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Iqbal U, Almakki R, Usman M, Altameem A, Albathan M, Jilani AK. Methodological identification of anomalies episodes in ECG streams: a systematic mapping study. BMC Med Res Methodol 2024; 24:127. [PMID: 38834955 DOI: 10.1186/s12874-024-02251-0] [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] [Received: 12/31/2023] [Accepted: 05/20/2024] [Indexed: 06/06/2024] Open
Abstract
An electrocardiogram is a medical examination tool for measuring different patterns of heart blood flow circle either in the form of usual or non-invasive patterns. These patterns are useful for the identification of morbidity condition of the heart especially in certain conditions of heart abnormality and arrhythmia. Myocardial infarction (MI) is one of them that happened due to sudden blockage of blood by the cause of malfunction of heart. In electrocardiography (ECG) intensity of MI is highlighted on the basis of unusual patterns of T wave changes. Various studies have contributed for MI through T wave's classification, but more to the point of T wave has always attracted the ECG researchers. Methodology. This Study is primarily designed for proposing the combination of latest methods that are worked for the solutions of pre-defined research questions. Such solutions are designed in the form of the systematic review process (SLR) by following the Kitchen ham guidance. The literature survey is a two phase's process, at first phase collect the articles that were published in IEEE Xplore, Scopus, science direct and Springer from 2008 to 2023. It consist of steps; the first level is executed by filtrating the articles on the basis of keyword phase of title and abstract filter. Similarly, at two level the manuscripts are scanned through filter of eligibility criteria of articles selection. The last level belongs to the quality assessment of articles, in such level articles are rectified through evaluation of domain experts. Results. Finally, the selected articles are addressed with research questions and briefly discuss these selected state-of-the-art methods that are worked for the T wave classification. These address units behave as solutions to research problems that are highlighted in the form of research questions. Conclusion and future directions. During the survey process for these solutions, we got some critical observations in the form of gaps that reflected the other directions for researchers. In which feature engineering, different dependencies of ECG features and dimensional reduction of ECG for the better ECG analysis are reflection of future directions.
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Affiliation(s)
- Uzair Iqbal
- Department of Artificial Intelligence and Data Science, National University of Computer and Emerging Sciences, Islamabad, Pakistan.
| | - Riyad Almakki
- Information Systems Department, College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), 11432, Riyadh, Saudi Arabia.
| | - Muhammad Usman
- Department of Computer Science and Technology, Harbin Institue of Technology, Harbin, Heilongjiang, China
| | - Abdullah Altameem
- Information Systems Department, College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), 11432, Riyadh, Saudi Arabia
| | - Mubarak Albathan
- Information Systems Department, College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), 11432, Riyadh, Saudi Arabia
| | - Abdul Khader Jilani
- Information Systems Department, College of Computer and Information Sciences, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
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Orchard J, Harmon KG, D'Ascenzi F, Meyer T, Pieles GE. What is the most appropriate age for the first cardiac screening of athletes? J Sci Med Sport 2024:S1440-2440(24)00210-X. [PMID: 38890019 DOI: 10.1016/j.jsams.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/20/2024] [Accepted: 05/28/2024] [Indexed: 06/20/2024]
Abstract
For sporting organisations that conduct screening of athletes, there are very few consistent guidelines on the age at which to start. Our review found the total rate of sudden cardiac arrest or death is very low between the ages of 8-11 years (less than 1/100,000/year), increasing to 1-2/100,000/year in both elite athletes and community athletes aged 12-15 years and then steadily increases with age. The conditions associated with sudden cardiac death in paediatric athletes and young adult athletes are very similar with some evidence that death from coronary artery abnormalities occurs more frequently in athletes 10-14 years old. The decision when to begin a screening program involves a complex interplay between requirements and usual practices in a country, the rules of different leagues and programs, the age of entry into an elite program, the underlying risk of the population and the resources available. Given the incidence of sudden cardiac arrest or death in young people, we recommend beginning cardiac screening no earlier than 12 years (not later than 16 years). The risk increases with age, therefore, starting a program at any point after age 12 has added value. Importantly, anyone with concerning symptoms (e.g. collapse on exercise) or family history of an inherited cardiac condition should see a physician irrespective of age. Finally, no screening program can capture all abnormalities, and it is essential for organisations to implement a cardiac emergency plan including training on recognition and response to sudden cardiac arrest and prompt access to resuscitation, including defibrillators.
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Affiliation(s)
- Jessica Orchard
- Sydney School of Public Health, The University of Sydney, Australia. https://twitter.com/jessicajorchard
| | | | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Sports Cardiology and Rehab Unit, University of Siena, Italy. https://twitter.com/FlavioDascenzi
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Germany. https://twitter.com/ProfTim_Meyer
| | - Guido E Pieles
- Department of Athlete Screening and Sports Cardiology, Aspetar Orthopaedic and Sports Medicine Hospital, Qatar; Institute of Sport, Exercise and Health, University College London, UK.
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3
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Steffen K, Bahr R, Clarsen B, Fossan B, Fredriksen H, Gjelsvik H, Haugvad L, Hoksrud AF, Iversen E, Koivisto-Mørk A, Moen E, Røstad V, Reier-Nilsen T, Torgalsen T, Berge HM. Comprehensive periodic health evaluations of 454 Norwegian Paralympic and Olympic athletes over 8 years: what did we learn? Br J Sports Med 2024:bjsports-2023-107942. [PMID: 38744502 DOI: 10.1136/bjsports-2023-107942] [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: 04/22/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE A periodic health evaluation (PHE) is a comprehensive and multidisciplinary investigation of athlete health widely used in elite sport, but its contents and benefits can be questioned. This study aimed to determine the prevalence of conditions identified by a PHE among Paralympic and Olympic athletes over four consecutive Games cycles from Rio de Janeiro 2016 to Beijing 2022 and to assess the benefits and potential pitfalls of a comprehensive PHE programme in detecting existing injuries, illnesses and other health issues. METHODS We collected extensive health history and clinical examination data on elite athletes: medical history, ECG, blood pressure, blood samples, spirometry, musculoskeletal health, cognitive function, mental health and compliance with public health programmes. RESULTS The final cohort included 87 Paralympic and 367 Olympic athletes, representing 565 PHE cycles. Musculoskeletal problems and unspecified pain, infections and allergies were the most frequent health issues. High blood pressure was the most prevalent cardiovascular finding, and vitamin D deficiency the most common laboratory abnormality. Most athletes complied with the public childhood vaccination programmes, but fewer with recommended cancer screening. Follow-up of health issues was variable. CONCLUSION Our PHE programme identified musculoskeletal problems, infections, allergies, elevated blood pressure and vitamin D deficiency as common health conditions. Longitudinal follow-up of health conditions identified during screening and improved compliance with public health and cancer screening programmes is needed to determine the true benefits of athlete care prompted by the PHE.
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Affiliation(s)
- Kathrin Steffen
- Olympiatoppen, The Norwegian Olympic Training Center, Oslo, Norway
- Oslo Sports Trauma Research Center, Insitute of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Roald Bahr
- Olympiatoppen, The Norwegian Olympic Training Center, Oslo, Norway
- Oslo Sports Trauma Research Center, Insitute of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Benjamin Clarsen
- Olympiatoppen, The Norwegian Olympic Training Center, Oslo, Norway
- Oslo Sports Trauma Research Center, Insitute of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Bjørn Fossan
- Olympiatoppen, The Norwegian Olympic Training Center, Oslo, Norway
| | - Hilde Fredriksen
- Olympiatoppen, The Norwegian Olympic Training Center, Oslo, Norway
| | - Hilde Gjelsvik
- Olympiatoppen, The Norwegian Olympic Training Center, Oslo, Norway
| | - Lars Haugvad
- Olympiatoppen, The Norwegian Olympic Training Center, Oslo, Norway
| | | | - Erik Iversen
- Olympiatoppen, The Norwegian Olympic Training Center, Oslo, Norway
| | | | - Ellen Moen
- Olympiatoppen, The Norwegian Olympic Training Center, Oslo, Norway
| | - Vibeke Røstad
- Olympiatoppen, The Norwegian Olympic Training Center, Oslo, Norway
| | | | - Thomas Torgalsen
- Olympiatoppen, The Norwegian Olympic Training Center, Oslo, Norway
| | - Hilde Moseby Berge
- Olympiatoppen, The Norwegian Olympic Training Center, Oslo, Norway
- Oslo Sports Trauma Research Center, Insitute of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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Bianchi D, Sethi NK, Velasco G, Qureshi UA, deWeber K. Care of The Older Fighter: Position Statement of the Association of Ringside Physicians. PHYSICIAN SPORTSMED 2024:1-7. [PMID: 38708547 DOI: 10.1080/00913847.2024.2344227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 04/14/2024] [Indexed: 05/07/2024]
Abstract
Older Fighters are defined as combat sports athletes older than 35 years, based on heightened medical risks and historical classification. Age-related changes to the neurological, cardiopulmonary, endocrinological, thermoregulatory, osmoregulatory, and musculoskeletal systems increase these athletes' risks for injury and may prolong their recovery. These age-related risks warrant special considerations for competition, licensure, prefight medical clearance, in-fight supervision, post-fight examination, and counseling regarding training practices and retirement from combat sports. Neurological considerations include increased risk of intracranial lesions, intracranial hemorrhage, and sequelae from traumatic brain injury (TBI), warranting more comprehensive neurological evaluation and neuroimaging. Increased risk of myocardial ischemia and infarction warrant careful assessment of cardiac risk factors and scrutiny of cardiovascular fitness. Older fighters may take longer time to recover from musculoskeletal injury; post-injury clearance should be individualized.
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Affiliation(s)
- Davide Bianchi
- Medbase Cornavin Sports Center, SwissBoxing, Geneva, Switzerland
| | - Nitin K Sethi
- Associate Professor of Neurology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - George Velasco
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Uneeb A Qureshi
- United States Public Health Service, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Kevin deWeber
- Program Director, SW Washington Sports Medicine Fellowship, Vancouver, WA USA
- Affiliate Associate Professor of Family Medicine, Oregon Health and Science University, Portland, OR, USA
- Clinical Assistant Professor of Family Medicine, University of Washington, Seattle, WA, USA
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Greciano Calero P, Escribá Bori S, Costa Orvay JA, González Pons N, Martín Pérez MDC, Cardona Alfonseca D, Nogales Velázquez C, Verd Vallespir S, Tur Salom AE, Chiandetti A, Navarro Noguera M, Grau Blanch A, Rotger Genestar MM, Mambié Meléndez M, Fernández Hidalgo M, Seguí Llinas JM, Martorell Bon L, Arestuche Aguilar P, Garrido Conde B, Sánchez Grao MDV, Sarraff Trujillo K, Muntaner Alonso A, Grimalt Ferragut C, Soriano Marco A, Gómez Rojas V, Pol Serra J. Can we screen for heart disease in children at public health centres? A multicentre observational study of screening for heart disease with a risk of sudden death in children. Eur J Pediatr 2024; 183:2411-2420. [PMID: 38459131 PMCID: PMC11035459 DOI: 10.1007/s00431-024-05489-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/02/2024] [Accepted: 02/18/2024] [Indexed: 03/10/2024]
Abstract
Sudden cardiac death in children is a rare event, but of great social significance. Generally, it is related to heart disease with a risk of sudden cardiac death (SCD), which may occur with cardiovascular symptoms and/or electrocardiographic markers; thus, a primary care paediatrician (PCP) could detect them. Therefore, we proposed a study that assesses how to put into practice and conduct a cardiovascular assessment within the routine healthy-child check-ups at six and twelve years of age; that reflects cardiovascular signs and symptoms, as well as the electrocardiographic alterations that children with a risk of SCD in the selected population present; and that assesses the PCP's skill at electrocardiogram (ECG) interpretation. In collaboration with PCPs, primary care nurses, and paediatric cardiologists, an observational, descriptive, multicentre, cross-sectional study was carried out in the Balearic Islands (Spain), from April 2021 to January 2022, inclusive. The PCPs gathered patient data through forms (medical record, electrocardiogram, and physical examination) and sent them to the investigator, together with the informed consent document and electrocardiogram. The investigator passed the electrocardiogram on to the paediatric cardiologists for reading, in an identical form to those the paediatricians had filled in. The variables were collected, and a descriptive analysis performed. Three paediatric cardiologists, twelve PCPs, and nine nurses from seven public health centres took part. They collected the data from 641 patients, but 233 patients did not participate (in 81.11% due to the PCP's workload). Therefore, the study coverage was around 64%, representing the quotient of the total number of patients who participated, divided by the total number of patients who were eligible for the study. We detected 30 patients with electrocardiographic alterations compatible with SCD risk. Nine of these had been examined by a paediatric cardiologist at some time (functional murmur in 8/9), five had reported shortness of breath with exercise, and four had reported a family history of sudden death. The physical examination of all the patients whose ECG was compatible with a risk of SCD was normal. Upon analysing to what extent the ECG results of the PCP and the paediatric cardiologist agreed, the percentage of agreement in the final interpretation (normal/altered) was 91.9%, while Cohen's kappa coefficient was 31.2% (CI 95%: 13.8-48.6%). The sensitivity of the ECG interpretation by the PCP to detect an ECG compatible with a risk of SCD was 29% and the positive predictive value 45%. Conclusions: This study lays the foundations for future SCD risk screening in children, performed by PCPs. However, previously, it would be important to optimise their training in reading and interpreting paediatric ECGs. What is Known: • In Spain at present, there is a programme in place to detect heart disease with a risk of sudden death [1], but it targets only children who are starting on or are doing a physical activity as a federated sport. Implementing such screening programmes has proven effective in several countries [2]. However, several studies showed that the incidence of sudden cardiac death is no higher in children competing in sport activities than in those who do not do any sport [3]. This poses an ethical conflict, because at present, children who do not do any federated sport are excluded from screening. According to the revised literature, so far, only in two studies did they screen the child population at schools, and in both, they successfully detected patients with heart disease associated to the risk of sudden death [4, 5]. We have found no studies where the screening of these features was included within the routine healthy-child check-ups by primary care paediatricians. What is New: • We did not know whether-in our setting, at present-the primary care paediatrician could perform a screening method within the routine healthy-child check-ups, in order to detect presumably healthy children at risk of sudden cardiac death, as they present one of the SCD risks. In this regard, we proposed our project: to assess how to put into practice and conduct a cardiovascular assessment via SCD risk screening in the healthy child population by primary care paediatricians and appraise primary care paediatricians' skills in identifying the electrocardiographic alterations associated with SCD risk. The ultimate intention of this pilot study was to make it possible, in the future, to design and justify a study aimed at universalising cardiovascular screening and achieving a long-term decrease in sudden cardiac death events in children.
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Affiliation(s)
- Paula Greciano Calero
- Children's Heart Unit, Paediatric Department, Son Espases University Hospital, Palma, Balearic Islands, Spain.
| | - Silvia Escribá Bori
- Children's Heart Unit, Paediatric Department, Son Espases University Hospital, Palma, Balearic Islands, Spain
| | - Juan Antonio Costa Orvay
- Children's Heart Unit, Paediatric Department, Can Misses Hospital, Ibiza, Balearic Islands, Spain
| | - Nina González Pons
- Children's Heart Unit, Paediatric Department, Mateu Orfila General Hospital, Mahon, Balearic Islands, Spain
| | | | | | | | | | | | | | | | - Anna Grau Blanch
- Es Mercadal Public Health Centre, Es Mercadal, Balearic Islands, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Juan Pol Serra
- S'Escorxador Public Health Centre, Palma, Balearic Islands, Spain
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6
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Reittinger AM, Jackson LB, Dean PN. Preparticipation Cardiac Evaluation from the Pediatric Perspective. Card Electrophysiol Clin 2024; 16:1-14. [PMID: 38280809 DOI: 10.1016/j.ccep.2023.09.003] [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: 01/29/2024]
Abstract
Each year millions of children and adolescents undergo sports preparticipation evaluations (PPEs) before participating in organized sports. A primary aim of the PPE is to screen for risk factors associated with sudden cardiac death. This article is designed to summarize the current thoughts on the PPE with a specific slant toward the pediatric and early adolescent evaluation and how these evaluations may differ from those in adults.
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Affiliation(s)
- Andrew M Reittinger
- Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia, 1204 West Main Street, Battle Building, 6th Floor, Charlottesville, VA 22903, USA
| | - Lanier B Jackson
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, 10 McClennan Banks Drive, MSC 915, Charleston, SC 29425, USA
| | - Peter N Dean
- Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia, 1204 West Main Street, Battle Building, 6th Floor, Charlottesville, VA 22903, USA.
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Zapata Martínez M, Pardo Ríos M, García Alberola A, López-Picazo Ferrer J, Banacloche Cano C, Iglesias Gómez C, Pérez Gálvez MD, Fernández Redondo C, Gimeno Blanes JR. [Screening for heart disease in kids and adolescents (Prevencar Program)]. Aten Primaria 2024; 56:102782. [PMID: 37924621 PMCID: PMC10654544 DOI: 10.1016/j.aprim.2023.102782] [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] [Received: 09/01/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 11/06/2023] Open
Abstract
OBJECTIVE The objective was to develop a screening for heart disease detection in primary care, to identify pathological electrocardiographic changes and underlying heart disease in adolescents. DESIGN The study was carried out for one year using multistage sampling. SITE: Primary care centers in a health area that had digital ECG equipment (12 centers) were selected. PARTICIPANTS Initially, 718 (16.6%) 14-year-old adolescents were recruited and those with a previous diagnosis of heart disease were excluded. INTERVENTIONS Screening consisted of including a health questionnaire in the mandatory 14-year-old check-up. MAIN MEASUREMENTS Screening included a questionnaire, cardiac auscultation, ECG and echocardiography. Abnormality criteria were established to refer for a second evaluation by a cardiologist. RESULTS Finally, the sample was made up of 698 adolescents, with a mean age of 13.7±0.5 years, and 354 (50.7%) were boys. A total of 149 (21.3%) were selected for a second review by cardiology: 88 (12.6%) due to a positive questionnaire, 11 (2.2%) due to abnormal cardiac auscultation, and 66 (9.5%) due to ECG findings. Adolescents with evidence of heart disease were 24 (3.4%). Of these, 14 (2.0%) had suggestive alterations and follow-up was recommended, 6 (0.9%) had a definitive diagnosis of heart disease, and 4 (0.6%) had other pathological findings related to the cardiovascular system. CONCLUSIONS The screening allowed us to identify 1% of adolescents with heart disease and another 2% will remain in follow-up. The ECG detected more pathological cases than the questionnaire.
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Affiliation(s)
- Marta Zapata Martínez
- Centro de Salud de Aljucer, Aljucer, Murcia, España; Universidad de Murcia, Murcia, España; Instituto Murciano de la Investigación Biosanitaria (IMIB), Murcia, España.
| | - Manuel Pardo Ríos
- Gerencia de Urgencias y Emergencias 061 de la Región de Murcia, Murcia, España; UCAM Universidad Católica de Murcia, Guadalupe, Murcia, España
| | - Arcadio García Alberola
- Universidad de Murcia, Murcia, España; Instituto Murciano de la Investigación Biosanitaria (IMIB), Murcia, España; Unidad Arrítmias y Electrofisiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Julio López-Picazo Ferrer
- Universidad de Murcia, Murcia, España; Instituto Murciano de la Investigación Biosanitaria (IMIB), Murcia, España; Unidad de Calidad, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | | | | | - M Dolores Pérez Gálvez
- Dirección y Gerencia, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | | | - Juan Ramón Gimeno Blanes
- Universidad de Murcia, Murcia, España; Instituto Murciano de la Investigación Biosanitaria (IMIB), Murcia, España; Unidad de Cardiopatías Familiares (CSUR- ERN Guard-Heart), Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; CIBERCV CB16/11/00385 (ISCIII)
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Khorgami MR, Rezaei Y, Tabib A, Ghavidel AA, Omrani G, Mohebbi A, Peighambari MM, Emkanjoo Z, Oveisi M, Hajianfar G, Kazemborji B, Hosseini S, Samiei N. Prevalence of electrocardiographic abnormalities among Iranian children and adolescents and associations with blood pressure and obesity: findings from the SHED LIGHT study. Cardiol Young 2024:1-9. [PMID: 38234002 DOI: 10.1017/s1047951123004304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND There are few studies for detecting rhythm abnormalities among healthy children and adolescents. The aim of the study was to investigate the prevalence of abnormal electrocardiographic findings in the young Iranian population and its association with blood pressure and obesity. METHODS A total of 15084 children and adolescents were examined in a randomly selected population of Tehran city, Iran, between October 2017 and December 2018. Anthropometric values and blood pressure measurements were also assessed. A standard 12-lead electrocardiogram was recorded by a unique recorder, and those were examined by electrophysiologists. RESULTS All students mean age was 12.3 ± 3.1 years (6-18 years), and 52% were boys. A total of 2900 students (192.2/1000 persons; 95% confidence interval 186-198.6) had electrocardiographic abnormalities. The rate of electrocardiographic abnormalities was higher in boys than girls (p < 0.001). Electrocardiographic abnormalities were significantly higher in thin than obese students (p < 0.001), and there was a trend towards hypertensive individuals to have more electrocardiographic abnormalities compared to normotensive individuals (p = 0.063). Based on the multivariable analysis, individuals with electrocardiographic abnormalities were less likely to be girls (odds ratio 0.745, 95% confidence interval 0.682-0.814) and had a lower body mass index (odds ratio 0.961, 95% confidence interval 0.944-0.979). CONCLUSIONS In this large-scale study, there was a high prevalence of electrocardiographic abnormalities among young population. In addition, electrocardiographic findings were significantly influenced by increasing age, sex, obesity, and blood pressure levels. This community-based study revealed the implications of electrocardiographic screening to improve the care delivery by early detection.
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Affiliation(s)
- Mohammad Rafie Khorgami
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Yousef Rezaei
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Behyan Clinic, Pardis New Town, Tehran, Iran
| | - Avisa Tabib
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza A Ghavidel
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Omrani
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Mohebbi
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Peighambari
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Emkanjoo
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular, Medical & Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Oveisi
- Faculty of Life Sciences & Medicine, Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Ghasem Hajianfar
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bahareh Kazemborji
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saeid Hosseini
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Niloufar Samiei
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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9
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Spencer R, Quraishi S. Athlete Screening and Sudden Cardiac Death. Pediatr Rev 2023; 44:669-681. [PMID: 38036435 DOI: 10.1542/pir.2023-005975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Robert Spencer
- Division of Pediatric Cardiology, Department of Pediatrics, Staten Island University Hospital, Northwell Health, Staten Island, NY
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Shahed Quraishi
- Division of Pediatric Cardiology, Department of Pediatrics, Staten Island University Hospital, Northwell Health, Staten Island, NY
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Goff NK, Hutchinson A, Koek W, Kamat D. Meta-analysis on the Effectiveness of ECG Screening for Conditions Related to Sudden Cardiac Death in Young Athletes. Clin Pediatr (Phila) 2023; 62:1158-1168. [PMID: 36797841 PMCID: PMC10478328 DOI: 10.1177/00099228231152857] [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] [Indexed: 02/18/2023]
Abstract
Controversy exists over the use of electrocardiograms (ECGs) in sports pre-participation screening. We performed a meta-analysis comparing the effectiveness of history and physical examination (H&P) with ECG at detecting both cardiac disease and sudden cardiac death-associated conditions (SCD-AC). Pre-participation studies published from 2015 to 2020 with athletes 10 to 35 years old were included. This yielded 28 011 athletes screened and 124 cardiac diagnoses, 103 of which were SCD-AC. A meta-analysis of log odds ratios (ORs) was conducted using a random-effects model. The ORs for the association between H&P and detecting both cardiac disease and SCD-AC were not statistically significant (OR = 3.4, P = .076; OR = 2.9, P = .078). The ORs for the association between ECG and detecting both cardiac disease and SCD-AC were statistically significant (60, P < .001; 148, P < .0001). In conclusion, the odds of detecting both cardiac disease and conditions related to SCD with ECG are greater than with H&P during sports pre-participation screening.
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Affiliation(s)
- Nicolas K. Goff
- Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | | | - Wouter Koek
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Deepak Kamat
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Schäfer M, Mitchell MB, Brateng C, Ivy DD, Hunter KS, Nash DB, von Alvensleben JC. Extraction and Digitization of ECG Signals from Standard Clinical Portable Document Format Files for the Principal Component Analysis of T-wave Morphology. Cardiovasc Eng Technol 2023; 14:631-639. [PMID: 37491551 DOI: 10.1007/s13239-023-00673-3] [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: 01/13/2023] [Accepted: 07/17/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION T-wave analysis from standard electrocardiogram (ECG) remains one of the most available clinical and research methods for evaluating myocardial repolarization. T-wave morphology was recently evaluated to aid with diagnosis and characterization of diastolic dysfunction. Unfortunately, PDF stored ECG datasets limit additional numerical post-processing of ECG waveforms. In this study, we apply a simple custom process pipeline to extract and re-digitize T-wave signals and subject them to principal component analysis (PCA) to define primary T-wave shape variations. METHODS We propose simple pre-processing and digitization algorithms programmable as a MATLAB tool using standard thresholding functions without the need for advanced signal analysis. To validate digitized datasets, we compared clinically standard measurements in 20 different ECGs with the original ECG machine interpreted values as a gold standard. Afterwards, we analyzed 212 individual ECGs for T-wave shape analysis using PCA. RESULTS The re-digitized signal was shown to preserve the original information as evidenced by excellent agreement between original - machine interpreted and re-digitized clinical variables including heart rate: bias ~ 1 bpm (95% CI: -1.0 to 3.5), QT interval: bias ~ 0.000 ms (95% CI: -0.012 to 0.012), PR interval: bias = -0.015 ms (95% CI: -0.015 to 0.003), and QRS duration: bias = -0.001 ms (95% CI: -0.007 to 0.006). PCA revealed that the first principal component universally modulates the T-wave height or amount of repolarization voltage regardless of the investigated ECG lead. The second and third principal components described variation in the T-wave peak onset and the T-wave peak morphology, respectively. CONCLUSION This study presents a straightforward method for re-digitizing ECGs stored in the PDF format utilized in many academic electronic medical record systems. This process can yield re-digitized lead specific signals which can be retrospectively analyzed using advanced custom post-processing numerical analysis independent of commercially available platforms.
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Affiliation(s)
- Michal Schäfer
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, 13123 E 16th Ave, Anschutz Medical Campus, Aurora, CO, 80045-2560, USA.
| | - Max B Mitchell
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Caitlin Brateng
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, 13123 E 16th Ave, Anschutz Medical Campus, Aurora, CO, 80045-2560, USA
- Division of Cardiology, Section of Electrophysiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - D Dunbar Ivy
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, 13123 E 16th Ave, Anschutz Medical Campus, Aurora, CO, 80045-2560, USA
| | - Kendall S Hunter
- Department of Bioengineering, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Dustin B Nash
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, 13123 E 16th Ave, Anschutz Medical Campus, Aurora, CO, 80045-2560, USA
- Division of Cardiology, Section of Electrophysiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Johannes C von Alvensleben
- Division of Cardiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, 13123 E 16th Ave, Anschutz Medical Campus, Aurora, CO, 80045-2560, USA
- Division of Cardiology, Section of Electrophysiology, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
- Division of Cardiology, Section of Adult Congenital Heart Disease, Heart Institute, Children's Hospital Colorado, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
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12
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D'Ascenzi F, Ragazzoni GL, Boncompagni A, Cavigli L. Sports cardiology: A glorious past, a well-defined present, a bright future. Clin Cardiol 2023; 46:1015-1020. [PMID: 37503665 PMCID: PMC10540010 DOI: 10.1002/clc.24112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 07/29/2023] Open
Abstract
The attention towards sports cardiology has dramatically grown after the introduction of preparticipation screening and the need for specific education on electrocardiogram interpretation in athletes, given the differences between athletes and the general population. The present article stresses the need for specific skills, knowledge, and clinical expertise in sports cardiology, which are essential for appropriately screening competitive athletes to prevent sudden cardiac death and avoid overdiagnosis. However, disqualification from sports competitions may lead to sports inactivity, and athletes may enter a gray zone where little or no information is provided about what they can or cannot do to stay active. However, modern sports cardiology cannot neglect the patient's needs and the importance of the safe practice of regular exercise. In this context, the personalized exercise prescription plays a crucial role in the core curriculum and the clinical activity of professionals involved in sports cardiology programs. Given its specificities, sports cardiology requires a formal education plan for medical school students and all residents. Additional education and practice are required for young colleagues who want to focus their professional lives on sports cardiology. The future directions of emerging modern sports cardiology should not neglect the importance of a scientific community that works together, designing multicenter international outcomes-based research to address the many remaining areas of uncertainty.
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Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of CardiologyUniversity of SienaSienaItaly
| | - Gian L. Ragazzoni
- Department of Medical Biotechnologies, Division of CardiologyUniversity of SienaSienaItaly
| | - Alex Boncompagni
- Department of Medical Biotechnologies, Division of CardiologyUniversity of SienaSienaItaly
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of CardiologyUniversity of SienaSienaItaly
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13
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Turska-Kmieć A, Neunhaeuserer D, Mazur A, Dembiński Ł, del Torso S, Grossman Z, Barak S, Hadjipanayis A, Peregud-Pogorzelski J, Kostka T, Bugajski A, Huss G, Kowalczyk-Domagała M, Wyszyńska J. Sport activities for children and adolescents: the Position of the European Academy of Paediatrics and the European Confederation of Primary Care Paediatricians 2023-Part 1. Pre-participation physical evaluation in young athletes. Front Pediatr 2023; 11:1125958. [PMID: 37425260 PMCID: PMC10323832 DOI: 10.3389/fped.2023.1125958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
The European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP) emphasize the importance of promoting healthy lifestyles within the pediatric population. Many health professionals have questions concerning adequate levels of physical activity for both the healthy pediatric population and for those who may have specific complications. Unfortunately, the academic literature that provides recommendations for participation in sport activities within the pediatric population that have been published during the last decade in Europe is limited and is mainly dedicated to specific illnesses or advanced athletes and not toward the general population. The aim of part 1 of the EAP and ECPCP position statement is to assist healthcare professionals in implementing the best management strategies for a pre-participation evaluation (PPE) for participation in sports for individual children and adolescents. In the absence of a uniform protocol, it is necessary to respect physician autonomy for choosing and implementing the most appropriate and familiar PPE screening strategy and to discuss the decisions made with young athletes and their families. This first part of the Position Statement concerning Sport Activities for Children and Adolescents is dedicated to healthy young athletes.
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Affiliation(s)
- Anna Turska-Kmieć
- Department of Cardiology, Children’s Memorial Health Institute, Warsaw, Poland
- Polish PaediatricSociety, Warsaw, Poland
- Working Group on Sports Cardiology, Polish Cardiac Society, Warsaw, Poland
| | - Daniel Neunhaeuserer
- Sports and Exercise Medicine Division, University of Padova Department of Medicine, Padova, Italy
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Artur Mazur
- Polish PaediatricSociety, Warsaw, Poland
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów, Poland
| | - Łukasz Dembiński
- Polish PaediatricSociety, Warsaw, Poland
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- Department of Paediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Stefano del Torso
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- Childcare Worldwide, Padova, Italy
| | - Zachi Grossman
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- Adelson School of Medicine, Ariel University, Ariel, Israel
- Maccabi Health Services, Pediatric Clinic, Tel Aviv, Israel
| | - Shimon Barak
- The European Confederation of Primary Care Paediatricians (ECPCP), Lyon, France
- Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Adamos Hadjipanayis
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- School of Medicine, European University Cyprus, Nicosia, Cyprus
- Paediatric Department, Larnaca General Hospital, Larnaca, Cyprus
| | - Jarosław Peregud-Pogorzelski
- Polish PaediatricSociety, Warsaw, Poland
- Department of Paediatrics, Paediatric Oncology and Immunology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Kostka
- Department of Geriatrics, Medical University of Lodz, Lodz, Poland
- The Polish Society of Sports Medicine, Wroclaw, Poland
| | - Andrzej Bugajski
- The Polish Society of Sports Medicine, Wroclaw, Poland
- Department of Physiotherapy, College of Physiotherapy, Wroclaw, Poland
| | - Gottfried Huss
- The European Confederation of Primary Care Paediatricians (ECPCP), Lyon, France
- Kinder-Permanence Hospital Zollikerberg, Zollikerberg, Switzerland
| | - Monika Kowalczyk-Domagała
- Department of Cardiology, Children’s Memorial Health Institute, Warsaw, Poland
- Working Group on Paediatric Cardiology, Polish Cardiac Society, Warsaw, Poland
| | - Justyna Wyszyńska
- Institute of Health Sciences, Medical College of Rzeszów University, Rzeszów, Poland
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The Cardiac Effects of COVID-19 on Young Competitive Athletes: Results from the Outcomes Registry for Cardiac Conditions in Athletes (ORCCA). J Cardiovasc Dev Dis 2023; 10:jcdd10020072. [PMID: 36826568 PMCID: PMC9964305 DOI: 10.3390/jcdd10020072] [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: 12/22/2022] [Revised: 02/01/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023] Open
Abstract
The Outcomes Registry for Cardiac Conditions in Athletes (ORCCA) study is a large-scale prospective investigation evaluating the cardiovascular effects and outcomes of SARS-CoV-2 infection on young competitive athletes. This review provides an overview of the key results from the ORCCA study. Results from the ORCCA study have provided important insights into the clinical impact of SARS-CoV-2 infection on the cardiovascular health of young competitive athletes and informed contemporary screening and return to sport practices. Key results include defining a low prevalence of both cardiac involvement and adverse cardiovascular outcomes after SARS-CoV-2 infection and evaluating the utility of a return-to-play cardiac evaluation. Future aims of the ORCCA study include the longer-term evaluation of cardiovascular outcomes among athletes post-SARS-CoV-2 infection and the transition to investigating outcomes in young athletes with potentially high-risk genetic or structural cardiac diagnoses.
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15
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Blank ZJ, Spicer RL, Robinson JA. Preparticipation State Cardiac Screening Forms for Athletes. Pediatrics 2023; 151:190288. [PMID: 36519230 DOI: 10.1542/peds.2022-056798] [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] [Accepted: 10/04/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Annual preparticipation physical evaluation (PPE) is used in the United States to screen adolescents for potential causes of sudden cardiac death. The American Heart Association recommends 14 screening elements of history and physical examination. This study sought to define the utilization of these screening elements by each of the 50 states before high school athletics. METHODS PPE forms were obtained from the public website of the high school athletics governing body in every state. Form content was analyzed to identify which of the 14 screening elements were explicitly fulfilled. Additional PPE forms provided by private/parochial schools, other professional societies, or independent groups were excluded from this study. RESULTS A total of 48 states (96%) had PPE forms posted online. The remaining 2 states (4%) deferred the specific method of PPE documentation to individual school districts and provided no standardized form. Of the 48 states providing PPE forms, 13 (27%) included all 14 American Heart Association screening elements. The median criteria included by each state was 11 (range 3-14). The 3 criteria most commonly absent were (1) the examination of femoral pulses to exclude coarctation (58%), (2) a family history of specific inherited cardiac disease (31%), and (3) personal history of hypertension (27%). CONCLUSIONS Annual preparticipation forms are important screening tools. Only a minority of states include all 14 cardiac screening elements recommended by the American Heart Association.
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Affiliation(s)
- Zane J Blank
- Department of Internal Medicine, University of Washington-Boise, Boise, Idaho
| | - Robert L Spicer
- Division of Cardiology, Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska.,The Criss Heart Center, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Jeffrey A Robinson
- Division of Cardiology, Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska.,The Criss Heart Center, Children's Hospital and Medical Center, Omaha, Nebraska
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16
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Reittinger AM, Jackson LB, Dean PN. Preparticipation Cardiac Evaluation from the Pediatric Perspective. Cardiol Clin 2022; 41:1-14. [DOI: 10.1016/j.ccl.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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17
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Cavarretta E, Pingitore A, Della Porta S, Capitani R, Bernardi M, Sciarra L, Saglietto A, Versaci F, Autore C, Perroni F, Biondi-Zoccai G, Frati G, Peruzzi M. Accuracy of the "International Criteria" for ECG screening in athletes in comparison with previous published criteria: rationale and design of a diagnostic meta-analysis. Minerva Cardiol Angiol 2022; 70:484-490. [PMID: 32996310 DOI: 10.23736/s2724-5683.20.05347-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
INTRODUCTION The impact of the International Criteria for ECG interpretation in athletes has further improved the diagnostic accuracy of the 12-lead ECG use for preparticipation screening (PPS); moreover, these criteria have been evaluated in different populations of athletes and settings proving good results. EVIDENCE ACQUISITION We aimed to perform a comprehensive review of the use of the International Criteria for ECG interpretation in athletes, stemming from a systematic review to diagnostic meta-analysis, limiting our inclusion only to observational studies to determine the diagnostic accuracy of ECG for detecting cardiac anomalies related to sudden cardiac death in athletes. EVIDENCE SYNTHESIS This meta-analysis is expected to include several important studies related to PPS on different populations of athletes comparing different ECG criteria and detail important data on the diagnostic accuracy of ECG in PPS. Furthermore, we intend to highlight the advantage of using ECG in PPS. CONCLUSIONS The present diagnostic meta-analysis results will aid sports medicine physicians and cardiologist in adhering to the most accurate criteria for ECG evaluation in athletes and it may help to solve controversies aroused regarding the excess cost of ECG in PPS related to the amount of false positive cases.
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Affiliation(s)
- Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy -
- Mediterranea Cardiocentro, Naples, Italy -
| | | | | | - Riccardo Capitani
- Department of Physiology and Pharmacology, Sapienza University, Rome, Italy
| | - Marco Bernardi
- Department of Physiology and Pharmacology, Sapienza University, Rome, Italy
| | - Luigi Sciarra
- Division of Cardiology, Casilino Polyclinic, Rome, Italy
| | - Andrea Saglietto
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Camillo Autore
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Fabrizio Perroni
- Section of Exercise and Health Sciences, Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- Department of Angio-Cardio-Neurology, IRCCS NeuroMed, Pozzilli, Isernia, Italy
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18
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Risk Factors for Sudden Death in Athletes, Is There a Role for Screening? CURRENT CARDIOVASCULAR RISK REPORTS 2022; 16:97-109. [PMID: 35813032 PMCID: PMC9251040 DOI: 10.1007/s12170-022-00697-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/15/2022]
Abstract
Purpose of Review Sudden cardiac death (SCD) in a young athlete is an infrequent yet devastating event often associated with substantial media attention. Screening athletes for conditions associated with SCD is a controversial topic with debate surrounding virtually each component including the ideal subject, method, and performer/interpreter of such screens. In fact, major medical societies such as the American College of Cardiology/American Heart Association and the European Society of Cardiology have discrepant recommendations on the matter, and major sporting associations have enacted a wide range of screening policies, highlighting the confusion on this subject. This review seeks to summarize the literature in this area to address the complex and disputed subject of screening young athletes for SCD. Recent Findings The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause myocarditis, which is one acquired cardiac disease associated with SCD. The coronavirus 2019 (COVID-19) pandemic has therefore resulted in an increased incidence of an otherwise less common condition, providing an expanded dataset for further study of this condition. Recent findings indicate that cardiac complications of athletes with myocardial involvement of SARS-CoV-2 infection are rare. Other contemporary work in SCD screening has been focused on the implementation of various screening protocols and measuring their effectiveness. Summary No universal consensus exists for athlete screening for conditions associated with SCD with varying guidelines and protocols across cardiology and sport-specific organizations. No screening program will prevent all SCD; however, small programs managed by physicians familiar with the examination of an athlete that carefully personalize screening to the individual may maximize detection of dangerous cardiac conditions while minimizing false positives.
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19
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Abstract
Sudden cardiac death (SCD) is the leading cause of medical death in athletes; however, many studies are significantly flawed making an accurate estimation of risk difficult. Incidence studies need to have accurate case ascertainment, a defined study population, and should be stratified by both sex and age. The risk of SCA/d in college-aged males is 1 in 35,000 person-years, black males 1 in 18,000 person-years, and higher-risk sports include men's basketball, men's soccer, and American football. Inherited cardiomyopathies and electrical conditions account for ∼ 2/3 of off SCA/d and can be detected with an ECG. More research is needed to provide more granular estimates.
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Affiliation(s)
- Kimberly G Harmon
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA; Department of Orthopaedics and Sports Medicine, University of Washington School of Medicine, Seattle, WA, USA; Sports Medicine Center at Husky Stadium, 3800 Montlake Boulevard, Seattle, WA 98195, USA.
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20
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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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21
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Zorzi A, Moreschi C, Basso C, Thiene G. Sudden death of an athlete due to concealed arrhythmogenic cardiomyopathy: Why preparticipation screening did fail. Int J Cardiol 2022:S0167-5273(22)00319-9. [PMID: 35248625 DOI: 10.1016/j.ijcard.2022.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/20/2022]
Abstract
We report the case of a professional soccer athlete who died suddenly for arrhythmogenic cardiomyopathy that was not diagnosed at the time of preparticipation screening. Exercise testing had repeatedly shown effort-induced premature ventricular beats with normal echocardiography, which was considered reassuring. However, there is emerging evidence that cardiac diseases characterized by focal ventricular scarring may not cause wall motion abnormalities and can be revealed only by tissue characterization with cardiac magnetic resonance. Modern interpretation of premature ventricular beats features is essential to select athletes who should undergo advanced cardiac imaging investigations, to achieve a correct diagnosis and allow safe sport participation.
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Affiliation(s)
- Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Italy
| | - Carlo Moreschi
- Department of Medicine, Section of Forensic Medicine, University of Udine
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Italy
| | - Gaetano Thiene
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Italy.
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22
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Findings From Cardiovascular Evaluation of National Collegiate Athletic Association Division I Collegiate Student-Athletes After Asymptomatic or Mildly Symptomatic SARS-CoV-2 Infection. Clin J Sport Med 2022; 32:103-107. [PMID: 34173780 DOI: 10.1097/jsm.0000000000000954] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/19/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The risk of myocardial damage after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been controversial. The purpose of this study is to report the incidence of abnormal cardiovascular findings in National Collegiate Athletic Association (NCAA) Division I student-athletes with a history of SARS-CoV-2 infection. DESIGN This is a case series of student-athletes with SARS-CoV-2 infection and their subsequent cardiac work-up, including troponin level, electrocardiogram, and echocardiogram. Additional testing was ordered as clinically indicated. SETTING This study was conducted at a single NCAA Division I institution. PARTICIPANTS Student-athletes were included if they tested positive for SARS-CoV-2 by PCR or antibody testing [immunoglobulin G (IgG)] from April 15, 2020 to October 31, 2020. INTERVENTION Cardiac testing was conducted as part of postinfection screening. MAIN OUTCOME MEASURES This study was designed to quantify abnormal cardiovascular screening results and cardiac diagnoses after SARS-CoV-2 infection in Division I collegiate athletes. RESULTS Fifty-five student-athletes tested positive for SARS-CoV-2. Of these, 14 (26%) had a positive IgG and 41 (74%) had a positive PCR test. Eight abnormal cardiovascular screening evaluations necessitated further testing including cardiac magnetic resonance imaging (cMRI). Two athletes received new cardiac diagnoses, one probable early cardiomyopathy and one pericarditis, whereas the remaining 6 had normal cMRIs. CONCLUSIONS These data support recent publications which recommend the de-escalation of cardiovascular testing such as cardiac MRI or echocardiogram for athletes who have recovered from asymptomatic or mildly symptomatic SARS-CoV-2 infection. Continued follow-up of these athletes for sequelae of SARS-CoV-2 is critical.
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An Exploratory Study on Vectorcardiographic Identification of the Site of Origin of Focally Induced Premature Depolarizations in Horses, Part II: The Ventricles. Animals (Basel) 2022; 12:ani12050550. [PMID: 35268119 PMCID: PMC8908816 DOI: 10.3390/ani12050550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 01/15/2023] Open
Abstract
In human cardiology, the anatomical origin of ventricular premature depolarizations (VPDs) is determined by the characteristics of a 12-lead electrocardiogram (ECG). Former studies in horses had contradictory results regarding the diagnostic value of the 12-lead ECG and vectorcardiography (VCG), which results were attributed to the different cardiac conduction system in this species. The objective of this study was to determine if the anatomical origin of pacing-induced VPDs could be differentiated in horses based upon VCG characteristics. A 12-lead ECG was recorded in seven horses under general anesthesia while right and left ventricular endomyocardial pacing was performed (800−1000 ms cycle length) at the apex, mid and high septum and mid and high free wall, and at the right ventricular outflow tract. Catheter positioning was guided by 3D electro-anatomical mapping and echocardiography. A median complex, obtained from four consecutive complexes, was calculated for each pacing location and sinus rhythm. The VCG was calculated from the 12-lead ECG-derived median complexes using custom-made algorithms and was used to determine the initial and maximum electrical axes of the QRS complex. An ANOVA for spherical data was used to test if VCGs between each paced location and between pacing and sinus rhythm were significantly (p < 0.05) different. The model included the radius, azimuth and elevation of each electrical axis. Pacing induced significantly different initial and maximum electrical axes between different locations and between pacing and sinus rhythm. The current results suggest that VCG is a useful technique to identify the anatomical origin of ventricular ectopy in horses.
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Hamad AS. Risk of sudden cardiac death and preventive measures in athletes. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2022. [DOI: 10.4103/ijca.ijca_17_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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25
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Parsons IT, Nicol ED, Holdsworth D, Guettler N, Rienks R, Davos CH, Halle M, Parati G. Cardiovascular risk in high-hazard occupations: the role of occupational cardiology. Eur J Prev Cardiol 2021; 29:702-713. [PMID: 34918040 DOI: 10.1093/eurjpc/zwab202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 12/20/2022]
Abstract
Work is beneficial for health, but many individuals develop cardiovascular disease (CVD) during their working lives. Occupational cardiology is an emerging field that combines traditional cardiology sub-specialisms with prevention and risk management unique to specific employment characteristics and conditions. In some occupational settings incapacitation through CVD has the potential to be catastrophic due to the nature of work and/or the working environment. These are often termed 'hazardous' or 'high-hazard' occupations. Consequently, many organizations that employ individuals in high-hazard roles undertake pre-employment medicals and periodic medical examinations to screen for CVD. The identification of CVD that exceeds predefined employer (or regulatory body) risk thresholds can result in occupational restriction, or disqualification, which may be temporary or permanent. This article will review the evidence related to occupational cardiology for several high-hazard occupations related to aviation and space, diving, high altitude, emergency workers, commercial transportation, and the military. The article will focus on environmental risk, screening, surveillance, and risk management for the prevention of events precipitated by CVD. Occupational cardiology is a challenging field that requires a broad understanding of general cardiology, environmental, and occupational medicine principles. There is a current lack of consensus and contemporary evidence which requires further research. Provision of evidence-based, but individualized, risk stratification and treatment plans is required from specialists that understand the complex interaction between work and the cardiovascular system. There is a current lack of consensus and contemporary evidence in occupational cardiology and further research is required.
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Affiliation(s)
- Iain T Parsons
- Academic Department of Military Medicine, Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK.,School of Cardiovascular Medicine and Sciences, King's College London, London, UK
| | - Edward D Nicol
- Academic Department of Military Medicine, Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK.,Faculty of Medicine, Imperial College, London, UK.,Department of Cardiology, Royal Brompton Hospital, London, UK
| | - David Holdsworth
- Academic Department of Military Medicine, Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
| | - Norbert Guettler
- Department of Internal Medicine and Cardiology, German Air Force Centre of Aerospace Medicine, Fuerstenfeldbruck, Germany
| | - Rienk Rienks
- CardioExpert, Outpatient Clinic for Sports and Occupational Cardiology, Amsterdam, The Netherlands
| | - Constantinos H Davos
- Division of Cardiovascular Research, Cardiovascular Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Martin Halle
- Department of Prevention and Sports Medicine, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Cardiovascular Research, DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
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26
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Schiavone M, Gobbi C, Gasperetti A, Zuffi A, Forleo GB. Congenital Coronary Artery Anomalies and Sudden Cardiac Death. Pediatr Cardiol 2021; 42:1676-1687. [PMID: 34459947 DOI: 10.1007/s00246-021-02713-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
Coronary artery anomalies (CAAs) are a heterogeneous group of rare congenital diseases whose features and pathophysiological mechanisms are extremely variable, ranging from silent anomalies to sudden cardiac death (SCD) in the most severe cases. Although rare, congenital CAAs confer a high risk of myocardial ischemia and SCD, especially in young, previously "healthy" athletes during or immediately after vigorous exertion. Although some high-risk features that may lead to SCD have been identified, specific pathophysiological mechanisms related to SCD still remain poorly understood. When a CAA is incidentally diagnosed, optimal SCD risk stratification remains challenging, particularly in cases of anomalous aortic origin of a coronary artery arising from the opposite aortic sinus of Valsalva (ACAOS). In recent times, invasive imaging with intravascular ultrasound has gained a role in further identifying high-risk anatomic features; it has been integrated with traditional, non-invasive anatomic imaging evaluations, typically high-quality echocardiography, and cardiac magnetic resonance. Multidisciplinary programs and specific SCD risk scores should be developed in an endeavor to choose the right therapeutic approach, either clinical or interventional/surgical. Intravascular ultrasound is an extremely useful tool to evaluate vessel stenosis, even if prospective studies are still required to further validate this diagnostic strategy. In the present review, we aimed to analyze the pathophysiology and the clinical impact of ACAOS. We also summarized the predominant mechanisms for interference with normal coronary artery function, which might contribute to the onset of life-threatening arrhythmias and SCD.
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Affiliation(s)
- Marco Schiavone
- Cardiology Unit, ASST Fatebenefratelli Sacco - Luigi Sacco University Hospital, University of Milan, Via G.B. Grassi, 74, 20157, Milan, Italy.
| | - Cecilia Gobbi
- Department of Cardiology, Saint Martin Private Hospital Center, Caen, France
| | - Alessio Gasperetti
- Cardiology Unit, ASST Fatebenefratelli Sacco - Luigi Sacco University Hospital, University of Milan, Via G.B. Grassi, 74, 20157, Milan, Italy.,Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrea Zuffi
- Department of Cardiology, Saint Martin Private Hospital Center, Caen, France
| | - Giovanni Battista Forleo
- Cardiology Unit, ASST Fatebenefratelli Sacco - Luigi Sacco University Hospital, University of Milan, Via G.B. Grassi, 74, 20157, Milan, Italy
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27
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Athlete Preparticipation Physical Evaluation. Sports Med Arthrosc Rev 2021; 29:200-206. [PMID: 34730121 DOI: 10.1097/jsa.0000000000000330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Preparticipation evaluations (PPE) are both a traditional and legal requirement by many governing bodies for sport. The ideal goal of the PPE is safe participation in sport for athletes. This article provides an overview of common PPE elements and current best practice recommendations. Descriptions of every possible examination are published elsewhere and are beyond the intent of this article. Additional considerations for transgender, masters athletes, and Special Olympians are also outside the scope of this review, but are well covered in The Preparticipation Physical Evaluation, fifth edition monograph.
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28
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Wang L, Yeo TJ, Tan B, Destrube B, Tong KL, Tan SY, Chan G, Huang Z, Tan F, Wang YC, Lee JY, Fung E, Mak GYK, So R, Wanlapakorn C, Ambari AM, Cuenza L, Koh CH, Tan JWC. Asian Pacific Society of Cardiology Consensus Recommendations for Pre-participation Screening in Young Competitive Athletes. Eur Cardiol 2021; 16:e44. [PMID: 34815752 PMCID: PMC8591617 DOI: 10.15420/ecr.2021.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/30/2021] [Indexed: 01/05/2023] Open
Abstract
Sports-related sudden cardiac death is a rare but devastating consequence of sports participation. Certain pathologies underlying sports-related sudden cardiac death could have been picked up pre-participation and the affected athletes advised on appropriate preventive measures and/or suitability for training or competition. However, mass screening efforts - especially in healthy young populations - are fraught with challenges, most notably the need to balance scarce medical resources and sustainability of such screening programmes, in healthcare systems that are already stretched. Given the rising trend of young sports participants across the Asia-Pacific region, the working group of the Asian Pacific Society of Cardiology (APSC) developed a sports classification system that incorporates dynamic and static components of various sports, with deliberate integration of sports events unique to the Asia-Pacific region. The APSC expert panel reviewed and appraised using the Grading of Recommendations Assessment, Development, and Evaluation system. Consensus recommendations were developed, which were then put to an online vote. Consensus was reached when 80% of votes for a recommendation were agree or neutral. The resulting statements described here provide guidance on the need for cardiovascular pre-participation screening for young competitive athletes based on the intensity of sports they engage in.
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Affiliation(s)
- Luokai Wang
- National Heart Centre Singapore Singapore.,Sengkang General Hospital Singapore
| | | | | | | | | | | | - Gregory Chan
- The Occupational and Diving Medicine Centre Singapore
| | | | - Frankie Tan
- Sports Science and Medicine Centre, Singapore Sports Institute Singapore
| | - Yu Chen Wang
- Department of Cardiology, Department of Internal Medicine, Asia University Hospital Taichung City, Taiwan
| | - Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine Seoul, Republic of Korea
| | - Erik Fung
- The Chinese University of Hong Kong Hong Kong
| | | | - Raymond So
- Elite Training Science & Technology, Hong Kong Sports Institute Hong Kong
| | | | - Ade Meidian Ambari
- National Cardiovascular Center Harapan Kita, Department of Cardiology and Vascular Medicine, University of Indonesia Jakarta, Indonesia
| | - Lucky Cuenza
- Sports and Exercise Medicine Center, Medical Center Manila Philippines
| | | | - Jack Wei Chieh Tan
- National Heart Centre Singapore Singapore.,Sengkang General Hospital Singapore
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29
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Albiński M, Saubade M, Menafoglio A, Meyer P, Capelli B, Perrin T, Trachsel L, Hagemeyer D, Casagrande D, Wilhelm M, Benaim C, Pirrello T, Albrecht S, Schmied C, Mivelaz Y, Tercier S, Baggish A, Gabus V. Diagnostic yield and cost analysis of electrocardiographic screening in Swiss paediatric athletes. J Sci Med Sport 2021; 25:281-286. [PMID: 34895837 DOI: 10.1016/j.jsams.2021.11.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Athletes performing sports on high level are at increased risk for sudden cardiac death. This includes paediatric athletes, even though data on screening strategies in this age group remain scarce. This study aimed to assess electrocardiogram interpretation criteria in paediatric athletes and to evaluate the cost of screening. METHODS National, multicentre, retrospective, observational study on 891 athletes of paediatric age (<18 years) evaluated by history, physical examination and 12-lead electrocardiogram. The primary outcome measure was abnormal electrocardiogram findings according to the International Recommendations for Electrographic Interpretation in Athletes. The secondary outcome measure was cost of screening. RESULTS 19 athletes (2.1%) presented abnormal electrocardiogram findings requiring further investigations, mainly abnormal T-wave inversion. These 19 athletes were predominantly males, performing endurance sports with a mean volume of 10 weekly hours for a mean duration of 6 years of training. Further investigations did not identify any relevant pathology. All athletes were cleared for competition with regular follow-up. Total costs of the screening were 108,860 USD (122 USD per athlete). CONCLUSIONS Our study using the International Recommendations for Electrographic Interpretation in Athletes identified a low count of abnormal findings in paediatric athletes, yet raising substantially the cost of screening. Hence, the utility of electrocardiogram-inclusive screening of paediatric athletes remains to be elucidated by longitudinal data.
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Affiliation(s)
- M Albiński
- Division of Paediatrics, Lausanne University Hospital, Switzerland.
| | - M Saubade
- Centre of Sports Medicine, Division of Physical and Rehabilitation Medicine, Lausanne University Hospital, Switzerland; Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland; SportAdo Centre, Department of Woman-Mother-Child, Lausanne University Hospital, Switzerland
| | - A Menafoglio
- Department of Cardiology, San Giovanni Hospital Bellinzona, Switzerland
| | - P Meyer
- Service of Cardiology, University Hospital Geneva, Switzerland
| | - B Capelli
- Department of Cardiology, Cardiocentro Ticino, Switzerland
| | - T Perrin
- Department of Cardiology, Inselspital, University Hospital Bern, Bern University, Switzerland
| | - L Trachsel
- Department of Cardiology, Inselspital, University Hospital Bern, Bern University, Switzerland
| | - D Hagemeyer
- Department of Cardiology, Inselspital, University Hospital Bern, Bern University, Switzerland
| | - D Casagrande
- Department of Cardiology, Inselspital, University Hospital Bern, Bern University, Switzerland
| | - M Wilhelm
- Department of Cardiology, Inselspital, University Hospital Bern, Bern University, Switzerland
| | - C Benaim
- Centre of Sports Medicine, Division of Physical and Rehabilitation Medicine, Lausanne University Hospital, Switzerland
| | - T Pirrello
- Swiss Federal Institute of Sports, Switzerland
| | - S Albrecht
- Swiss Federal Institute of Sports, Switzerland
| | - C Schmied
- Department of Cardiology, University Heart Centre Zurich, University of Zurich, Switzerland
| | - Y Mivelaz
- Paediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital, Switzerland
| | - S Tercier
- SportAdo Centre, Department of Woman-Mother-Child, Lausanne University Hospital, Switzerland
| | - A Baggish
- Division of Cardiology, Massachusetts General Hospital, United States of America
| | - V Gabus
- Department of Cardiology, Lausanne University Hospital, Switzerland
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30
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Ionescu AM, Pitsiladis YP, Rozenstoka S, Bigard X, Löllgen H, Bachl N, Debruyne A, Pigozzi F, Casasco M, Jegier A, Smaranda AM, Caramoci A, Papadopoulou T. Preparticipation medical evaluation for elite athletes: EFSMA recommendations on standardised preparticipation evaluation form in European countries. BMJ Open Sport Exerc Med 2021; 7:e001178. [PMID: 34745648 PMCID: PMC8527121 DOI: 10.1136/bmjsem-2021-001178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2021] [Indexed: 01/12/2023] Open
Abstract
Sports medicine is a medical specialty that supports the performance of professional and amateur athletes while maintaining their health. Sports medicine professionals need to ensure the safe participation of athletes in sports activities achieved through a periodical preparticipation evaluation (PPE) and a regular medical monitoring of the athletes’ health in accordance with the latest recommendations regarding health condition and medical history, physical working capacity, training period and programme, recovery, nutrition, use of supplements, injuries prevention and safe return to play. In order to harmonise these national variations in the content and application of the PPE, the EFSMA Scientific and Educational Commission proposes a ‘gold standard’ for elite athletes across Europe. Important objectives of PPE are early detection and prevention of severe complications during sports activities both in leisure time and competitive sports. The PPE should entail the following diagnostic components: health status, anthropometry, functional and exercise capacity. It is of utmost importance to develop and implement preventive strategies such as the PPE. Besides monitoring the health status of athletes, the PPE plays an important role in the selection process, bringing valuable information for coaches and supporting a personalised treatment approach. Screening of athletes through a standardised digital PPE could be beneficial for a better understanding of the impact of long-term physical activity. Furthermore, PPE leads the scientific community to a way of working closer together in the interest of the athletes.
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Affiliation(s)
- Anca Mirela Ionescu
- European Federation of Sports Medicine Associations, Lausanne, Switzerland.,Sports Medicine, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania
| | - Yannis P Pitsiladis
- European Federation of Sports Medicine Associations, Lausanne, Switzerland.,Collaborating Centre of Sports Medicine, University of Brighton, Eastbourne, UK
| | - Sandra Rozenstoka
- European Federation of Sports Medicine Associations, Lausanne, Switzerland.,Sports Medicine and Rehabilitation Centre, Riga Stradins University, Riga, Latvia
| | - Xavier Bigard
- European Federation of Sports Medicine Associations, Lausanne, Switzerland.,Union Cycliste Internationale, Aigle, Switzerland
| | - Herbert Löllgen
- European Federation of Sports Medicine Associations, Lausanne, Switzerland.,Practice for Cardiology, Sports Medicine, Remscheid, Germany
| | - Norbert Bachl
- European Federation of Sports Medicine Associations, Lausanne, Switzerland.,Austrian Institute of Sports Medicine, Vienna, Austria
| | - Andre Debruyne
- European Federation of Sports Medicine Associations, Lausanne, Switzerland
| | - Fabio Pigozzi
- European Federation of Sports Medicine Associations, Lausanne, Switzerland.,Sports Medicine Unit, University of Rome Foro Italico, Rome, Italy
| | - Maurizio Casasco
- European Federation of Sports Medicine Associations, Lausanne, Switzerland.,Italian Sports Medicine Federation, Rome, Italy
| | - Anna Jegier
- European Federation of Sports Medicine Associations, Lausanne, Switzerland.,Sports Medicine, Medical University of Lodz, Lodz, Poland
| | - Alina Maria Smaranda
- Sports Medicine, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania
| | - Adela Caramoci
- Sports Medicine, Carol Davila University of Medicine and Pharmacy, Bucuresti, Romania
| | - Theodora Papadopoulou
- European Federation of Sports Medicine Associations, Lausanne, Switzerland.,Lower Limbs- ADMR Hip & Groin, Defence Medical Rehabilitation Centre Headley Court, Loughborought, UK
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31
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Differences in American Athletes Undergoing Preparticipation Examination by Sex, Participation Level, and Age. Clin J Sport Med 2021; 31:e432-e441. [PMID: 32073474 DOI: 10.1097/jsm.0000000000000807] [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] [Received: 01/30/2019] [Accepted: 08/17/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the preparticipation examination findings among American athletes by sex, participation level, and age. DESIGN Hypothesis-generating retrospective cohort study. SETTING Saint-Luke's Athletic Heart Center, Kansas City, Missouri. PARTICIPANTS A total of 2954 student athletes. INTERVENTIONS Athletes underwent preparticipation examination, which included history and physical, electrocardiogram, and 2-D transthoracic echocardiogram. MAIN OUTCOME MEASURES Differences noted on screening preparticipation examination by sex, participation level, and age. RESULTS Female athletes reported more symptoms than male athletes (odds ratio [OR] = 1.61; 95% confidence interval [CI], 1.32-1.97; P < 0.0001) but had lower prevalence of abnormal electrocardiogram (OR 0.52; CI, 0.39-0.68; P < 0.0001). College athletes reported fewer symptoms than novice athletes (OR 0.35; CI, 0.29-0.43; P < 0.0001) with no difference in the prevalence of abnormal electrocardiography (ECG) (OR 0.96; CI, 0.73-1.26; P = 0.78). Older athletes reported fewer symptoms than younger athletes (OR 0.61; CI, 0.52-0.71; P < 0.0001) with no difference in the prevalence of abnormal ECG (OR 1.00; CI, 0.81-1.23; P = 0.89). There were 43 athletes with clinically important findings with no difference in prevalence of these findings across sex, participation level, and age. CONCLUSIONS Among this American cohort of athletes, male athletes reported fewer symptoms and had higher prevalence of abnormal ECG findings compared with female athletes. College and older athletes reported fewer symptoms and had no difference in prevalence of abnormal ECG findings compared with novice and younger athletes, respectively. Despite these differences between groups, the prevalence of clinically important findings was comparable among groups.
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32
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Šarčević Z, Tepavčević A. Increased number of electrocardiogram findings requiring additional cardiac examination in young athletes during the coronavirus disease 2019 pandemic: a case series. J Int Med Res 2021; 49:3000605211053280. [PMID: 34693778 PMCID: PMC8551426 DOI: 10.1177/03000605211053280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We aimed to compare the results of electrocardiogram (ECG) examinations in young athletes from 2017 to 2020, which includes a period during the coronavirus disease 2019 (COVID-19) pandemic, with special attention to T-wave inversion that might be a sign of myocarditis. This was a retrospective observational study. We reviewed data of ECG examinations among 640 young athletes aged 10 to 14 years (160 in each year from 2017–2020). The setting was Novi Sad Sports Medicine Center in Serbia. We hypothesized that most young athletes with changes on ECG had asymptomatic COVID-19. In the group from 2020, there were significantly more ECG findings requiring additional cardiac examination, according to modern sports cardiology, compared with previous years. We describe one case of documented asymptomatic COVID-19 infection and with T-wave inversion in V4 and V5. The number of schoolchildren with asymptomatic COVID-19 infection might be high because most classes in Novi Sad were conducted face-to-face during 2020. Because a serious risk of myocarditis exists in young athletes, especially in relation to COVID-19 infection, a careful sports preparticipation examination is important to identify athletes possibly requiring additional testing and medical care prior to a return to sports.
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Affiliation(s)
- Zoran Šarčević
- Novi Sad Health Care Centre, Sports Medicine Centre, Novi Sad, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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Maurizi N, Baldi M, Castelletti S, Lisi C, Galli M, Bianchi S, Panzera F, Fumagalli C, Mochi N, Parati G, Olivotto I, Cecchi F. Age-dependent diagnostic yield of echocardiography as a second-line diagnostic investigation in athletes with abnormalities at preparticipation screening. J Cardiovasc Med (Hagerstown) 2021; 22:759-766. [PMID: 34230438 DOI: 10.2459/jcm.0000000000001215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Systematic pre-participation screening of subjects practicing sports activity has the potential to identify athletes at risk of sudden cardiac death. However, limited evidence are present concerning the yield of echocardiography as a second-line exam in athletes with abnormal pre-participation screening. METHODS Consecutive athletes were screened (2011-2017) in a community-based sports medicine center in Tuscany, with familial history, physical examination and ECG. Patients with abnormal/>1 borderline ECG findings, symptoms/signs of cardiovascular diseases, cardiovascular risk factors or family history of juvenile/genetic cardiac disease underwent echocardiography. RESULTS A total of 30109 athletes (age 21 [15;31]) were evaluated. Of these, 6234 (21%) were aged 8-11 years, 18309 (61%) 12-18 years, 4442 (15%) 19-35 years, 1124 (4%) >35 years. A total of 2569 (9%) athletes were addressed to echocardiography. Referral rates increased significantly with age (5% in preadolescents to 38% in master athletes, P< 0.01). Subclinical heart diseases were found in 290/30109 (0.8%) and were common >35 years (135/1124, 11%), but rare at 19-35 years (91/4442, 2%), very rare <18 years (64/24 543, 0.2%; P< 0.01). Seventy-four (0.3%) athletes were disqualified because of the structural alterations identified, 29 (0.1%) with cardiac structural diseases at risk for sudden death. CONCLUSIONS Italian community-based pre-participation screening showed an age-dependent yield, with a three-fold increase in referral in athletes >35 years. Subclinical structural abnormalities potentially predisposing to sudden death were rare (0.01%), mostly in post-pubertal and senior athletes. Age-specific pre-participation screening protocols may help optimize resources and improve specificity.
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Affiliation(s)
- Niccolò Maurizi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
- Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Massimo Baldi
- Complex Operative Unit, USL Tuscany Center, Pistoia, Italy
| | - Silvia Castelletti
- Department of Cardiovascular, Neural and Metabolic Sciences, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
| | - Corrado Lisi
- Complex Operative Unit, USL Tuscany Center, Pistoia, Italy
| | - Michele Galli
- Complex Operative Unit, USL Tuscany Center, Pistoia, Italy
| | | | | | - Carlo Fumagalli
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Nicola Mochi
- Complex Operative Unit, USL Tuscany Center, Pistoia, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Franco Cecchi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
- Department of Cardiovascular, Neural and Metabolic Sciences, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
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34
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Feasibility of a Novel Strategy for Cardiovascular Screening During the Preparticipation Physical Examination. Clin J Sport Med 2021; 31:407-413. [PMID: 31789870 DOI: 10.1097/jsm.0000000000000770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 05/21/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the feasibility of simultaneously conducting history and physical (H&P), limb-lead electrocardiogram (ECG), and preparticipation echocardiography by frontline providers (PEFP) at one screening station. METHODS This cross-sectional study compares limb-lead versus 12-lead ECG as part of a preparticipation physical examination (PPE) including H&P and PEFP conducted in year 1 and year 2 on 2 cohorts (n = 36, n = 53, respectively) of college athletes at one institution. Year 1 screening was conducted at 3 stations, one station per screening component. Time to complete each station was recorded, and total time for screening was the summation of times for each station. Year 2 screening was conducted at one station; timing began when the patient entered the room and ended when all 3 components of screening were complete. An unpaired t test was used to compare the mean time difference between years 1 and 2 screening stations. RESULTS Year 1 screening time was significantly longer than time to complete cardiac screening using the year 2 protocol (10.51 ± 1.98 vs 3.96 ± 1.43 minutes, respectively; P < 0.001). Five athletes in year 1 and 3 athletes in year 2 were referred to cardiology for further evaluation; all athletes were ultimately cleared to participate. CONCLUSIONS A comprehensive PPE can be completed in a timely fashion using a single screening station and limb-lead ECG to improve efficiency, while still allowing providers to gather information on history, physical examination, heart rhythm, and heart structure. This strategy may serve as a potential solution in the longstanding debate over best practices for PPEs.
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35
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Le HM, Downey BC, Lanois CJ, Miller PE, Stein CJ, Kerkhof DL, Corrado GD. Comparison of the Limb-lead Electrocardiogram to the 12-Lead Electrocardiogram for Identifying Conditions Associated with Sudden Cardiac Death in Youth Athletes. Am J Cardiol 2021; 152:146-149. [PMID: 34237610 DOI: 10.1016/j.amjcard.2021.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/19/2022]
Abstract
The optimal screening strategy to prevent sudden cardiac death (SCD) in athletes remains unknown. Pre-participation screening with electrocardiogram (ECG) remains controversial. The utility and accuracy of limb-lead (LL) ECG alone in identifying cardiac abnormalities associated with SCD has not been studied. This study was a comparative secondary data analysis, comparing the interpretation accuracy of 4 physicians evaluating publicly available ECGs of the most common cardiac conditions associated with SCD in athletes. Each physician interpreted a total of 100 ECGs: 50 normal ECGs (25 LL and 25 standard 12L) and 50 abnormal ECGs (25 LL and 25 standard 12L). The agreement between LL ECGs and 12L ECGs was assessed by Cohen's kappa coefficient and the accuracy of identifying an abnormal ECG was compared across LL and 12L ECGs using a chi-squared test. Inter-rater reliability was assessed by estimating the Fleiss's kappa coefficient. The sensitivity of LL ECG and 12L ECG was identical at 86%. The specificity of LL ECG was 75% (95% CI = 65% to 83%) and 12L ECG was 82% (95% CI = 73% to 89%). Substantial agreement was seen between LL ECG and 12L ECG interpretation across all readers (k = 0.63; 95% CI = 0.49 to 0.77). Interpretation accuracy was 81% (95% CI = 74% to 86%) and 84% (95% CI 78% to 89%) using LL ECG and 12L ECG, respectively (p = 0.43). In conclusion, the accuracy, sensitivity, and specificity were high and comparable for both LL ECG and 12L ECG in identifying cardiovascular conditions associated with SCD. Agreement between LL ECG and 12L ECG was substantial.
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MESH Headings
- Arrhythmogenic Right Ventricular Dysplasia/complications
- Arrhythmogenic Right Ventricular Dysplasia/diagnosis
- Arrhythmogenic Right Ventricular Dysplasia/physiopathology
- Athletes
- Brugada Syndrome/complications
- Brugada Syndrome/diagnosis
- Brugada Syndrome/physiopathology
- Cardiomyopathy, Dilated/complications
- Cardiomyopathy, Dilated/diagnosis
- Cardiomyopathy, Dilated/physiopathology
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/physiopathology
- Cardiovascular Diseases/complications
- Cardiovascular Diseases/diagnosis
- Cardiovascular Diseases/physiopathology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Electrocardiography/methods
- Humans
- Long QT Syndrome/complications
- Long QT Syndrome/diagnosis
- Long QT Syndrome/physiopathology
- Mass Screening
- Myocarditis/complications
- Myocarditis/diagnosis
- Myocarditis/physiopathology
- Wolff-Parkinson-White Syndrome/complications
- Wolff-Parkinson-White Syndrome/diagnosis
- Wolff-Parkinson-White Syndrome/physiopathology
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Affiliation(s)
- Hung M Le
- Boston Children's Hospital, Department of Orthopedics, Division of Sports Medicine, Boston, Massachusetts.
| | - Brian C Downey
- Tufts Medical Center, Division of Cardiology, Boston, Massachusetts
| | - Corey J Lanois
- Boston Children's Hospital, Department of Orthopedics, Division of Sports Medicine, Boston, Massachusetts
| | - Patricia E Miller
- Boston Children's Hospital, Department of Orthopedics, Division of Sports Medicine, Boston, Massachusetts
| | - Cynthia J Stein
- Boston Children's Hospital, Department of Orthopedics, Division of Sports Medicine, Boston, Massachusetts
| | | | - Gianmichel D Corrado
- Boston Children's Hospital, Department of Orthopedics, Division of Sports Medicine, Boston, Massachusetts; Northeastern University, Boston, Massachusetts
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Ishihara R, Barros MPD, Silva CMD, Borges LDS, Hatanaka E, Lambertucci RH. Melatonin improves the antioxidant capacity in cardiac tissue of Wistar rats after exhaustive exercise. Free Radic Res 2021; 55:776-791. [PMID: 34100318 DOI: 10.1080/10715762.2021.1939024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
We investigated the effects of melatonin on the onset and resolution of the oxidative stress in the cardiac muscle in melatonin-treated and nontreated rats subjected to an exhaustive exercise session. Forty male rats were divided into: melatonin-treated (20 mg/kg supplemented for 10 d) and control. On the 10th day, each group was subdivided according to euthanasia moments: control or melatonin-treated not exercised (C0h and M0h); immediately after the exercise (CIA and MIA); and 2 h after exercise (C2h and M2h). The heart of animals was removed and the levels of oxidative stress index (OSI) and the formation of thiobarbituric acid reactive substances (TBARS), protein carbonyl, and the activities of aconitase, catalase (CAT), glutathione peroxidase (GPx), and superoxide dismutase (SOD) were evaluated. Total antioxidant status (TAS), total oxidant status (TOS), and the protein expression of CAT, GPx, and SOD was also measured. Our data revealed significant differences on: (i) OSI (p=.029), CAT activity (p=.016), CAT content (p<.001), GPx content (p=.014), reduced glutathione levels (p<.001), and aconitase activity (p<.001) for interaction of melatonin; (ii) GPx activity (p=.005), reduced glutathione (p=.004), protein carbonyl (p=.035), and TBARS levels (p=.028) between groups, and (iii) TBARS levels (p=.016) for significance between moments. Although the exhaustive exercise protocol imposed mild oxidative stress on the cardiac tissue of rats, melatonin induced antioxidant responses that rebalanced the redox status of the cardiac tissue, especially after exhaustive exercise.
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Affiliation(s)
- Rafael Ishihara
- Department of Biosciences, Federal University of Sao Paulo, Santos, Brazil
| | - Marcelo Paes de Barros
- Institute of Physical Activity Sciences and Sports (ICAFE), Cruzeiro do Sul University, São Paulo, Brazil
| | | | - Leandro da Silva Borges
- Institute of Physical Activity Sciences and Sports (ICAFE), Cruzeiro do Sul University, São Paulo, Brazil
| | - Elaine Hatanaka
- Institute of Physical Activity Sciences and Sports (ICAFE), Cruzeiro do Sul University, São Paulo, Brazil
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Chung EH, Shantha G. My Approach to Sudden Death Risk Evaluation in Athletes, Who Should Play and Who Can Return to Play? CURRENT CARDIOVASCULAR RISK REPORTS 2021. [DOI: 10.1007/s12170-021-00675-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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38
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Lear A, Patel N, Mullen C, Simonson M, Leone V, Koshiaris C, Nunan D. Screening electrocardiogram in young athletes and military members: a systematic review and meta-analysis. J Athl Train 2021; 57:444-451. [PMID: 34038955 PMCID: PMC9205557 DOI: 10.4085/1062-6050-0746.20] [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: 11/09/2022]
Abstract
OBJECTIVE To determine the effect of electrocardiogram (ECG) screening on prevention of sudden cardiac arrest and death (SCA/D) in young athletes and military members. DATA SOURCES MEDLINE, Embase, Cochrane CENTRAL, Web of Science, BIOSIS, Scopus, SPORT discus, PEDro, and clinicaltrials.gov were searched from inception to dates between 2/21/19 and 7/29/19. STUDY SELECTION Randomized and non-randomized controlled trials, where pre-participation examination including ECG was the primary intervention used to screen athletes or military 40 years of age or younger. Accepted controls were no screening, usual care, or pre-participation examination without ECG. 3 published studies , and one conference abstract were identified for inclusion. DATA EXTRACTION In all four studies, risk of bias was assessed with the Cochrane risk of bias tool, and found to be generally high. Two studies had data extracted for random effects meta-analysis, and the remaining study and conference abstract were included in narrative review. Overall quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Data Synthesis: Four non-randomized studies (11,689,172 participants) were included, all at high risk of bias. Pooled data from two studies (n= 3,869,274; very low quality evidence) observed an inconclusive 42% relative decrease in risk of sudden cardiac death (RR 0.58; 95% CI 0.23, 1.45), equating to an absolute risk reduction of .0016% The findings were consistent with a potential 67% relative decrease to a 45% relative increased risk in participants screened with ECG. Heterogeneity was found to be high as measured with I2 statistic (71%). Data from the remaining study and abstract were similarly inconclusive. CONCLUSION Existing evidence for the effect of ECG screening is inconclusive and of very low quality. Our meta-analysis observed that screening ECG may result in considerable benefit or harm to participants. Higher quality studies are needed to reduce this uncertainty. PROSPERO Registration: CRD42019125560.
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Affiliation(s)
- Aaron Lear
- Cleveland Clinic Akron General, Akron, OH USA
| | | | | | | | - Vince Leone
- Northeast Ohio Medical University (NEOMED), Akron, OH USA
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39
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Patel R, Kemp CL, Hafejee M, Peckham N, Jain V, McCann GP, Pallikadavath S. The Underrepresentation of Females in Studies Assessing the Impact of High-Dose Exercise on Cardiovascular Outcomes: a Scoping Review. SPORTS MEDICINE-OPEN 2021; 7:30. [PMID: 33914201 PMCID: PMC8085142 DOI: 10.1186/s40798-021-00320-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/18/2021] [Indexed: 11/24/2022]
Abstract
High-dose exercise-induced cardiac outcomes may vary between sexes. However, many studies investigating the cardiovascular effects of high-dose exercise have excluded or under-recruited females. This scoping review aimed to describe the recruitment of females in studies assessing the impact of high-dose exercise on cardiovascular outcomes and describe how this has changed over time. This scoping review followed the protocol outlined by Arksey and O’Malley and is reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. The OVID and EMBASE databases were searched for studies that assessed the effects of high-dose exercise on cardiovascular outcomes. Both professional and nonprofessional groups were included. The review found 2973 studies, and 250 met the inclusion criteria including cumulatively 17,548,843 subjects. Over half the studies (n = 127) excluded females entirely, and only 8 (3.2%) studies recruited all-female participants. The overall mean percentage of females recruited was 18.2%. The mean percentage was 14.5% in studies conducted before 2011 and 21.8% in studies conducted after 2011. Females are an underrepresented group in studies assessing the cardiovascular outcomes related to high-dose exercise. As cardiovascular outcomes vary between sexes, translating findings from a largely male-based evidence may not be appropriate. Future investigators should aim to establish and overcome barriers to female recruitment.
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Affiliation(s)
- Roshan Patel
- College of Life Sciences, University of Leicester, Leicester, UK
| | - Caitlin L Kemp
- College of Life Sciences, University of Leicester, Leicester, UK
| | | | - Nicholas Peckham
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Vageesh Jain
- Institute for Global Health, University College London, London, UK
| | - Gerry P McCann
- NIHR Leicester Biomedical Research Centre for Cardiovascular Disease, Glenfield Hospital, University of Leicester, Leicester, UK
| | - Susil Pallikadavath
- NIHR Leicester Biomedical Research Centre for Cardiovascular Disease, Glenfield Hospital, University of Leicester, Leicester, UK.
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40
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Jefferson KA. Implementing a Standardized Cardiac Protocol for the Adolescent Preparticipation Sports Examination. J Pediatr Health Care 2021; 35:188-195. [PMID: 33358687 DOI: 10.1016/j.pedhc.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/28/2020] [Accepted: 10/03/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION To evaluate adolescent athletes for cardiovascular (CV) abnormalities before engaging in competitive sports, the American Heart Association guidelines recommend preparticipation screening. The initiative aimed to implement a standardized protocol to increase the identification of CV abnormalities during athletic physical examinations. METHOD A rapid-cycle model with four Plan-Do-Study-Act cycles was implemented in two urgent care clinics. Providers used a CV-specific screening checklist; parents were engaged in a discussion about the importance of this screening, and team engagement activities were used. Outcomes were measured with chart audits and surveys. RESULTS Because of the intervention, 62% of athletes were screened, with 29% identified as having a CV risk. The satisfaction of the patients and the team increased by 3% and 62.5%, respectively. DISCUSSION Despite competing foci in the clinics, athletes were properly screened using a standardized checklist, which is easily sustainable and can be duplicated in other settings.
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41
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Sokunbi OJ, Okoromah CAN, Ekure EN, Olawale OA, Eke WS. Electrocardiographic pattern of apparently healthy African adolescent athletes in Nigeria. BMC Pediatr 2021; 21:97. [PMID: 33632178 PMCID: PMC7905616 DOI: 10.1186/s12887-021-02557-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 02/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background Strategies to prevent sudden cardiac death (SCD) among young athletes have become topical worldwide and unrecognized cardiac pathology has been identified as a leading cause. Black ethnicity has been reported as an independent predictor of abnormal electrocardiography (ECG) findings among athletes and the frequency and significance of training-related ECG findings versus findings suggestive of an underlying pathology in the young African athletes is crucial. Methods This cross sectional study aimed to determine the prevalence and distribution of ECG patterns in young athletes and controls. A total of 360 participants (180 athletes and 180 controls) were recruited from six secondary schools in Lagos, Nigeria between November 2014 and July 2015. Evaluation included interviewer-administered questionnaires for relevant history, physical examination and resting 12 - lead ECG for each participant. Results Abnormal ECG patterns were found in 48.3% of athletes and 35.6% of controls. Training-related ECG findings occurred in 33.3% of athletes and 18.3% of controls. Athletes and controls had 7.7% prevalence of training un-related ECG patterns respectively. Left ventricular hypertrophy was the most common ECG finding among the athletes and male athletes had a higher prevalence of ECG abnormalities compared to females. Conclusion Adolescent athletes in Nigeria have a high prevalence of training-related ECG patterns and athletes and non-athletes alike have similar proportions of ECG findings suggestive of underlying structural heart disease. Cardiovascular evaluation including ECG should be performed for young athletes prior to competition at any level and should also be considered as part of pre-school entry assessment for all children. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02557-8.
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Affiliation(s)
- Ogochukwu J Sokunbi
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Lagos / Lagos University Teaching Hospital, Lagos, Nigeria.
| | - Christy A N Okoromah
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Lagos / Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ekanem N Ekure
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Lagos / Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olajide A Olawale
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Lagos / Lagos University Teaching Hospital, Lagos, Nigeria
| | - Wuraola S Eke
- Department of Nursing Services, Lagos University Teaching Hospital, Lagos, Nigeria
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Dhutia H, Malhotra A, Finocchiaro G, Parpia S, Bhatia R, D'Silva A, Gati S, Mellor G, Narain R, Chandra N, Behr E, Tome M, Papadakis M, Sharma S. Diagnostic yield and financial implications of a nationwide electrocardiographic screening programme to detect cardiac disease in the young. Europace 2021; 23:1295-1301. [PMID: 33570096 PMCID: PMC8350863 DOI: 10.1093/europace/euab021] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Indexed: 01/08/2023] Open
Abstract
Aims There is limited information on the role of screening with electrocardiography (ECG)
for identifying cardiovascular diseases associated with sudden cardiac death (SCD) in a
non-select group of adolescents and young adults in the general population. Methods and results Between 2012 and 2014, 26 900 young individuals (aged 14–35 years) were prospectively
evaluated with a health questionnaire and ECG. Individuals with abnormal results
underwent secondary investigations, the costs of which were being based on the UK
National Health Service tariffs. Six hundred and seventy-five (2.5%) individuals
required further investigation for an abnormal health questionnaire, 2175 (8.1%) for an
abnormal ECG, and 114 (0.5%) for both. Diseases associated with young SCD were
identified in 88 (0.3%) individuals of which 15 (17%) were detected with the health
questionnaire, 72 (81%) with ECG and 2 (2%) with both. Forty-nine (56%) of these
individuals received medical intervention beyond lifestyle modification advice in the
follow-up period of 24 months. The overall cost of the evaluation process was €97 per
person screened, €17 834 per cardiovascular disease detected, and €29 588 per
cardiovascular disease associated with SCD detected. Inclusion of ECG was associated
with a 36% cost reduction per diagnosis of diseases associated with SCD compared with
the health questionnaire alone. Conclusion The inclusion of an ECG to a health questionnaire is associated with a five-fold
increase in the ability to detect disease associated with SCD in young individuals and
is more cost effective for detecting serious disease compared with screening with a
health questionnaire alone.
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Affiliation(s)
- Harshil Dhutia
- Department of Cardiology, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK.,Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's, University of London University of London, UK
| | - Aneil Malhotra
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's, University of London University of London, UK.,Division of Cardiovascular Sciences, University of Manchester and Manchester Foundation NHS Trust, Manchester, UK
| | - Gherardo Finocchiaro
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's, University of London University of London, UK
| | - Sameer Parpia
- Ontario Clinical Oncology Group, McMaster University, Hamilton, ON, Canada
| | - Raghav Bhatia
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's, University of London University of London, UK
| | - Andrew D'Silva
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's, University of London University of London, UK
| | - Sabiha Gati
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's, University of London University of London, UK
| | - Greg Mellor
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's, University of London University of London, UK
| | - Rajay Narain
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's, University of London University of London, UK
| | - Navin Chandra
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's, University of London University of London, UK
| | - Elijah Behr
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's, University of London University of London, UK
| | - Maite Tome
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's, University of London University of London, UK
| | - Michael Papadakis
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's, University of London University of London, UK
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's, University of London University of London, UK
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43
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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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44
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Jones JC, Sugimoto D, Kobelski GP, Rao P, Miller S, Koilor C, Corrado GD, Shipon DM. Parameters of cardiac symptoms in young athletes using the Heartbytes database. PHYSICIAN SPORTSMED 2021; 49:37-44. [PMID: 32281468 DOI: 10.1080/00913847.2020.1755908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: To determine clinical parameters that are related to abnormal cardiac symptoms in physically active youth. Methods: We used Simon's Heart Heartbytes National Youth Cardiac Registry to collect data from adolescent athletes in southeastern Pennsylvania. We collected age, race/ethnicity, abnormal cardiac symptoms, medical history, medication use, caffeine intake, and family history. We obtained height, weight, blood pressure, cardiac murmur findings, and ECGs. Echocardiogram was obtained if necessary. Binary logistic regression analysis was performed to identify independent associations between abnormal cardiac symptoms and collected variables. The odds ratio (OR), 95% confidence interval (95% CI), and p-values were used as statistical values. Results: Of the 887 athletes (543 males and 344 females, age = 16.9 ± 2.1 years, height = 166.9 ± 11.4 cm, weight = 62.0 ± 16.0 kg), 186 (21%) had abnormal cardiac symptoms including chest pain, passing out, difficulty breathing, extreme fatigue, and heart race. There was an independent association between abnormal symptoms and a past medical history (OR: 4.77, 95%CI: 3.18, 7.17, p = 0.001) and medication use (OR: 1.74, 95%CI: 1.08, 2.79, p = 0.022). In medical history, young athletes with asthma showed a greater propensity of abnormal cardiac symptoms (48.9%) compared to young athletes without (14.0%, p = 0.001). Additionally, young athletes with anxiety or depression demonstrated a higher proportion of abnormal cardiac symptoms (48.9%) than those without (19.5%, p = 0.001). Although the association between the presence of abnormal symptoms and African-American race (OR: 2.04, 95%CI: 0.96, 4.35, p = 0.065) and average daily consumption of at least 2 caffeine drinks (OR: 2.08, 95%CI: 0.86, 5.02, p = 0.103) were not significant, there was a trend to reach the a priori significance level. Conclusions: This study identified several clinical parameters that are associated with symptoms suggestive of abnormal cardiac conditions. Larger studies need to be done to better sort out the clinical history that may contribute to false positives to further reduce false positives at heart screenings.
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Affiliation(s)
- Jacob C Jones
- The Micheli Center for Sports Injury Prevention , Waltham, MA, USA.,Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital , Waltham, MA, USA.,Department of Orthopaedic Surgery, Harvard Medical School , Boston, MA, USA
| | - Dai Sugimoto
- The Micheli Center for Sports Injury Prevention , Waltham, MA, USA.,Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital , Waltham, MA, USA.,Department of Orthopaedic Surgery, Harvard Medical School , Boston, MA, USA
| | - Greggory P Kobelski
- The Micheli Center for Sports Injury Prevention , Waltham, MA, USA.,Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital , Waltham, MA, USA
| | - Prashant Rao
- Division of Cardiovascular Medicine, Department of Medicine, Thomas Jefferson University Hospitals , Philadelphia, PA, USA
| | - Stanton Miller
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University , Philadelphia, PA, USA
| | - Chris Koilor
- Division of Cardiovascular Medicine, Department of Medicine, Thomas Jefferson University Hospitals , Philadelphia, PA, USA
| | - Gianmichel D Corrado
- The Micheli Center for Sports Injury Prevention , Waltham, MA, USA.,Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital , Waltham, MA, USA.,Department of Orthopaedic Surgery, Harvard Medical School , Boston, MA, USA
| | - David M Shipon
- Division of Cardiovascular Medicine, Department of Medicine, Thomas Jefferson University Hospitals , Philadelphia, PA, USA
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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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Feasibility and diagnostic performance of including point-of-care ultrasound (POCUS) in preparticipation screening of young competitive athletes. Cardiol Young 2020; 30:1970-1972. [PMID: 32993839 DOI: 10.1017/s1047951120003145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Optimal pre-participative screening in young athletes is still controversial. We sought to evaluate the strategy of including point-of-care ultrasound to electrocardiogram. In total, 1188 young competitive athletes were screened in different sports institutions. This proved to be a useful strategy by improving diagnostic performance primarily with respect to detect structural abnormalities and also by minimising positive false cases of electrocardiogram alone.
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47
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Liu HW, Huang LW, Chiu SN, Lue HC, Wu MH, Chen MR, Wang JK. Cardiac Screening for High Risk Sudden Cardiac Death in School-Aged Children. ACTA CARDIOLOGICA SINICA 2020; 36:641-648. [PMID: 33235421 DOI: 10.6515/acs.202011_36(6).20200515a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Sudden cardiac death (SCD) is an uncommon but significant cause of death in the young. Citywide cardiac screening of school-aged children has been performed in Taipei since 1989. In this study, we investigate the efficacy of this screening method for identifying those at high risk of SCD. Methods This study analyzed the data from the results of cardiac screening for school-aged children in Taipei from 2003 to 2014. The cardiac screening included: Stage I, questionnaire surveys, simplified phonocardiography test and simplified electrocardiography (ECG) test; Stage II, physical examination and auscultation by a pediatric cardiologist for all children who had abnormal findings in stage I screening; Stage III, referral to a pediatric cardiologist for further examinations. Logistic regression and decision tree analyses were performed. Results A total of 566,447 students were screened, of whom 685 were identified as being at high risk of SCD. The most common causes of being at high risk of SCD included Wolff-Parkinson-White syndrome, long QT syndrome, cardiomyopathy and Marfan's syndrome. Using logistic regression analysis, the simplified ECG test was identified as being the most effective tool (odds ratio = 16.4, p < 0.001) and past history as the second most crucial factor (odds ratio = 3.95, p < 0.001) for detecting a high risk of SCD. Decision tree analysis showed that serial studies with a past history and the simplified ECG test could accurately identify those at high risk of SCD. Conclusions Questionnaire survey and simplified electrocardiography test-based cardiovascular screening in school-aged children can identify those at high risk of SCD.
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Affiliation(s)
- Hsiu-Wen Liu
- Department of Business Administration, Soochow University
| | | | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University
| | - Hung-Chi Lue
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University
| | - Ming-Ren Chen
- Department of Pediatrics, MacKay Memorial Hospital and Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University
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Hallak YO, Battistin U, Al-Masaeed AM. Cardiac Screening to Mitigate the Risk of Sudden Cardiac Death in Middle Eastern and African Competitive Athletes. A Systematic Review. J Saudi Heart Assoc 2020; 32:174-185. [PMID: 33154912 PMCID: PMC7640562 DOI: 10.37616/2212-5043.1047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/05/2020] [Accepted: 04/15/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The study aims to review the literature regarding abnormalities predisposing to Sudden Cardiac Death (SCD) in young Middle Eastern and African competitive athletes between the years 2009-2019 and aims to assess cardiac pre-participation screening methods. METHODS A PubMed search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search targeted articles that reported the prevalence of cardiac abnormalities found in Middle Eastern and African athletes, and it also focused on comparing cardiac screening methods for assessment of athletes. RESULTS our studies fell within the inclusion criteria and were included in the study. Results identified a shortage in the literature regarding prevalence rates of SCD in the Middle East and Africa. Additionally, there seems to be a lack of ethnicity-specific cardiac pre-participation screening programs in the region. Nevertheless, the prevalence of SCD-related abnormalities (HCM, ARVC, etc …) ranged from 0.47 to 4.29%. Included studies conveyed only male athletes with no reports on the female athletic population. CONCLUSION The present study highlights a need to develop an efficient cardiac pre-participation screening program specific to Arab and African athletes due to their high false-positive rates in contrast to Caucasian athletes. Significant evidence proves that an adequate cardiac screening program can prevent SCD in young competitive athletes. Therefore, it is imperative that future studies highlight the prevalence of abnormalities directly related to SCD in order to create a valid screening program that can be implemented in the region to mitigate the risk of shocking events.
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Affiliation(s)
- Yusuf Omar Hallak
- College of Medicine, Mohammad Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Umberto Battistin
- College of Medicine, Mohammad Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Bestmögliche Prävention lebensbedrohlicher Situationen mithilfe des EKG-Screenings. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-00956-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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50
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Abela M, Sharma S. Electrocardiographic interpretation in athletes. Minerva Cardiol Angiol 2020; 69:533-556. [PMID: 33059398 DOI: 10.23736/s2724-5683.20.05331-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Participation in regular exercise of moderate intensity is associated with a plethora of systemic benefits, including a reduction in risk factors for coronary atherosclerosis; however, intensive exercise may paradoxically culminate in sudden cardiac arrest among individuals harboring arrhythmogenic substrates. The precise mechanism for arrhythmogenesis is likely multifactorial, however, surges in catecholamines, electrolyte shifts, acid-base disturbances, increased core temperature and demand myocardial ischemia are potential contributors. Although most deaths occur in middle aged and older males with atherosclerotic coronary artery disease, a significant proportion also affect young athletes with inherited or congenital cardiac abnormalities. The impact of such catastrophes on society, particularly when a young high-profile athlete is affected could be considered a justified reason for identifying individuals who may be at risk. Given the rarity of deaths in young athletes, only the simplest screening test, such as the 12-lead electrocardiography (ECG) may be considered to be cost effective. The ECG is effective for detecting serious electrical diseases in young athletes such as congenital electrical accessory pathways and ion channel diseases but can also identify athletes with potential life-threatening structural diseases such as hypertrophic and arrhythmogenic cardiomyopathy. One of the concerns about ECG screening is that regular intensive exercise results in several physiological alterations in cardiac structure and function that are reflected on the athlete's ECG. Sinus bradycardia, first-degree atrioventricular block, incomplete right bundle branch block, minor J-point elevation and large QRS voltages are common. Conversely, some repolarization anomalies affecting the ST segment, T waves and QT interval may overlap with patterns observed in patients with serious cardiac diseases. The situation is complicated further because age, sex and ethnicity of the athletes also influence the ECG and there is a risk that erroneous interpretation could have serious consequences. This review will describe the normal electrical patterns of the "athlete's heart" and provide insights into differentiation physiological electrical patterns from those observed in serious cardiac disease.
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Affiliation(s)
- Mark Abela
- Department of Cardiology, Mater Dei Hospital, Msida, Malta - .,Malta Medical School, University of Malta, Msida, Malta - .,St. George's University Hospitals, NHS Foundation Trust, St George's University, London, UK -
| | - Sanjay Sharma
- St. George's University Hospitals, NHS Foundation Trust, St George's University, London, UK
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