural heart disease. 743 (82%) murmurs were described as physiological and 162 (18%) as pathological. Twenty-five (2.8%) participants with murmurs and 61 (1.4%) participants without murmurs had structural heart disease. Three (0.3%) participants in the murmur group were diagnosed with hypertrophic cardiomyopathy (HCM) which was the only identified condition associated with SCD. Two participants with HCM had physiological murmurs, one had a pathological murmur, and all three had an abnormal ECG. The most common minor structural heart disease was bicuspid aortic valve in both the murmur (7; 0.8%) and comparison (20; 0.5%) groups. The positive predictive value of physiological versus pathological murmurs for identifying any structural heart disease was 2.4% versus 4.3% (p=0.21), respectively. The positive predictive value of having any murmur versus no murmur for identifying structural heart disease was 2.8% versus 1.4% (p=0.003), respectively. CONCLUSIONS In adolescents, the traditional classification of cardiac murmurs as 'physiologic' or 'pathologic' does not differentiate for structural heart disease that puts individuals at risk for SCD. We recommend ECG evaluation in all patients with a cardiac murmur found during preparticipation screening to increase detection of HCM.
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Affiliation(s)
- Ashley V Austin
- Department of Family Medicine, Sports Medicine Section, University of Washington, Seattle, Washington, USA
| | - David S Owens
- Department of Internal Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Jordan M Prutkin
- Department of Internal Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Jack C Salerno
- Division of Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Brian Ko
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Hank F Pelto
- Department of Family Medicine, Sports Medicine Section, University of Washington, Seattle, Washington, USA
| | - Ashwin L Rao
- Department of Family Medicine, Sports Medicine Section, University of Washington, Seattle, Washington, USA
| | - David M Siebert
- Department of Family Medicine, Sports Medicine Section, University of Washington, Seattle, Washington, USA
| | - Jennifer S Carrol
- Department of Family Medicine, Sports Medicine Section, University of Washington, Seattle, Washington, USA
| | - Kimberly G Harmon
- Department of Family Medicine, Sports Medicine Section, University of Washington, Seattle, Washington, USA
| | - Jonathan A Drezner
- Department of Family Medicine, Sports Medicine Section, University of Washington, Seattle, Washington, USA
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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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25
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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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26
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Etiology of Sudden Cardiac Arrest and Death in US Competitive Athletes: A 2-Year Prospective Surveillance Study. Clin J Sport Med 2020; 30:305-314. [PMID: 32639440 DOI: 10.1097/jsm.0000000000000598] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the etiology of sudden cardiac arrest and death (SCA/D) in competitive athletes through a prospective national surveillance program. DESIGN Sudden cardiac arrest and death cases in middle school, high school, college, and professional athletes were identified from July 2014 to June 2016 through traditional and social media searches, reporting to the National Center for Catastrophic Sports Injury Research, communication with state and national high school associations, review of the Parent Heart Watch database, and search of student-athlete deaths on the NCAA Resolutions List. Autopsy reports and medical records were reviewed by a multidisciplinary panel to determine the underlying cause. SETTING AND PARTICIPANTS US competitive athletes with SCA/D. MAIN OUTCOME MEASURES Etiology of SCA/D. RESULTS A total of 179 cases of SCA/D were identified (74 arrests with survival, 105 deaths): average age 16.6 years (range 11-29), 149 (83.2%) men, 94 (52.5%) whites, and 54 (30.2%) African American. One hundred seventeen (65.4%) had an adjudicated diagnosis, including 83 deaths and 34 survivors. The most common etiologies included hypertrophic cardiomyopathy (19, 16.2%), coronary artery anomalies (16, 13.7%), idiopathic left ventricular hypertrophy/possible cardiomyopathy (13, 11.1%), autopsy-negative sudden unexplained death (8, 6.8%), Wolff-Parkinson-White (8, 6.8%), and long QT syndrome (7, 6.0%). Hypertrophic cardiomyopathy was more common in male basketball (23.3%), football (25%), and African American athletes (30.3%). An estimated 56.4% of cases would likely demonstrate abnormalities on an electrocardiogram. CONCLUSIONS The etiology of SCA/D in competitive athletes involves a wide range of clinical disorders. More robust reporting mechanisms, standardized autopsy protocols, and accurate etiology data are needed to better inform prevention strategies.
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Preparticipation Cardiovascular Screening: An Infrastructure Assessment in Collegiate Athletics. Clin J Sport Med 2020; 30:315-320. [PMID: 29952837 DOI: 10.1097/jsm.0000000000000616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the available infrastructure for secondary testing after preparticipation cardiovascular screening of collegiate athletes. DESIGN Cross-sectional study. SETTING National Collegiate Athletic Association (NCAA) athletic programs PARTICIPANTS:: Team physicians. INTERVENTIONS Online survey distributed by the NCAA and American Medical Society for Sports Medicine. MAIN OUTCOME MEASURES Availability of secondary cardiovascular diagnostic testing and services. RESULTS Team physicians from 235 schools completed the assessment, representing 21% of all NCAA schools. Ninety (38.3%) NCAA team physicians reported screening athletes using electrocardiogram (ECG). Division I schools were more likely than Division II and III schools to perform both screening ECG (RR, 2.38, P < 0.0001) and echocardiogram (RR, 2.83, P = 0.01). More than 97% of schools had access to resting echocardiogram, stress ECG/echocardiogram, and Holter monitoring within 25 miles with no significant variability between divisions, regions, or size of undergraduate student body. Cardiac magnetic resonance imaging and electrophysiology studies were available within 25 miles of more than 80% of schools, and genetics testing was available within 25 miles for 64.8%. CONCLUSIONS Secondary testing for cardiovascular abnormalities seems to be readily available for NCAA athletes, regardless of division, region, or school size.
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Design and Implementation of an Emergency Action Plan for Sudden Cardiac Arrest in Sport. J Cardiovasc Transl Res 2020; 13:331-338. [PMID: 32300931 DOI: 10.1007/s12265-020-09988-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/11/2020] [Indexed: 12/15/2022]
Abstract
Sudden cardiac arrest (SCA) is the leading cause of exercise-related fatalities in athletes. A comprehensive emergency action plan (EAP) is critical to facilitate a rapid and effective response to a cardiac emergency. SCA should be suspected in any athlete that collapses suddenly and is unresponsive. All potential responders to a collapsed athlete should be trained in the recognition of SCA, cardiopulmonary resuscitation, and use of an automated external defibrillator (AED). AEDs should be accessible on-site at sporting venues with a target collapse to first shock interval of less than 3 min. Every school, club, and sporting organization that sponsors athletic activities should have a written EAP for SCA. An EAP coordinator should be designated to foster compliance with training, practice, and rehearsal of the EAP at least once annually. Some sports require special considerations for equipment removal or access to emergency services in geographically broad or water-based venues.
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DeFroda SF, McDonald C, Myers C, Cruz AI, Owens BD, Daniels AH. Sudden Cardiac Death in the Adolescent Athlete: History, Diagnosis, and Prevention. Am J Med 2019; 132:1374-1380. [PMID: 31199891 DOI: 10.1016/j.amjmed.2019.05.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 05/10/2019] [Accepted: 05/12/2019] [Indexed: 12/18/2022]
Abstract
Sudden cardiac death in young athletes is a devastating condition that occurs without warning. While most middle and high school athletes require preparticipation screening, many predisposing conditions go undiagnosed until they occur. The frequency of sudden cardiac death is often under-reported because there is no mandatory system for reporting sports-related death in high school sports. Additionally, there is debate about the cost-effectiveness of more advanced screening tests, such as electrocardiogram, due to high false-positive rates. It is, however, accepted that participants with a family history of sudden cardiac death should undergo more in-depth screening. If sudden cardiac arrest occurs, it is important for the patient to undergo immediate defibrillation. Community outreach to ensure that automated external defibrillators are present at athletic events, as well as cardiopulmonary resuscitation training for coaches, could potentially save lives. Ultimately, prevention of sudden cardiac death depends on physician awareness of how to properly screen and identify those at risk, and how to best be prepared if sudden cardiac arrest occurs.
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Affiliation(s)
- Steven F DeFroda
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Bown University, Providence, RI.
| | - Christopher McDonald
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Bown University, Providence, RI
| | - Christopher Myers
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Bown University, Providence, RI
| | - Aristides I Cruz
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Bown University, Providence, RI
| | - Brett D Owens
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Bown University, Providence, RI
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Bown University, Providence, RI
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30
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Emery MS, Kovacs RJ. Sudden Cardiac Death in Athletes. JACC-HEART FAILURE 2019; 6:30-40. [PMID: 29284578 DOI: 10.1016/j.jchf.2017.07.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 12/24/2022]
Abstract
Sudden cardiac death is a tragedy at any age and under any circumstances but is perhaps most tragic when it claims the life of the athlete, the individual who epitomizes health and a healthy lifestyle. Sports cardiologists from around the world have worked to quantitate the incidence of sudden cardiac death (SCD) in the athlete, to identify risk factors, to develop pre-participation screening tools, and to formulate plans to deal with on-field SCD. Progress has been made, but much remains to be done in order to make both competitive and recreational sports safer for both patients with known cardiac disease and athletes without known or suspected cardiac abnormalities.
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Affiliation(s)
- Michael S Emery
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana; Center for Cardiovascular Care in Athletics, Indiana University Health, Indianapolis, Indiana
| | - Richard J Kovacs
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana; Center for Cardiovascular Care in Athletics, Indiana University Health, Indianapolis, Indiana.
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Parsons JT, Anderson SA, Casa DJ, Hainline B. Preventing Catastrophic Injury and Death in Collegiate Athletes: Interassociation Recommendations Endorsed by 13 Medical and Sports Medicine Organisations. J Athl Train 2019; 54:843-851. [PMID: 31536387 DOI: 10.4085/1062-6050-54.085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Second Safety in College Football Summit resulted in interassociation consensus recommendations for three paramount safety issues in collegiate athletics: (1) independent medical care for collegiate athletes; (2) diagnosis and management of sport-related concussion; and (3) year-round football practice contact for collegiate athletes. This document, the fourth arising from the 2016 event, addresses the prevention of catastrophic injury, including traumatic and non-traumatic death, in collegiate athletes. The final recommendations in this document are the result of presentations and discussions on key items that occurred at the summit. After those presentations and discussions, endorsing organisation representatives agreed on 18 foundational statements that became the basis for this consensus paper that has been subsequently reviewed by relevant stakeholders and endorsing organisations. This is the final endorsed document for preventing catastrophic injury and death in collegiate athletes. This document is divided into the following components. (1) Background-this section provides an overview of catastrophic injury and death in collegiate athletes. (2) Interassociation recommendations: preventing catastrophic injury and death in collegiate athletes-this section provides the final recommendations of the medical organisations for preventing catastrophic injuries in collegiate athletes. (3) Interassociation recommendations: checklist-this section provides a checklist for each member school. The checklist statements stem from foundational statements voted on by representatives of medical organisations during the summit, and they serve as the primary vehicle for each member school to implement the prevention recommendations. (4) References-this section provides the relevant references for this document. (5) Appendices-this section lists the foundational statements, agenda, summit attendees and medical organisations that endorsed this document.
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Affiliation(s)
- John T Parsons
- Sport Science Institute, National Collegiate Athletic Association, Indianapolis, IN
| | | | | | - Brian Hainline
- Sport Science Institute, National Collegiate Athletic Association, Indianapolis, IN
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Parsons JT, Anderson SA, Casa DJ, Hainline B. Preventing catastrophic injury and death in collegiate athletes: interassociation recommendations endorsed by 13 medical and sports medicine organisations. Br J Sports Med 2019; 54:208-215. [PMID: 31537549 DOI: 10.1136/bjsports-2019-101090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2019] [Indexed: 11/03/2022]
Abstract
The following organisations endorsed this document: American Association of Neurological Surgeons, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, American Osteopathic Academy of Sports Medicine, College Athletic Trainers' Society, Collegiate Strength and Conditioning Coaches Association, Congress of Neurological Surgeons, Korey Stringer Institute, National Athletic Trainers' Association, National Strength and Conditioning Association, National Operating Committee for Standards on Athletic Equipment, Sports Neuropsychology Society. The following organisation has affirmed the value of this document: American Academy of Neurology. The Second Safety in College Football Summit resulted in interassociation consensus recommendations for three paramount safety issues in collegiate athletics: (1) independent medical care for collegiate athletes; (2) diagnosis and management of sport-related concussion; and (3) year-round football practice contact for collegiate athletes. This document, the fourth arising from the 2016 event, addresses the prevention of catastrophic injury, including traumatic and non-traumatic death, in collegiate athletes. The final recommendations in this document are the result of presentations and discussions on key items that occurred at the summit. After those presentations and discussions, endorsing organisation representatives agreed on 18 foundational statements that became the basis for this consensus paper that has been subsequently reviewed by relevant stakeholders and endorsing organisations. This is the final endorsed document for preventing catastrophic injury and death in collegiate athletes. This document is divided into the following components. (1) Background-this section provides an overview of catastrophic injury and death in collegiate athletes. (2) Interassociation recommendations: preventing catastrophic injury and death in collegiate athletes-this section provides the final recommendations of the medical organisations for preventing catastrophic injuries in collegiate athletes. (3) Interassociation recommendations: checklist-this section provides a checklist for each member school. The checklist statements stem from foundational statements voted on by representatives of medical organisations during the summit, and they serve as the primary vehicle for each member school to implement the prevention recommendations. (4) References-this section provides the relevant references for this document. (5) Appendices-this section lists the foundational statements, agenda, summit attendees and medical organisations that endorsed this document.
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Affiliation(s)
- John T Parsons
- Sport Science Institute, National Collegiate Athletic Association (NCAA), Indianapolis, Indiana, USA
| | | | - Douglas J Casa
- Kinesiology, University of Connecticut, Storrs, Connecticut, USA
| | - Brian Hainline
- Sport Science Institute, National Collegiate Athletic Association (NCAA), Indianapolis, Indiana, USA
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Williams EA, Pelto HF, Toresdahl BG, Prutkin JM, Owens DS, Salerno JC, Harmon KG, Drezner JA. Performance of the American Heart Association ( AHA ) 14-Point Evaluation Versus Electrocardiography for the Cardiovascular Screening of High School Athletes: A Prospective Study. J Am Heart Assoc 2019; 8:e012235. [PMID: 31286819 PMCID: PMC6662133 DOI: 10.1161/jaha.119.012235] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Preparticipation cardiovascular screening in athletes is fully endorsed by major medical societies, yet the most effective screening protocol remains debated. We prospectively compared the performance of the American Heart Association (AHA) 14‐point screening evaluation and a resting ECG for cardiovascular screening of high school athletes. Methods and Results Competitive athletes participating in organized high school or premier/select level sports underwent cardiovascular screening using the AHA 14‐point history and physical examination, and an ECG interpreted with the Seattle Criteria. A limited echocardiogram was performed for all screening abnormalities. The primary outcome measure was identification of a cardiovascular disorder associated with sudden cardiac death. From October 2014 to June 2017, 3620 high school athletes (median age, 16 years; range 13–19; 46.2% female; 78.6% white, 8.0% black) were screened. One or more positive responses to the AHA 14‐point questionnaire were present in 814 (22.5%) athletes. The most common history responses included chest pain (8.1%), family history of inheritable conditions (7.3%), and shortness of breath (6.4%). Abnormal physical examination was present in 356 (9.8%) athletes, and 103 (2.8%) athletes had an abnormal ECG. Sixteen (0.4%) athletes had conditions associated with sudden cardiac death. The sensitivity (18.8%), specificity (68.0%), and positive predictive value (0.3%) of the AHA 14‐point evaluation was substantially lower than the sensitivity (87.5%), specificity (97.5%), and positive predictive value (13.6%) of ECG. Conclusions The AHA 14‐point evaluation performs poorly compared with ECG for cardiovascular screening of high school athletes. The use of consensus‐derived history questionnaires as the primary tool for cardiovascular screening in athletes should be reevaluated. See Editorial Maron et al
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Affiliation(s)
- Elizabeth A Williams
- 1 Sports Medicine Section Department of Family Medicine University of Washington Seattle WA
| | - Hank F Pelto
- 1 Sports Medicine Section Department of Family Medicine University of Washington Seattle WA
| | - Brett G Toresdahl
- 2 Department of Sports Medicine Hospital of Special Surgery New York NY
| | - Jordan M Prutkin
- 3 Division of Cardiology Department of Medicine University of Washington Seattle WA
| | - David S Owens
- 3 Division of Cardiology Department of Medicine University of Washington Seattle WA
| | - Jack C Salerno
- 4 Division of Cardiology Department of Pediatrics University of Washington Seattle WA
| | - Kimberly G Harmon
- 1 Sports Medicine Section Department of Family Medicine University of Washington Seattle WA
| | - Jonathan A Drezner
- 1 Sports Medicine Section Department of Family Medicine University of Washington Seattle WA
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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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Reagan J, Moulson N, Velghe J, Cater C, Taylor T, Isserow S, McKinney J. Automated External Defibrillator and Emergency Action Plan Preparedness Amongst Canadian University Athletics. Can J Cardiol 2019; 35:92-95. [DOI: 10.1016/j.cjca.2018.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/17/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022] Open
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Johri AM, Poirier P, Dorian P, Fournier A, Goodman JM, McKinney J, Moulson N, Pipe A, Philippon F, Taylor T, Connelly K, Baggish AL, Krahn A, Sharma S. Canadian Cardiovascular Society/Canadian Heart Rhythm Society Joint Position Statement on the Cardiovascular Screening of Competitive Athletes. Can J Cardiol 2019; 35:1-11. [DOI: 10.1016/j.cjca.2018.10.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 12/15/2022] Open
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Drezner JA, Peterson DF, Siebert DM, Thomas LC, Lopez-Anderson M, Suchsland MZ, Harmon KG, Kucera KL. Survival After Exercise-Related Sudden Cardiac Arrest in Young Athletes: Can We Do Better? Sports Health 2018; 11:91-98. [PMID: 30204540 PMCID: PMC6299352 DOI: 10.1177/1941738118799084] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND: Sudden cardiac arrest (SCA) is the leading cause of death in young athletes during sports. HYPOTHESIS: Survival after SCA in young athletes is variable. STUDY DESIGN: Prospective, active surveillance study. LEVEL OF EVIDENCE: Level 3. METHODS: From July 1, 2014, to June 30, 2016, exercise-related SCA in competitive young athletes was identified through a systematic search of traditional and social media sources, direct reporting to the National Center for Catastrophic Sports Injury Research, searching of the National Collegiate Athletic Association Resolutions List, regular communication with national and state high school athletic associations, and review of cases in the Parent Heart Watch database. RESULTS: A total of 132 cases were identified during the 2-year study period (mean patient age, 16 years; age range, 11-27 years; 84% male; 51% white non-Hispanic/Latino, 30% black/African American, and 11% white Hispanic/Latino). High school athletes accounted for 78 (59%) cases, with 28 (21%) in middle school and 15 (11%) in college athletes. Overall survival was 48% (95% CI, 40%-57%; 64 survivors, 68 deaths). Survival was similar in male versus female athletes but higher in white non-Hispanic/Latino (40/67; 60%) versus black/African American (13/39; 33%) athletes (difference, 27%; 95% CI, 7%-45%; P = 0.008) and white non-Hispanic/Latino versus all minority (18/59; 31%) athletes (difference, 29%; 95% CI, 13%-46%; P = 0.001). Basketball accounted for 30% of cases, followed by football (25%), track/cross-country (12%), and soccer (11%). The majority (93%) of cases were witnessed. If a certified athletic trainer was on-site and involved in the resuscitation, 83% of athletes survived. If an on-site automated external defibrillator was used in the resuscitation, 89% of athletes survived. CONCLUSION: Exercise-related SCA in young, competitive athletes is typically witnessed, providing an opportunity for rapid resuscitation. Additional research is needed to identify factors that affect survival in different athlete populations. CLINICAL RELEVANCE: Public access defibrillator programs should be universal in schools and youth sporting venues and have the potential to increase survival after SCA in young athletes.
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Affiliation(s)
- Jonathan A. Drezner
- Jonathan A. Drezner, MD, Department of Family Medicine, Director, UW Medicine Center for Sports Cardiology, University of Washington, Box 354060, Seattle, WA 98195-4060 () (Twitter: @DreznerJon)
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Familial clustering of cardiac conditions in patients with anomalous aortic origin of a coronary artery and myocardial bridges. Cardiol Young 2018; 28:1099-1105. [PMID: 30001755 DOI: 10.1017/s1047951118000835] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Anomalous aortic origin of a coronary artery is the second leading cause of sudden cardiac arrest/death in young athletes in the United States of America. Limited data are available regarding family history in this patient population. METHODS Patients were evaluated prospectively from 12/2012 to 02/2017 in the Coronary Anomalies Program at Texas Children's Hospital. Relevant family history included the presence of CHD, sudden cardiac arrest/death, arrhythmia/pacemaker use, cardiomyopathy, and atherosclerotic coronary artery disease before the age of 50 years. The presence of one or more of these in 1st- or 2nd-degree relatives was considered significant. RESULTS Of 168 unrelated probands (171 patients total) included, 36 (21%) had significant family history involving 19 (53%) 1st-degree and 17 (47%) 2nd-degree relatives. Positive family history led to cardiology referral in nine (5%) patients and the presence of abnormal tests/symptoms in the remaining patients. Coronary anomalies in probands with positive family history were anomalous right (27), anomalous left (five), single right coronary artery (two), myocardial bridge (one), and anomalous circumflex coronary artery (one). Conditions present in their family members included sudden cardiac arrest/death (15, 42%), atherosclerotic coronary artery disease (14, 39%), cardiomyopathy (12, 33%), CHD (11, 31%), coronary anomalies (3, 8%), myocardial bridge (1, 3%), long-QT syndrome (2, 6%), and Wolff-Parkinson-White (1, 3%). CONCLUSION In patients with anomalous aortic origin of a coronary artery and/or myocardial bridges, there appears to be familial clustering of cardiac diseases in approximately 20% of patients, half of these with early occurrence of sudden cardiac arrest/death in the family.
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Affiliation(s)
- Robert J Myerburg
- Division of Cardiology, University of Miami Miller School of Medicine, Miami, Florida
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Miars CW, Stamatis A, Morgan GB, Drezner JA. Cardiovascular Screening Practices and Attitudes From the NCAA Autonomous "Power" 5 Conferences. Sports Health 2018; 10:547-551. [PMID: 29792780 PMCID: PMC6204637 DOI: 10.1177/1941738118775039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND: The development of athlete-specific electrocardiogram (ECG) interpretation standards, along with recent rates of sudden cardiac death (SCD) in athletes being higher than previously estimated, has heightened the debate in the sports medicine community regarding cardiovascular screening of the college athlete, including whether certain high-risk subsets, such as male basketball athletes, should undergo more intensive screening. HYPOTHESIS: ECG and/or echocardiography screening in National Collegiate Athletic Association Autonomous 5 Division I (A5DI) schools will be more common than previous reports, and there will be more frequent use of noninvasive cardiac screening for men's basketball players than the general athlete population. STUDY DESIGN: Cross-sectional, quantitative study. LEVEL OF EVIDENCE: Level 4. METHODS: The head team physician for each of the 65 schools in the A5DI conferences was contacted to complete an anonymous survey regarding cardiovascular screening practices at their institution. The survey inquired about current screening protocols, whether SCD epidemiology (SCD-E) was considered in establishing those practices, and whether awareness of present epidemiology altered physician attitudes toward screening. RESULTS: A total of 45 of the 65 team physicians (69%) responded. All schools reported performing history and a physical evaluation. While 17 (38%) perform only history and physical, 26 (58%) also include an ECG, and 12 (27%) include echocardiography for all student-athletes. Specifically for male basketball athletes, 10 (22%) schools perform only history and physical, 32 (71%) include ECG, and 20 (45%) include echocardiography. Additionally, 64% reported using SCD-E in developing their screening protocol. Those that had not considered SCD-E indicated they were unlikely to change their screening protocol when presented with current SCD-E. CONCLUSION: The majority (62%) of A5DI institutions include ECG and/or echocardiography as part of their cardiovascular screening of all athletes, increasing to 78% when specifically analyzing male basketball athletes. CLINICAL RELEVANCE: A5DI institutions, presumably with greater resources, have largely implemented more intensive cardiovascular screening than just history and physical for all student-athletes and specifically for men's basketball-the athlete group at greatest risk.
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Affiliation(s)
| | - Andreas Stamatis
- Department of Sport and Wellness, State University of New York Plattsburgh, Plattsburgh, New York
| | - Grant B Morgan
- Department of Educational Psychology, Baylor University, Waco, Texas
| | - Jonathan A Drezner
- Department of Family Medicine, University of Washington, Seattle, Washington
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AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current Evidence, Knowledge Gaps, Recommendations, and Future Directions: Erratum. Clin J Sport Med 2018; 28:324. [PMID: 29762263 DOI: 10.1097/jsm.0000000000000382] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Abstract
The image of a young athlete collapsing on the pitch, followed by resuscitation, leaves an unforgettable impression. However, this impression should not seduce us into resuscitating the debate for large-scale preparticipation screening without doing the smart thing: taking a step back to review what we know to be effective, and what has been shown not to be effective. What we should do is use this momentum to focus on what we still need to know.
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Affiliation(s)
- H Thune Jørstad
- Fellow Sports Cardiology, Department of Cardiology, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands.
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Panhuyzen-Goedkoop NM, Wellens HJ, Piek JJ. Early recognition of sudden cardiac arrest in athletes during sports activity. Neth Heart J 2018; 26:21-25. [PMID: 29196876 PMCID: PMC5758452 DOI: 10.1007/s12471-017-1061-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Sudden cardiac arrest (SCA) in athletes is an unexpected life-threatening event, which is often not recognised early and cardiopulmonary resuscitation (CPR) is not always initiated immediately. We describe key features to rapidly recognise non-traumatic SCA in athletes during sports activity. METHODS We reviewed videos and images of athletes suffering from non-traumatic SCA during sports activity. We searched Google images, Google videos and YouTube.com using the keywords 'sudden cardiac death athlete' and 'resuscitation athlete'. We analysed (1) the athlete's performance before syncope, (2) the athlete's performance at the start of syncope, (3) the position of the body, and (4) the athlete's facial expressions before CPR. We analysed our data by describing these four features to answer our research question. RESULTS We analysed the sequence of events in six well-known soccer players in whom a camera-witnessed non-traumatic SCA occurred during their athletic activity. All six athletes showed no changes before syncope. Four became unstable while standing and unexpectedly collapsed falling on their back. Two suddenly 'dropped dead' and fell face down. All six had their eyes wide open with a fixed gaze and fixed pupils. CONCLUSIONS Sudden unexpected loss of consciousness in an athlete in action and a fixed gaze eye position are key features of SCA. Immediate cardiac massage should follow. The described features to immediately recognise SCA in athletes during sports activity should be taught to everyone involved in athletic activity leading to earlier recognition of SCA followed by earlier CPR.
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Affiliation(s)
- N M Panhuyzen-Goedkoop
- AMC Heart Center, Academic Medical Center, Amsterdam, The Netherlands.
- Sports Medical Center Papendal Arnhem, Arnhem, The Netherlands.
- Radboud University Medical Center, Nijmegen, The Netherlands.
| | - H J Wellens
- Cardiovascular Research Center, Maastricht, The Netherlands
| | - J J Piek
- AMC Heart Center, Academic Medical Center, Amsterdam, The Netherlands
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Abstract
Sudden death is a major problem, with significant impact on public health. Many conditions predispose to sudden cardiac death and sudden cardiac arrest (SCA), foremost among them coronary artery disease, and an effective therapy exists in the form of the implantable cardioverter defibrillator. Risk stratification for SCA remains imperfect, especially for patients with nonischemic cardiomyopathy. Ongoing trials may make it easier to identify those at high risk, and potentially those at very low risk, in the future.
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Affiliation(s)
- Daniel P Morin
- Ochsner Medical Center, Ochsner Clinical School, University of Queensland Medical School, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
| | - Munther K Homoud
- New England Cardiac Arrhythmia Center, Division of Cardiology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - N A Mark Estes
- New England Cardiac Arrhythmia Center, Division of Cardiology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
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Baggish AL, Battle RW, Beckerman JG, Bove AA, Lampert RJ, Levine BD, Link MS, Martinez MW, Molossi SM, Salerno J, Wasfy MM, Weiner RB, Emery MS. Sports Cardiology. J Am Coll Cardiol 2017; 70:1902-1918. [DOI: 10.1016/j.jacc.2017.08.055] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 08/27/2017] [Indexed: 01/02/2023]
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Prutkin JM, Drezner JA. Training and Experience Matter: Improving Athlete ECG Screening, Interpretation, and Reproducibility. Circ Cardiovasc Qual Outcomes 2017; 10:e003881. [PMID: 28808092 DOI: 10.1161/circoutcomes.117.003881] [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: 11/16/2022]
Affiliation(s)
- Jordan M Prutkin
- From the Division of Cardiology (J.M.P.) and Department of Family Medicine (J.A.D.), University of Washington, Seattle
| | - Jonathan A Drezner
- From the Division of Cardiology (J.M.P.) and Department of Family Medicine (J.A.D.), University of Washington, Seattle.
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Braillon A. Electrocardiographic Screening in Athletes: Emotion- or Evidence-Based Medicine. Am J Cardiol 2017; 120:e51. [PMID: 28277267 DOI: 10.1016/j.amjcard.2016.09.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 09/26/2016] [Indexed: 11/19/2022]
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Drezner JA. Reply. Am J Cardiol 2017; 120:e53. [PMID: 28277268 DOI: 10.1016/j.amjcard.2016.09.028] [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: 09/22/2016] [Accepted: 09/26/2016] [Indexed: 11/25/2022]
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Cheezum MK, Liberthson RR, Shah NR, Villines TC, O'Gara PT, Landzberg MJ, Blankstein R. Anomalous Aortic Origin of a Coronary Artery From the Inappropriate Sinus of Valsalva. J Am Coll Cardiol 2017; 69:1592-1608. [PMID: 28335843 DOI: 10.1016/j.jacc.2017.01.031] [Citation(s) in RCA: 219] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/05/2016] [Accepted: 01/03/2017] [Indexed: 02/07/2023]
Abstract
Anomalous aortic origin of a coronary artery (AAOCA) from the inappropriate sinus of Valsalva is increasingly recognized by cardiac imaging. Although most AAOCA subtypes are benign, autopsy studies report an associated risk of sudden death with interarterial anomalous left coronary artery (ALCA) and anomalous right coronary artery (ARCA). Despite efforts to identify high-risk ALCA and ARCA patients who may benefit from surgical repair, debate remains regarding their classification, prevalence, risk stratification, and management. We comprehensively reviewed 77 studies reporting the prevalence of AAOCA among >1 million patients, and 20 studies examining outcomes of interarterial ALCA/ARCA patients. Observational data suggests that interarterial ALCA is rare (weighted prevalence = 0.03%; 95% confidence interval [CI]: 0.01% to 0.04%) compared with interarterial ARCA (weighted prevalence = 0.23%; 95% CI: 0.17% to 0.31%). Recognizing the challenges in managing these patients, we review cardiac tests used to examine AAOCA and knowledge gaps in management.
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Affiliation(s)
- Michael K Cheezum
- Departments of Medicine and Radiology, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Cardiology Service, Fort Belvoir Community Hospital, Ft. Belvoir, Virginia.
| | - Richard R Liberthson
- Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nishant R Shah
- Lifespan Cardiovascular Institute, Division of Cardiovascular Medicine, Department of Medicine, Brown University Alpert School of Medicine, Providence, Rhode Island
| | - Todd C Villines
- Department of Medicine, Cardiology Service, Walter Reed National Military Medical Center, Bethesda Maryland
| | - Patrick T O'Gara
- Departments of Medicine and Radiology, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Ron Blankstein
- Departments of Medicine and Radiology, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Drezner JA, O'Connor FG, Harmon KG, Fields KB, Asplund CA, Asif IM, Price DE, Dimeff RJ, Bernhardt DT, Roberts WO. AMSSM Position Statement on Cardiovascular Preparticipation Screening in Athletes: Current Evidence, Knowledge Gaps, Recommendations and Future Directions. Curr Sports Med Rep 2017; 15:359-75. [PMID: 27618246 DOI: 10.1249/jsr.0000000000000296] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cardiovascular screening in young athletes is widely recommended and routinely performed prior to participation in competitive sports. While there is general agreement that early detection of cardiac conditions at risk for sudden cardiac arrest and death (SCA/D) is an important objective, the optimal strategy for cardiovascular screening in athletes remains an issue of considerable debate. At the center of the controversy is the addition of a resting electrocardiogram (ECG) to the standard preparticipation evaluation using history and physical examination. The American Medical Society for Sports Medicine (AMSSM) formed a task force to address the current evidence and knowledge gaps regarding preparticipation cardiovascular screening in athletes from the perspective of a primary care sports medicine physician. The absence of definitive outcomes-based evidence at this time precludes AMSSM from endorsing any single or universal cardiovascular screening strategy for all athletes, including legislative mandates. This statement presents a new paradigm to assist the individual physician in assessing the most appropriate cardiovascular screening strategy unique to their athlete population, community needs, and resources. The decision to implement a cardiovascular screening program, with or without the addition of ECG, necessitates careful consideration of the risk of SCA/D in the targeted population and the availability of cardiology resources and infrastructure. Importantly, it is the individual physician's assessment in the context of an emerging evidence-base that the chosen model for early detection of cardiac disorders in the specific population provides greater benefit than harm. AMSSM is committed to advancing evidenced-based research and educational initiatives that will validate and promote the most efficacious strategies to foster safe sport participation and reduce SCA/D in athletes.
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Affiliation(s)
- Jonathan A Drezner
- 1Department of Family Medicine, University of Washington, Seattle, WA; 2Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; 3Department of Family Medicine, University of North Carolina, Greensboro, NC; 4Department of Health and Kinesiology, Georgia Southern University, Statesboro, GA; 5Department of Family Medicine, University of South Carolina Greenville School of Medicine, Greenville, SC; 6Department of Family Medicine, Carolinas Healthcare System, Charlotte, NC; 7Departments of Orthopedic Surgery, Family & Community Medicine, and Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX; 8Departments of Pediatrics, Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI; 9Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
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