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Harvey A, Curnier D, Dodin P, Jacquemet V, Caru M. The Effects of Cycle Ergometer Versus Treadmill Exercise Stress Testing on QTc Interval Prolongation in Patients With Long QT Syndrome: A Systematic Review and Meta-analysis. Clin J Sport Med 2024; 34:474-502. [PMID: 39012267 DOI: 10.1097/jsm.0000000000001256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 01/16/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVE The safest and most effective exercise stress tests (EST) modalities for long QT syndrome (LQTS) are currently unknown. The main objective was to explore the effects of EST on the corrected QT interval (QTc) in patients with LQTS, and to compare the effects of different EST modalities (cycle ergometer vs treadmill). DATA SOURCES Systematic searches were performed in September 2022 in accordance with the PRISMA statement through PubMed, Medline, EBM Reviews, Embase, and Web of Science. MAIN RESULTS A total of 1728 patients with LQTS, whether congenital or acquired, without any age restrictions (pediatric age ≤18 years and adult age >19 years), and 2437 control subjects were included in the 49 studies. The QT interval data were available for 15 studies. Our analyses showed that the QT interval prolonged in a similar manner using either a cycle ergometer or a treadmill (standardized mean difference [SMD] = 1.89 [95% CI, 1.07-2.71] vs SMD = 1.46 [95% CI, 0.78-2.14], respectively). Therefore, it seems that either modality may be used to evaluate patients with LQTS. CONCLUSIONS The methodology for the measurement of the QT interval was very heterogeneous between studies, which inevitably influenced the quality of the analyses. Hence, researchers should proceed with caution when exploring and interpreting data in the field of exercise and LQTS.
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Affiliation(s)
- Audrey Harvey
- Laboratory of Pathophysiology of EXercise (LPEX), School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, Canada
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
| | - Daniel Curnier
- Laboratory of Pathophysiology of EXercise (LPEX), School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, Canada
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
| | - Philippe Dodin
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
| | - Vincent Jacquemet
- Department of Pharmacology and Physiology, Faculty of Medicine, University of Montreal, Montreal, Canada ; and
| | - Maxime Caru
- Department of Pediatrics and Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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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; 27:583-593. [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] [MESH Headings] [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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Orchard JJ, La Gerche A, Puranik R, Raju H, Davis AJ, Eggleton S, Driscoll T, Lorimer M, Doughty RN, Hamilton B, Drezner JA, Orchard JW. Rationale and Design of the Australasian Registry of Screening ECGs in National Athletes Project. J Am Heart Assoc 2024; 13:e035898. [PMID: 39158566 DOI: 10.1161/jaha.124.035898] [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: 04/10/2024] [Accepted: 07/24/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Cardiac screening of elite athletes is widely recommended by Australasian sporting federations, but data are not structured to be shared. Data are lacking from underrepresented groups to inform ECG interpretation guidelines. The ARENA (Australasian Registry of Screening ECGs in National Athletes) project is a retrospective and prospective, multicenter, longitudinal, observational registry of athlete cardiac screening results and outcomes. The aim is to create a repository to improve our understanding of the diagnoses and outcomes of screening. METHODS Participating sports that conduct cardiac screening of athletes will contribute data. This includes an initial collection (retrospective data, waiver of consent) and future prospective data (opt-out consent). Data include sex, age, sport/event, screening date, ECG findings, cardiac test results, follow-up details, sport participation status, cardiac diagnoses, and major cardiovascular outcomes defined as sudden cardiac arrest/death, cardiac syncope or implanted cardioverter defibrillator shock, cardiac hospitalization, and arrhythmias requiring intervention. Comparisons will be made between diagnoses, outcomes, and ECG features and analyzed by sport and sex. The ARENA project was developed in collaboration with sporting bodies, team physicians, and players association representatives and endorsed by the Australasian College of Sport & Exercise Physicians and Sports Medicine Australia. CONCLUSIONS The ARENA project will provide a long-term international data repository to improve our understanding of ECG interpretation, cardiac screening and diagnoses, and the prevalence of cardiovascular outcomes in screened athletes. A unique aim is to address evidence gaps in underrepresented athlete groups, specifically female athletes and Indigenous populations. Results will inform screening policies and guidelines.
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Affiliation(s)
- Jessica J Orchard
- Sydney School of Public Health, Faculty of Medicine and Health The University of Sydney NSW Australia
| | - Andre La Gerche
- St Vincent's Institute for Medical Research Melbourne Victoria Australia
- National Centre for Sports Cardiology Melbourne Victoria Australia
| | - Rajesh Puranik
- Faculty of Medicine and Health The University of Sydney NSW Australia
| | | | - Angus J Davis
- Sydney School of Public Health, Faculty of Medicine and Health The University of Sydney NSW Australia
| | | | - Tim Driscoll
- Sydney School of Public Health, Faculty of Medicine and Health The University of Sydney NSW Australia
| | - Michelle Lorimer
- South Australian Health and Medical Research Institute Adelaide South Australia Australia
| | - Robert N Doughty
- University of Auckland New Zealand
- The Heart Group Auckland New Zealand
| | - Bruce Hamilton
- High Performance Sport Auckland New Zealand
- Sport Research Institute Auckland New Zealand
| | | | - John W Orchard
- Sydney School of Public Health, Faculty of Medicine and Health The University of Sydney NSW Australia
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4
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Clerico A, Zaninotto M, Aimo A, Galli C, Sandri MT, Correale M, Dittadi R, Migliardi M, Fortunato A, Belloni L, Plebani M. Assessment of cardiovascular risk and physical activity: the role of cardiac-specific biomarkers in the general population and athletes. Clin Chem Lab Med 2024; 0:cclm-2024-0596. [PMID: 39016272 DOI: 10.1515/cclm-2024-0596] [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: 05/14/2024] [Accepted: 06/11/2024] [Indexed: 07/18/2024]
Abstract
The first part of this Inter-Society Document describes the mechanisms involved in the development of cardiovascular diseases, particularly arterial hypertension, in adults and the elderly. It will also examine how consistent physical exercise during adolescence and adulthood can help maintain blood pressure levels and prevent progression to symptomatic heart failure. The discussion will include experimental and clinical evidence on the use of specific exercise programs for preventing and controlling cardiovascular diseases in adults and the elderly. In the second part, the clinical relevance of cardiac-specific biomarkers in assessing cardiovascular risk in the general adult population will be examined, with a focus on individuals engaged in sports activities. This section will review recent studies that suggest a significant role of biomarkers in assessing cardiovascular risk, particularly the presence of cardiac damage, in athletes who participate in high-intensity sports. Finally, the document will discuss the potential of using cardiac-specific biomarkers to monitor the effectiveness of personalized physical activity programs (Adapted Physical Activity, APA). These programs are prescribed for specific situations, such as chronic diseases or physical disabilities, including cardiovascular diseases. The purposes of this Inter-Society Document are the following: 1) to discuss the close pathophysiological relationship between physical activity levels (ranging from sedentary behavior to competitive sports), age categories (from adolescence to elderly age), and the development of cardiovascular diseases; 2) to review in detail the experimental and clinical evidences supporting the role of cardiac biomarkers in identifying athletes and individuals of general population at higher cardiovascular risk; 3) to stimulate scientific societies and organizations to develop specific multicenter studies that may take into account the role of cardiac biomarkers in subjects who follow specific exercise programs in order to monitor their cardiovascular risk.
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Affiliation(s)
- Aldo Clerico
- Coordinator of the Study Group on Cardiac Biomarkers of the Italian Societies SIBioC and ELAS, Pisa, Italy
| | | | - Alberto Aimo
- Fondazione CNR - Regione Toscana G. Monasterio, Pisa, Italy
| | | | | | - Mario Correale
- UOC Medical Pathology, IRCCS De Bellis, Castellana Grotte, Bari, Italy
| | | | - Marco Migliardi
- Primario Emerito S.C. Laboratorio Analisi Chimico-Cliniche e Microbiologia, Ospedale Umberto I, A.O. Ordine Mauriziano di Torino, Turin, Italy
| | | | - Lucia Belloni
- Dipartimento di Diagnostica - per Immagini e Medicina di Laboratorio, Laboratorio Autoimmunità, Allergologia e Biotecnologie Innovative, Azienda USL-IRCCS di Reggio Emilia, Emilia-Romagna, Italy
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5
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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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Petek BJ, Drezner JA, Churchill TW. The International Criteria for Electrocardiogram Interpretation in Athletes: Common Pitfalls and Future Directions. Card Electrophysiol Clin 2024; 16:35-49. [PMID: 38280813 PMCID: PMC11207195 DOI: 10.1016/j.ccep.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Preparticipation cardiovascular screening (PPCS) in young athletes is performed to detect conditions associated with sudden cardiac death. Many medical societies and sports governing bodies support the addition of a 12-lead electrocardiogram (ECG) to the history and physical to improve PPCS sensitivity. The current standard for ECG interpretation in athletes, the International Criteria, was developed to distinguish physiologic from pathologic ECG findings in athletes. Although application of the International Criteria has reduced the PPCS false-positive rate, interpretative challenges and potential areas of improvement remain. This review provides an overview of common pitfalls and future directions for ECG interpretation in athletes.
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Affiliation(s)
- Bradley J Petek
- Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA
| | - Jonathan A Drezner
- University of Washington Medical Center for Sports Cardiology, Massachusetts General Hospital, 3800 Montlake Boulevard Northeast, Box 354060, Seattle, WA 98195, USA
| | - Timothy W Churchill
- Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA.
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7
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Viegas JM, Dores H, Freitas A, Cavigli L, D'Ascenzi F. Developments in sports cardiology: The way to a brighter future. Rev Port Cardiol 2024; 43:87-89. [PMID: 37769847 DOI: 10.1016/j.repc.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 10/03/2023] Open
Affiliation(s)
- José Miguel Viegas
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
| | - Hélder Dores
- Department of Cardiology, Hospital da Luz, Lisbon, Portugal; Human Performance Department, Sport Lisboa e Benfica, Lisbon, Portugal; Department of Pathophysiology, NOVA Medical School, Lisbon, Portugal
| | - António Freitas
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal; Centro de Medicina Desportiva de Lisboa, Lisbon, Portugal
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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8
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Sharykin AS, Badtieva VA. Sudden Death In Sports: Modern Concepts. KARDIOLOGIIA 2024; 64:80-87. [PMID: 38323448 DOI: 10.18087/cardio.2024.1.n2617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/26/2023] [Indexed: 02/08/2024]
Abstract
Regular physical activity provides significant health benefits and reduces the risk of premature death from any cause, including cardiovascular diseases (CVD). However, physical activity may provoke sudden cardiac death (SCD), especially in presence of unrecognized diseases. It is essential to identify risk factors that contribute to SCD in athletes and to implement effective prevention of such episodes. For this purpose, SCD registries are being created, medical terminology is being unified, and schedules of medical examination are being developed. The best strategy to combat SCD during sport activities is a combination of primary prevention by screening examination to identify athletes with CVD at risk and a proper planning of first aid measures during sports events, including the availability of an automatic external defibrillator on site.
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Affiliation(s)
- A S Sharykin
- Moscow Center for Research and Practice in Medical Rehabilitation, Restorative and Sport Medicine; Pirogov Russian National Research Medical University
| | - V A Badtieva
- Moscow Center for Research and Practice in Medical Rehabilitation, Restorative and Sport Medicine; Sechenov First Moscow State Medical University
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9
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Petek BJ, Churchill TW, Moulson N, Kliethermes SA, Baggish AL, Drezner JA, Patel MR, Ackerman MJ, Kucera KL, Siebert DM, Salerno L, Suchsland MZ, Asif IM, Maleszewski JJ, Harmon KG. Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A 20-Year Study. Circulation 2024; 149:80-90. [PMID: 37955565 PMCID: PMC10843024 DOI: 10.1161/circulationaha.123.065908] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/24/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Understanding the incidence, causes, and trends of sudden cardiac death (SCD) among young competitive athletes is critical to inform preventive policies. METHODS This study included National Collegiate Athletic Association athlete deaths during a 20-year time frame (July 1, 2002, through June 30, 2022). Athlete deaths were identified through 4 separate independent databases and search strategies (National Collegiate Athletic Association resolutions list, Parent Heart Watch database and media reports, National Center for Catastrophic Sports Injury Research database, and insurance claims). Autopsy reports and medical history were reviewed by an expert panel to adjudicate causes of SCD. RESULTS A total of 143 SCD cases in National Collegiate Athletic Association athletes were identified from 1102 total deaths. The National Collegiate Athletic Association resolutions list identified 117 of 143 (82%), the Parent Heart Watch database or media reports identified 89 of 143 (62%), the National Center for Catastrophic Sports Injury Research database identified 63 of 143 (44%), and insurance claims identified 27 of 143 (19%) SCD cases. The overall incidence of SCD was 1:63 682 athlete-years (95% CI, 1:54 065-1:75 010). Incidence was higher in male athletes than in female athletes (1:43 348 [95% CI, 1:36 228-1:51 867] versus 1:164 504 [95% CI, 1:110 552-1:244 787] athlete-years, respectively) and Black athletes compared with White athletes (1:26 704 [1:20 417-1:34 925] versus 1:74 581 [1:60 247-1:92 326] athlete-years, respectively). The highest incidence of SCD was among Division I male basketball players (1:8188 [White, 1:5848; Black, 1:7696 athlete-years]). The incidence rate for SCD decreased over the study period (5-year incidence rate ratio, 0.71 [95% CI, 0.61-0.82]), whereas the rate of noncardiovascular deaths remained stable (5-year incidence rate ratio, 0.98 [95% CI, 0.94-1.04]). Autopsy-negative sudden unexplained death (19.5%) was the most common postmortem examination finding, followed by idiopathic left ventricular hypertrophy or possible cardiomyopathy (16.9%) and hypertrophic cardiomyopathy (12.7%), in cases with enough information for adjudication (118 of 143). Eight cases of death were attributable to myocarditis over the study period (1 case from January 1, 2020, through June 30, 2022), with none attributed to COVID-19 infection. SCD events were exertional in 50% of cases. Exertional SCD was more common among those with coronary artery anomalies (100%) and arrhythmogenic cardiomyopathy (83%). CONCLUSIONS The incidence of SCD in college athletes has decreased. Male sex, Black race, and basketball are associated with a higher incidence of SCD.
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Affiliation(s)
- Bradley J. Petek
- Sports Cardiology Program, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR
- Division of Cardiology, Massachusetts General Hospital, Boston, MA
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA
| | - Timothy W. Churchill
- Division of Cardiology, Massachusetts General Hospital, Boston, MA
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA
| | - Nathaniel Moulson
- Division of Cardiology and Sports Cardiology BC, University of British Columbia, Vancouver, BC, Canada
| | | | - Aaron L. Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, MA
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA
- Swiss Olympic Medical Center, Lausanne University Hospital (CHUV), Lusanne, Switzerland
- Institute for Sport Science, University of Lausanne (ISSUL), Lusanne, Switzerland
| | - Jonathan A. Drezner
- Department of Family Medicine and Center for Sports Cardiology, University of Washington, Seattle, WA
| | - Manesh R. Patel
- Division of Cardiology, Duke Heart Center, and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Michael J. Ackerman
- Department of Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory), Mayo Clinic, Rochester, MN
- Department of Cardiovascular Medicine (Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic), Mayo Clinic, Rochester, MN
- Department of Pediatric and Adolescent Medicine (Division of Pediatric Cardiology), Mayo Clinic
| | - Kristen L. Kucera
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - David M. Siebert
- Department of Family Medicine and Center for Sports Cardiology, University of Washington, Seattle, WA
| | - Lauren Salerno
- Department of Family Medicine and Center for Sports Cardiology, University of Washington, Seattle, WA
| | - Monica Zigman Suchsland
- Department of Family Medicine and Center for Sports Cardiology, University of Washington, Seattle, WA
| | - Irfan M. Asif
- Family and Community Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL
| | | | - Kimberly G. Harmon
- Department of Family Medicine and Center for Sports Cardiology, University of Washington, Seattle, WA
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Orchard JJ, Orchard JW, Davis AJ, Puranik R, Isbister JC, La Gerche A, Driscoll T, Doughty RN, Hamilton B. Clinical outcomes of 10 years of cardiac screening in elite New Zealand athletes. J Sci Med Sport 2023; 26:659-666. [PMID: 37932202 DOI: 10.1016/j.jsams.2023.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To report findings from the High Performance Sport New Zealand cardiac screening programme, including comparisons between sexes and ethnicities. DESIGN Retrospective cohort study. METHODS Elite Olympic-sport athletes were screened (2012-2022) with personal/family history, physical examination, resting 12-lead ECG and followed from the date of first screening until July 2022. An audit reviewed screening records, including demographic data, ECGs, follow-up and diagnoses. Flagged/equivocal ECGs were re-reviewed (International Criteria). RESULTS 2075 ECGs from 1189 athletes (53 % female, mean age 21 years; 83 % European, 9 % Māori, 5 % Pacific Islander, 3 % other) were included. No athletes retired for cardiac reasons; there were no cardiac deaths or major cardiac incidents (mean follow-up from first screening: 6.1 years (range: 0.6-10.9 years)). Diagnoses included Wolff-Parkinson-White (WPW) syndrome (0.7 %) and cardiomyopathies (0.3 %). Overall, 3.5 % of ECGs were abnormal, with ECGs of females more commonly abnormal (4.4 % vs 2.5 %, p = 0.02) and with a higher proportion of ECGs with abnormal T-wave inversion (TWI) (3.1 % vs 0.9 %, p < 0.001) compared to males. Of the abnormal TWI in females (all aged ≥16 years), 47 % was limited to V1-V3 with no other abnormalities. Abnormality rates were similar between Māori, Pacific Islander and European athlete ECGs. CONCLUSIONS WPW was the most frequent diagnosis, with very little cardiomyopathy found. The proportion of abnormal ECGs was low overall, but higher in females. This was driven by anterior TWI in V1-V3 which was not associated with diagnoses of conditions associated with sudden cardiac death (SCD). There was no difference in the proportion of abnormal ECGs of Māori or Pacific Island athletes compared to European athletes.
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Affiliation(s)
- Jessica J Orchard
- Sydney School of Public Health, Faculty of Medicine & Health, The University of Sydney, Australia. https://twitter.com/jessicajorchard
| | - John W Orchard
- Sydney School of Public Health, Faculty of Medicine & Health, The University of Sydney, Australia. https://twitter.com/DrJohnOrchard
| | - Angus J Davis
- Sydney School of Public Health, Faculty of Medicine & Health, The University of Sydney, Australia. https://twitter.com/AngusDavis6
| | - Rajesh Puranik
- Faculty of Medicine & Health, The University of Sydney, Australia
| | - Julia C Isbister
- Sydney School of Public Health, Faculty of Medicine & Health, The University of Sydney, Australia. https://twitter.com/JuliaIsbister
| | - Andre La Gerche
- Baker Heart & Diabetes Institute, Australia; National Centre for Sports Cardiology, Australia. https://twitter.com/ALaGerche
| | - Tim Driscoll
- Sydney School of Public Health, Faculty of Medicine & Health, The University of Sydney, Australia
| | - Robert N Doughty
- University of Auckland, New Zealand; The Heart Group, New Zealand
| | - Bruce Hamilton
- High Performance Sport New Zealand, New Zealand; Sport Research Institute of New Zealand, Auckland University of Technology, New Zealand.
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11
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Klein CF, Petek BJ, Moulson N, Baggish AL, Churchill TW, Harmon KG, Kliethermes SA, Patel MR, Drezner JA. Non-COVID-19 cardiovascular pathology from return-to-play screening in college athletes after COVID-19. Heart 2023; 109:1851-1857. [PMID: 37460194 PMCID: PMC10792102 DOI: 10.1136/heartjnl-2023-322645] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/27/2023] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVE Concerns for cardiac involvement after SARS-CoV-2 infection led to widespread cardiac testing in athletes. We examined incidental non-COVID-19 cardiovascular pathology in college athletes undergoing postinfection return-to-play screening. METHODS The Outcomes Registry for Cardiac Conditions in Athletes was a nationwide prospective multicentre observational cohort study that captured testing and outcomes data from 45 institutions (September 2020-June 2021). Athletes with an ECG and transthoracic echocardiogram (TTE) and no pre-existing conditions were included. Findings were defined as major (associated with sudden cardiac death or requiring intervention), minor (warrants surveillance), incidental (no follow-up needed) or uncertain significance (abnormal with subsequent normal testing). RESULTS Athletes with both ECG and TTE (n=2900, mean age 20±1, 32% female, 27% black) were included. 35 (1.2%) had ECG abnormalities. Of these, 2 (5.7%) had TTE abnormalities indicating cardiomyopathy (hypertrophic-1, dilated-1), and 1 with normal TTE had atrial fibrillation. Of 2865 (98.8%) athletes with a normal ECG, 54 (1.9%) had TTE abnormalities: 3 (5.6%) with aortic root dilatation ≥40 mm, 15 (27.8%) with minor abnormalities, 25 (46.3%) with incidental findings and 11 (20.4%) with findings of uncertain significance. Overall, 6 (0.2%) athletes had major conditions; however, coronary anatomy and aortic dimensions were inconsistently reported and pathology may have been missed. CONCLUSION Major non-COVID-19 cardiovascular pathology was identified in 1/500 college athletes undergoing return-to-play screening. In athletes without ECG abnormalities, TTE's added value was limited to pathological aortic root dilatation in 1/1000 athletes and minor abnormalities warranting surveillance in 1/160 athletes. Two-thirds of findings were incidental or of uncertain significance.
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Affiliation(s)
- Christian F Klein
- Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Bradley J Petek
- Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nathaniel Moulson
- Centre for Cardiovascular Innovation, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron L Baggish
- Cardiovascular Performance Program, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Stephanie A Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Jonathan A Drezner
- Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
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12
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Halasz G, Capelli B, Nardecchia A, Cattaneo M, Cassina T, Biasini V, Barbieri D, Villa M, Beltrami M, Perone F, Villani M, Badini M, Gervasi F, Piepoli M, Via G. Cost-effectiveness and diagnostic accuracy of focused cardiac ultrasound in the pre-participation screening of athletes: the SPORT-FoCUS study. Eur J Prev Cardiol 2023; 30:1748-1757. [PMID: 37668353 DOI: 10.1093/eurjpc/zwad287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/02/2023] [Accepted: 08/24/2023] [Indexed: 09/06/2023]
Abstract
AIMS The role of pre-participation screening (PPS) modalities in preventing sudden cardiac death (SCD) in athletes is debated due to a high false-positive rate. Focused cardiac ultrasound (FoCUS) has shown higher sensitivity and specificity, but its cost-effectiveness remains uncertain. This study aimed to determine the diagnostic performance and cost-effectiveness of FoCUS use in PPS. METHODS AND RESULTS A total of 2111 athletes (77.4% male, mean age 24.9 ± 15.2years) underwent standardized family and medical history collection, physical examination, resting electrocardiography (ECG), FoCUS (10 min/5 views protocol), comprehensive echocardiography and exercise stress test. We prospectively evaluated three PPS incremental models: Model A, standardized medical history and physical examination Model B, Model A plus resting and stress ECG and Model C, Model B plus FoCUS (10 min/5 views protocol). We determined their incremental diagnostic accuracy and cost-effectiveness ratio. A total of 30 athletes were diagnosed with a cardiac condition associated with SCD: 3 were identified by Model A, 14 by Model B, and 13 athletes by Model C. The introduction of FoCUS markedly increased the sensitivity of PPS, compared with Model A and Model B (sensitivity 94% vs. 19% vs. 58% specificity 93% vs. 93% vs. 92%). The total screening costs were as follows: Model A 35.64 euros, Model B 87.68 euros, and Model C 120.89 euros. Considering the sole conditions at risk of SCD, the incremental cost-effectiveness ratio was 135.62 euros for Model B and 114.31 for Model C. CONCLUSIONS The implementation of FoCUS into the PPS allows to identify a significantly greater number of athletes at risk of SCD and markedly lowers the false negative rate. Furthermore, the incorporation of FoCUS into the screening process has shown to be cost-effective.
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Affiliation(s)
- Geza Halasz
- Cardiology Department, Azienda Ospedaliera SanCamillo Forlanini, Circonvallazione Gianicolense, 87, Rome 00152, Italy
| | - Bruno Capelli
- Sport and Exercise Medicine, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Alessia Nardecchia
- Italian Ministry of Education and Research, I.I.S Ceccano, Via Gaeta 105, Ceccano 03023, Italy
| | - Mattia Cattaneo
- Cardiologia, Centro Medico, Lugano, Switzerland
- Cardiology Department, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Tiziano Cassina
- Cardiac Anesthesia and Intensive Care, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Vincenzo Biasini
- Sport Medicine and Exercise Medicine, Centro di Medicina dello Sport I° Livello, L'Aquila 67100, Italy
| | - Davide Barbieri
- Department of Neuroscience and Rehabilitation, University of Ferrara, Corso Ercole I d'Este 32, Ferrara, Italy
| | - Michele Villa
- Cardiac Anesthesia and Intensive Care, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Matteo Beltrami
- Cardiology Unit, San Giovanni di Dio Hospital, Florence 50142, Italy
| | - Francesco Perone
- Cardiac Rehabilitation Unit, Rehabilitation Clinic 'Villa delle Magnolie', Castel Morrone, Caserta 81020, Italy
| | - Matteo Villani
- Intensive Care Unit, G. Da Saliceto Hospital, Via Taverna Giuseppe, 49, 29121 Piacenza, Italy
| | - Matteo Badini
- Cardiology Department, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Federico Gervasi
- Postgraduate School of Medical Statistics and Biometry, University of Milan, Via Festa del Perdono 7, Milan 20122, Italy
| | - Massimo Piepoli
- Clinical Cardiology, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, Milan 20097, Italy
- Department of Biomedical Science for Health, University of Milan, Via Festa del Perdono 7, Milan 20122, Italy
| | - Gabriele Via
- Cardiac Anesthesia and Intensive Care, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
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13
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Panhuyzen-Goedkoop NM, Verbeek ALM, Goedkoop RJ, Malekzadeh A, Wilde AAM, Peters RJG, Jørstad HT. Quality of athlete screening for high-risk cardiovascular conditions-A systematic review. Scand J Med Sci Sports 2023; 33:2094-2109. [PMID: 37449413 DOI: 10.1111/sms.14446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 04/21/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Sudden cardiac death (SCD) is the leading medical cause of death in athletes. To prevent SCD, screening for high-risk cardiovascular conditions (HRCC) is recommended. Screening strategies are based on a limited number of studies and expert consensus. However, evidence and efficacy of athlete HRCC screening is unclear. OBJECTIVE To determine methodological quality and quality of evidence of athlete screening, and screening efficacy to detect HRCC in a systematic review. METHODS We performed a systematic search of Medline, Embase, Scopus and Cochrane Library up to June 2021. We included articles containing original data of athlete cardiovascular screening, providing details of screening strategies, test results and HRCC detection. We assessed methodological quality of the included articles by QUADAS-2, quality of evidence of athlete HRCC screening by GRADE, and athlete HRCC screening efficacy by SWiM. RESULTS Of 2720 citations, we included 33 articles (1991-2018), comprising 82 417 athletes (26.7% elite, 73.4% competitive, 21.7% women, 75.2% aged ≤35). Methodological quality was 'very low' (33 articles), caused by absence of data blinding and inappropriate statistical analysis. Quality of evidence was 'very low' (33 articles), due to observational designs and population heterogeneity. Screening efficacy could not be reliably established. The prevalence of HRCC was 0.43% with false positive rate (FPR) 13.0%. CONCLUSIONS Methodological quality and quality of evidence on athlete screening are suboptimal. Efficacy could not be reliably established. The prevalence of screen detected HRCC was very low and FPR high. Given the limitations of the evidence, individual recommendations need to be prudent.
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Affiliation(s)
- Nicole M Panhuyzen-Goedkoop
- Department of Cardiology, Amsterdam University Medical Centers, Heart Centre, Amsterdam, The Netherlands
- Sports Medical Centre Papendal, Arnhem, The Netherlands
| | - André L M Verbeek
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Arjan Malekzadeh
- University Library, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam University Medical Centers, Heart Centre, Amsterdam, The Netherlands
| | - Ron J G Peters
- Department of Cardiology, Amsterdam University Medical Centers, Heart Centre, Amsterdam, The Netherlands
| | - Harald T Jørstad
- Department of Cardiology, Amsterdam University Medical Centers, Heart Centre, Amsterdam, The Netherlands
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14
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Sim HSS, Imran SS, Teoh CS. Progression of Wolff-Parkinson-White pattern 12-lead electrocardiogram changes in an asymptomatic athlete. Singapore Med J 2023; 64:449-453. [PMID: 37459000 PMCID: PMC10395805 DOI: 10.4103/singaporemedj.smj-2021-151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 01/05/2022] [Indexed: 07/20/2023]
Affiliation(s)
- Hwei Sian Shauna Sim
- Department of Orthopaedic Surgery, Sports Medicine Centre, Khoo Teck Puat Hospital, Singapore
| | | | - Chin Sim Teoh
- Department of Orthopaedic Surgery, Sports Medicine Centre, Khoo Teck Puat Hospital, Singapore
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15
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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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16
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Ferderber M, Wilson K, Buchanan BK, Street Callender SV, Deck JW, Kerr H, Lemmen B, Stafford CD, Wang DA, Waterbrook AL. Sports Medicine Curricular Recommendations for Undergraduate Medical Education. Curr Sports Med Rep 2023; 22:172-180. [PMID: 37141612 DOI: 10.1249/jsr.0000000000001064] [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: 05/06/2023]
Abstract
ABSTRACT Sports medicine is a unique field encompassing many specialties and aspects of medicine. While musculoskeletal medicine is a significant aspect of sports medicine, the breadth of sports medicine extends beyond the musculoskeletal system and includes the spectrum of care for the patient who is or desires to be physically active. This article provides recommendations for sports medicine education in undergraduate medical education. The framework highlighting these recommendations uses domains of competence. Entrustable professional activities, measures that are endorsed by the Association of American Medical Colleges, were matched to domains of competence to provide objective markers of achievement. In addition to recommended sports medicine educational content, there should be consideration of both methods of assessment and implementation catered to each individual institution's needs and resources. These recommendations may serve as a guide for medical educators and institutions pursing optimization of sports medicine education.
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Affiliation(s)
- Megan Ferderber
- Department of Family Medicine, East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Kristina Wilson
- Department of Pediatrics, University of Arizona College of Medicine-Phoenix, Phoenix, AZ
| | - Benjamin K Buchanan
- Department of Orthopaedics, Intermountain Healthcare-Southwest Orthopedics & Sports Medicine, St George, UT
| | - Shelley V Street Callender
- Department of Pediatrics and Family Medicine, Mercer University/Atrium Navicent Health System, St Macon, GA
| | - Jason W Deck
- Department of Family Medicine, OU-TU School of Community Medicine/University of Oklahoma Health Science Center, Tulsa, OK
| | - Hamish Kerr
- Department of Medicine and Pediatrics, Albany Medical College, Albany, NY
| | - Brooke Lemmen
- Department of Family Medicine, Central Michigan University Medical Sciences College of Medicine, Mount Pleasant, MI
| | - Cleo D Stafford
- Department of Orthopaedics and Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA
| | - David A Wang
- Department of Medicine, Hospital for Special Surgery, Paramus, NJ
| | - Anna L Waterbrook
- Department of Emergency and Sports Medicine, The University of Arizona, Tucson, AZ
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17
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Sarto P, Zorzi A, Merlo L, Vessella T, Pegoraro C, Giorgiano F, Graziano F, Basso C, Drezner JA, Corrado D. Value of screening for the risk of sudden cardiac death in young competitive athletes. Eur Heart J 2023; 44:1084-1092. [PMID: 36760222 PMCID: PMC10027466 DOI: 10.1093/eurheartj/ehad017] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 11/17/2022] [Accepted: 01/05/2023] [Indexed: 02/11/2023] Open
Abstract
AIMS This study aimed to report the long-term findings of the Italian programme of cardiovascular preparticipation screening (PPS) in young, competitive athletes. METHODS AND RESULTS The study assessed the diagnostic yield for diseases at risk of sudden cardiac death (SCD), the costs of serial evaluations, and the long-term outcomes of PPS in a large population of Italian children (age range, 7-18 years). The PPS was repeated annually and included medical history, physical examination, resting electrocardiogram, and stress testing; additional tests were reserved for athletes with abnormal findings. Over an 11-year study period, 22 324 consecutive children [62% males; mean age, 12 (interquartile range, 10-14) years at first screening] underwent a total of 65 397 annual evaluations (median 2.9/child). Cardiovascular diseases at risk of SCD were identified in 69 children (0.3%) and included congenital heart diseases (n = 17), channelopathies (n = 14), cardiomyopathies (n = 15), non-ischaemic left ventricular scar with ventricular arrhythmias (n = 18), and others (n = 5). At-risk cardiovascular diseases were identified over the entire age range and more frequently in children ≥12 years old (n = 63, 91%) and on repeat evaluation (n = 44, 64%). The estimated cost per diagnosis was 73 312€. During a follow-up of 7.5 ± 3.7 years, one child with normal PPS findings experienced an episode of resuscitated cardiac arrest during sports activity (event rate of 0.6/100.000 athletes/year). CONCLUSION The PPS programme led to the identification of cardiovascular diseases at risk of SCD over the whole study age range of children and more often on repeat evaluations. Among screened children, the incidence of sport-related cardiac arrest during long-term follow-up was low.
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Affiliation(s)
- Patrizio Sarto
- Sports Medicine Unit regional referral center for exercise prescription in young patients with heart diseases, AULSS 2, Via Castellana, 2, 31100 Treviso, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via n. Giustiniani 2, 35121 Padova, Italy
| | - Laura Merlo
- Sports Medicine Unit regional referral center for exercise prescription in young patients with heart diseases, AULSS 2, Via Castellana, 2, 31100 Treviso, Italy
| | - Teresina Vessella
- Sports Medicine Unit regional referral center for exercise prescription in young patients with heart diseases, AULSS 2, Via Castellana, 2, 31100 Treviso, Italy
| | - Cinzia Pegoraro
- Sports Medicine Unit regional referral center for exercise prescription in young patients with heart diseases, AULSS 2, Via Castellana, 2, 31100 Treviso, Italy
| | - Flaviano Giorgiano
- Sports Medicine Unit regional referral center for exercise prescription in young patients with heart diseases, AULSS 2, Via Castellana, 2, 31100 Treviso, Italy
| | - Francesca Graziano
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via n. Giustiniani 2, 35121 Padova, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via n. Giustiniani 2, 35121 Padova, Italy
| | - Jonathan A Drezner
- Center for Sports Cardiology, University of Washington, 3800 Montlake Blvd NE, Box 354060, Seattle, WA 98195, USA
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via n. Giustiniani 2, 35121 Padova, Italy
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18
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Riding NR, Dorobantu DM, Williams CA, Stuart G, Fritsch P, Wilson MG, Mossialos E, Pieles G. Protecting the stars of tomorrow: do international cardiovascular preparticipation screening policies account for the paediatric athlete? A systematic review and quality appraisal. Br J Sports Med 2023; 57:371-380. [PMID: 36332982 DOI: 10.1136/bjsports-2022-105659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE (1) Identify and review current policies for the cardiovascular screening of athletes to assess their applicability to the paediatric population and (2) evaluate the quality of these policy documents using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. DESIGN Systematic review and quality appraisal of policy documents. DATA SOURCES A systematic search of PubMed, MEDLINE, Scopus, Web of Science, SportDiscus and CINAHL. ELIGIBILITY CRITERIA FOR SELECTING STUDIES An article was included if it was a policy/position statement/guideline/consensus or recommendation paper relating to athletes and cardiovascular preparticipation screening. RESULTS AND SUMMARY Of the 1630 articles screened, 13 met the inclusion criteria. Relevance to paediatric athletes was found to be high in 3 (23%), moderate in 6 (46%) and low in 4 (31%), and only 2 provide tailored guidance for the athlete aged 12-18 years. A median 5 related citations per policy investigated solely paediatric athletes, with study designs most commonly being retrospective (72%). AGREEII overall quality scores ranged from 25% to 92%, with a median of 75%. The lowest scoring domains were rigour of development; (median 32%) stakeholder involvement (median 47%) and Applicability (median 52%). CONCLUSION Cardiac screening policies for athletes predominantly focus on adults, with few providing specific recommendations for paediatric athletes. The overall quality of the policies was moderate, with more recent documents scoring higher. Future research is needed in paediatric athletes to inform and develop cardiac screening guidelines, to improve the cardiac care of youth athletes.
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Affiliation(s)
- Nathan R Riding
- Bristol Medical School, University of Bristol, Bristol, UK.,Institute of Sport and Exercise Health (ISEH), University College London, London, UK
| | - Dan-Mihai Dorobantu
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, UK.,Population Health Sciences, University of Bristol, Bristol, UK.,Congenital Heart Unit, Bristol Royal Hospital for Children and Heart Institute, Bristol, UK
| | - Craig A Williams
- Children's Health and Exercise Research Centre, University of Exeter, Exeter, UK
| | - Graham Stuart
- Congenital Heart Unit, Bristol Royal Hospital for Children and Heart Institute, Bristol, UK.,National Institute for Health Research Cardiovascular Biomedical Research Centre, Bristol Heart Institute, Bristol, UK
| | | | - Mathew G Wilson
- Institute of Sport and Exercise Health (ISEH), University College London, London, UK.,Athlete Health and Performance Research Centre and the Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Elias Mossialos
- Department of Health Policy, London School of Economics, London, UK
| | - Guido Pieles
- Institute of Sport and Exercise Health (ISEH), University College London, London, UK .,Athlete Health and Performance Research Centre and the Sports Medicine Department, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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19
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Sudden Cardiac Death in Athletes: Facts and Fallacies. J Cardiovasc Dev Dis 2023; 10:jcdd10020068. [PMID: 36826564 PMCID: PMC9965876 DOI: 10.3390/jcdd10020068] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/23/2023] [Accepted: 01/29/2023] [Indexed: 02/09/2023] Open
Abstract
The benefits of exercise for cardiovascular and general health are many. However, sudden cardiac death (SCD) may occur in apparently healthy athletes who perform at the highest levels. A diverse spectrum of diseases is implicated in SCD in athletes, and while atherosclerotic coronary artery disease predominates in individuals of >35 years of age, primary cardiomyopathies and ion channelopathies are prevalent in young individuals. Prevention of SCD in athletes relies on the implementation of health policies aimed at the early identification of arrhythmogenic diseases (such as cardiac screening) and successful resuscitation (such as widespread utilization of automatic external defibrillators and training members of the public on cardiopulmonary resuscitation). This review will focus on the epidemiology and aetiologies of SCD in athletes, and examine fallacies in the approach to this controversial field. Furthermore, potential strategies to prevent these tragic events will be discussed, analysing current practice, gaps in knowledge and future directions.
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20
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Petek BJ, Drezner JA, Churchill TW. The International Criteria for Electrocardiogram Interpretation in Athletes: Common Pitfalls and Future Directions. Cardiol Clin 2023; 41:35-49. [PMID: 36368810 PMCID: PMC10292923 DOI: 10.1016/j.ccl.2022.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Preparticipation cardiovascular screening (PPCS) in young athletes is performed to detect conditions associated with sudden cardiac death. Many medical societies and sports governing bodies support the addition of a 12-lead electrocardiogram (ECG) to the history and physical to improve PPCS sensitivity. The current standard for ECG interpretation in athletes, the International Criteria, was developed to distinguish physiologic from pathologic ECG findings in athletes. Although application of the International Criteria has reduced the PPCS false-positive rate, interpretative challenges and potential areas of improvement remain. This review provides an overview of common pitfalls and future directions for ECG interpretation in athletes.
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Affiliation(s)
- Bradley J Petek
- Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA
| | - Jonathan A Drezner
- University of Washington Medical Center for Sports Cardiology, Massachusetts General Hospital, 3800 Montlake Boulevard Northeast, Box 354060, Seattle, WA 98195, USA
| | - Timothy W Churchill
- Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA.
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21
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Hill B, Grubic N, Williamson M, Phelan DM, Baggish AL, Dorian P, Drezner JA, Johri AM. Does cardiovascular preparticipation screening cause psychological distress in athletes? A systematic review. Br J Sports Med 2023; 57:172-178. [PMID: 36418151 DOI: 10.1136/bjsports-2022-105918] [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] [Accepted: 11/09/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the psychological implications of cardiovascular preparticipation screening (PPS) in athletes. DESIGN Systematic review. DATA SOURCES MEDLINE, EMBASE, PubMed, CINAHL, SPORTDiscus, APA PsycInfo, Cochrane Library and grey literature sources. STUDY ELIGIBILITY CRITERIA Observational and experimental studies assessing a population of athletes who participated in a cardiovascular PPS protocol, where psychological outcomes before, during and/or after PPS were reported. METHODS Results of included studies were synthesised by consolidating similar study-reported measures for key psychological outcomes before, during and/or after screening. Summary measures (medians, ranges) were computed across studies for each psychological outcome. RESULTS A total of eight studies were included in this review (median sample size: 479). Study cohorts consisted of high school, collegiate, professional and recreational athletes (medians: 59% male, 20.5 years). Most athletes reported positive reactions to screening and would recommend it to others (range 88%-100%, five studies). Increased psychological distress was mainly reported among athletes detected with pathological cardiac conditions and true-positive screening results. In comparison, athletes with false-positive screening results still reported an increased feeling of safety while participating in sport and were satisfied with PPS. A universal conclusion across all studies was that most athletes did not experience psychological distress before, during or after PPS, regardless of the screening modality used or accuracy of results. CONCLUSION Psychological distress associated with PPS in athletes is rare and limited to athletes with true-positive findings. To mitigate downstream consequences in athletes who experience psychological distress, appropriate interventions and resources should be accessible prior to the screening procedure. PROSPERO REGISTRATION NUMBER CRD42021272887.
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Affiliation(s)
- Braeden Hill
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Nicholas Grubic
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Dermot M Phelan
- Sports Cardiology Center, Atrium Health Sanger Heart and Vascular Institute, Charlotte, North Carolina, USA
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paul Dorian
- Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan A Drezner
- Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
| | - Amer M Johri
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
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22
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The Sports Cardiology Team: Personalizing Athlete Care Through a Comprehensive, Multidisciplinary Approach. MAYO CLINIC PROCEEDINGS: INNOVATIONS, QUALITY & OUTCOMES 2022; 6:525-535. [PMID: 36267910 PMCID: PMC9576626 DOI: 10.1016/j.mayocpiqo.2022.08.006] [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: 11/09/2022] Open
Abstract
Objective To systematically investigate and document the infrastructure, practices, recommendations, and clinical consequences of a structured, organized sports cardiology multidisciplinary team (MDT) for athletes and patients who wish to engage in sports and exercise. Patients and Methods We established bimonthly sports cardiology MDT meetings, with a permanent panel of experts in sports cardiology, genetics, pediatric cardiology, cardiovascular imaging, electrophysiology, and sports and exercise medicine. Cases were referred nationally or internationally by cardiologists/sports physicians. We retrospectively analyzed all MDT cases (April 10, 2019 through May 13, 2020) and collected clinical follow-up data up to 1 year after the initial review. Results A total of 115 athletes underwent MDT review; of them, 11% were women, 65% were recreational athletes, and 54% were performing "mixed" type of sports; the mean age was 32±16 years. An MDT review led to a diagnosis revision of "suspected cardiac pathology" to "no cardiac pathology" in 38% of the athletes and increased the number of definitive diagnoses (from 77 to 109; P=.03). We observed fewer "total sports restrictions" (from 6 to 0; P=.04) and more tailored sports advice concerning "no peak load/specific maximum load" (from 10 to 26; P=.02). At the 14±6-month follow-up, 112 (97%) athletes reported no cardiovascular events, 111 (97%) athletes reported no (new) cardiac symptoms, 113 (98%) athletes reported adherence to the MDT sports advice, and no diagnoses were revised. Conclusion Our experiences with a comprehensive sports cardiology MDT demonstrate that this approach leads to higher percentages of definitive diagnoses and fewer cardiac pathology diagnoses, more tailored sports advice with excellent rates of adherence, and fewer total sports restrictions. Our findings highlight the added value of sports cardiology MDTs for patient and athlete care.
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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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Orchard JJ, Orchard JW, Raju H, La Gerche A, Puranik R, Davis A, Drezner JA, Semsarian C. Analysis of athlete QT intervals by age: Fridericia and Hodges heart rate corrections outperform Bazett for athlete ECG screening. J Electrocardiol 2022; 74:59-64. [PMID: 36027674 DOI: 10.1016/j.jelectrocard.2022.08.002] [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: 06/28/2022] [Revised: 07/27/2022] [Accepted: 08/11/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cardiac screening of elite athletes including a 12‑lead electrocardiogram (ECG) is recommended by numerous international bodies. Current athlete ECG interpretation guidelines recommend the Bazett method to correct the QT interval (QTc). OBJECTIVE This study sought to investigate normative QTc changes by age using athlete screening ECGs and different QT correction methods in a population of elite cricketers. METHODS Initial cardiac screening ECGs from an existing database of elite Australian cricketers aged 14-35 years were examined. Average QT interval, QTcB (corrected QT-Bazett), QTcF (Fridericia), QTcH (Hodges), and heart rate (HR) were analyzed by age and sex. RESULTS A total of 1310 athletes (66% male, 34% female) were included with mean age 19.1 years and mean heart rate 66.9 bpm (range 38-121 bpm). With increasing age, HR decreased and absolute QT increased. The pattern of QTc change with age differed depending on the method of correction: Bazett correction (QTcB) demonstrated a "dish-shaped" or broad U-shaped appearance; while Fridericia and Hodges corrections showed a linear increase in QTc from young to older age. The Bazett method had a stronger correlation of HR with QTc (R2 = 0.32) than either Fridericia (R2 = 0.0007) or Hodges (R2 = 0.009) methods. CONCLUSIONS The Bazett method is not the most accurate QT correction in athletes, especially during adolescence. In elite cricketers, QTcB revealed a drop in QTc from adolescence to early adulthood due to mis-correction of the QT interval. The Fridericia method has the smoothest correction of HR and least QT variation by age and may be preferred for athlete screening.
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Affiliation(s)
- Jessica J Orchard
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - John W Orchard
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Andre La Gerche
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Melbourne, Australia; National Centre for Sports Cardiology, St Vincent's Hospital, Melbourne, Fitzroy, Australia
| | - Rajesh Puranik
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Angus Davis
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Chris Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
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Hajduczok AG, Ruge M, Emery MS. 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] [Key Words] [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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Affiliation(s)
- Alexander G. Hajduczok
- Division of Cardiology, Jefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, PA USA
| | - Max Ruge
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA USA
| | - Michael S. Emery
- Sports Cardiology Center, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute; Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH Desk J2-4 USA
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The Impact of Ethnicity on Athlete ECG Interpretation: A Systematic Review. J Cardiovasc Dev Dis 2022; 9:jcdd9060183. [PMID: 35735812 PMCID: PMC9225578 DOI: 10.3390/jcdd9060183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 11/30/2022] Open
Abstract
Athlete ECG interpretation criteria have been developed and refined from research in athlete populations; however, current guidelines are based on available data primarily from Caucasian and Black athletes. This study aimed to assess the impact of ethnicity on ECG interpretation in athletes. A systematic review was conducted of the MEDLINE, EMBASE, Scopus, SPORTDiscus, and Web of Science databases, for papers that assessed athlete screening ECGs and compared findings on the basis of ethnicity. Fifty-one papers which compared ECGs from various ethnicities were included. Most studies assessed Black athletes against Caucasian athletes and found a greater prevalence of T-wave inversion (TWI) (2.6–22.8% vs. 0–5.0%) and anterior TWI (3.7–14.3% vs. 0.6–2.0%). Black athlete subgroups in Africa had TWI (20–40%) and anterior TWI (4.3–18.7%) at a higher prevalence than other Black athletes. Athletes who were defined as mixed-race, Asian, and Pacific Islander are potentially more like Black athletes than Caucasian athletes. Black ethnicity is known to have an impact on the accurate interpretation of athlete ECGs; however, there is nuance related to origin of both parents. Asian and Pacific Islander origin also may impact athlete ECG interpretation. Further research is required to assist in distinguishing abnormal and normal athlete ECGs in different ethnic populations.
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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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Baggish AL, Chang CJ, Drezner JA, Harmon KG, Kraus WE, Matuszak J, Wasfy MM. ACSM-AMSSM Call to Action: Adapting Preparticipation Cardiovascular Screening to the COVID-19 Pandemic. Curr Sports Med Rep 2022; 21:159-162. [PMID: 35522440 DOI: 10.1249/jsr.0000000000000956] [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: 11/21/2022]
Abstract
ABSTRACT Preparticipation cardiovascular screening, designed to identify cardiovascular pathology responsible for sudden unexpected death, is recommended by all major professional medical organizations overseeing the clinical care of competitive athletes. Data from several large, prospective, cohort studies indicate that cardiac imaging findings consistent with inflammatory heart disease following COVID-19 infection are more common than most forms of heart disease associated with sudden death during exercise. This call-to-action document is intended to provide recommendations about how routine preparticipation cardiovascular screening for young competitive athletes - which has the capacity to detect both COVID-19 cardiovascular complications and pathology unrelated to infection - should be altered to account for recent scientific advances.
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Affiliation(s)
- Aaron L Baggish
- Division of Cardiology, Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA
| | - Cindy J Chang
- Departments of Orthopedics and Family & Community Medicine, University of California, San Francisco, CA
| | - Jonathan A Drezner
- Department of Family Medicine and Center for Sports Cardiology, University of Washington, Seattle, WA
| | - Kimberly G Harmon
- Department of Family Medicine and Center for Sports Cardiology, University of Washington, Seattle, WA
| | - William E Kraus
- Division of Cardiology, Duke University School of Medicine, Dunham, NC
| | - Jason Matuszak
- Department of Family Medicine, Excelsior Orthopedics & University at Buffalo, School of Medicine, Amherst, NY
| | - Meagan M Wasfy
- Division of Cardiology, Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA
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Cabral MD, Patel DR, Greydanus DE, Deleon J, Hudson E, Darweesh S. Medical perspectives on pediatric sports medicine–Selective topics. Dis Mon 2022; 68:101327. [DOI: 10.1016/j.disamonth.2022.101327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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30
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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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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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32
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Orchard JJ, Orchard JW, Toresdahl B, Asif IM, Hughes D, La Gerche A, Semsarian C. Cardiovascular Screening of Elite Athletes by Sporting Organizations in Australia: A Survey of Chief Medical Officers. Clin J Sport Med 2021; 31:401-406. [PMID: 32073477 DOI: 10.1097/jsm.0000000000000798] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/27/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare cardiovascular screening policies of Australian elite sporting organizations. DESIGN Online survey. SETTING Elite/professional sports in Australia. PARTICIPANTS Chief medical officers (CMOs) of elite/professional sports in Australia, including rugby union and league, cricket, tennis, Australian football, and cycling. ASSESSMENT OF VARIABLES Survey questions about each sport's cardiac screening policy: which screening components were included [eg, history and physical (H&P), resting 12-lead electrocardiogram (ECG)], whether screening was mandatory, whether the policy applied to elite junior and/or adult players, and which criteria were used to interpret ECGs. MAIN OUTCOME MEASURES Which sports had a formal cardiac screening policy, which athletes the policy applied to, components of screening, ECG interpretation criteria used. RESULTS Chief medical officers for 22/31 (71%) sports responded, representing >5000 athletes. Of these, 19/22 (86%) perform regular screening (100% H&P; 89% included ECG) with international cyclists also having routine echocardiograms and stress testing. Thirty-three percent of CMOs used the 2017 International Criteria for athlete ECG interpretation. Screening was mandatory with enforcement (26%), mandatory without enforcement (48%), and opt-out (26%). All screened adult elite athletes, and 68% screened junior elite athletes. Forty-two percent indicated athletes were required to pay for screening tests, and 63% required athletes to pay for follow-up tests. Almost all (94%) sports with a sports physician as the CMO screened athletes. CONCLUSIONS Most sports have a screening policy, with reasonable uniformity of components. All included H&P, and almost all included ECG. Only one sport included an echocardiogram and stress test as a standard (international players only). Promoting the latest ECG interpretation criteria may reduce false-positives and cost. Future work should explore cardiac emergency plans, screening infrastructure, cost, and long-term follow-up.
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Affiliation(s)
- Jessica J Orchard
- Heart Research Institute, Charles Perkins Centre, Sydney, Australia
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - John W Orchard
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | | | - Irfan M Asif
- University of Alabama Birmingham, Birmingham, Alabama
| | - David Hughes
- Australian Institute of Sport, Canberra, Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, Melbourne, Australia ; and
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Sydney, Australia
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Abstract
ABSTRACT Introduction: The study and collection of athletes’ heart function index parameters and the correct and reasonable evaluation of body functions can effectively adjust training plans and avoid athletes’ bodily exhaustion. Objective: To study the diagnosis of myocardial injury by cardiovascular monitoring in athletes from two aspects: extraction of characteristic parameters of heart function and research of signal processing. Methods: The heart function intelligent evaluation algorithm was studied by using multi-source information fusion, and embedded technology; miniature sensors were used as well. Results: The incidence of severe ventricular arrhythmia was lower in both groups. The incidence of sinus arrhythmia and intermittent second degree I atrioventricular block in the high-intensity group was significantly higher than that in the control group. The number of atrial and ventricular premature beats was lower in the control group, but increased significantly in the high-intensity group. Conclusions: This study applied the theory of multi-source information fusion to carry out representative research on the intelligent monitoring and evaluation of the heart function of elite athletes, centering on the application requirements of the heart function monitoring of elite athletes. Level of evidence II; Therapeutic studies - investigation of treatment results.
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Affiliation(s)
| | - Chang Sun
- Qiqihar Institute of Engineering, China
| | - Jie Bai
- Qiqihar Medical University, China
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34
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Panhuyzen-Goedkoop NM, Wellens HJ, Verbeek ALM, Piek JJ, Peters RJG. Immediate Bystander Cardiopulmonary Resuscitation to Sudden Cardiac Arrest During Sports is Associated with Improved Survival-a Video Analysis. SPORTS MEDICINE-OPEN 2021; 7:50. [PMID: 34292409 PMCID: PMC8298728 DOI: 10.1186/s40798-021-00346-2] [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: 07/01/2020] [Accepted: 07/08/2021] [Indexed: 11/21/2022]
Abstract
Background Sudden cardiac arrest (SCA) during sports can be the first symptom of yet undetected cardiovascular conditions. Immediate chest compressions and early defibrillation offer SCA victims the best chance of survival, which requires prompt bystander cardiopulmonary resuscitation (CPR). Aims To determine the effect of rapid bystander CPR to SCA during sports by searching for and analyzing videos of these SCA/SCD events from the internet. Methods We searched images.google.com, video.google.com, and YouTube.com, and included any camera-witnessed non-traumatic SCA during sports. The rapidity of starting bystander chest compressions and defibrillation was classified as < 3, 3–5, or > 5 min. Results We identified and included 29 victims of average age 27.6 ± 8.5 years. Twenty-eight were males, 23 performed at an elite level, and 18 participated in soccer. Bystander CPR < 3 min (7/29) or 3–5 min (1/29) and defibrillation < 3 min was associated with 100% survival. Not performing chest compressions and defibrillation was associated with death (14/29), and > 5 min delay of intervention with worse outcome (death 4/29, severe neurologic dysfunction 1/29). Conclusions Analysis of internet videos showed that immediate bystander CPR to non-traumatic SCA during sports was associated with improved survival. This suggests that immediate chest compressions and early defibrillation are crucially important in SCA during sport, as they are in other settings. Optimal use of both will most likely result in survival. Most videos showing recent events did not show an improvement in the proportion of athletes who received early resuscitation, suggesting that the problem of cardiac arrest during sports activity is poorly recognized.
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Affiliation(s)
- Nicole M Panhuyzen-Goedkoop
- Heart Centre, Amsterdam University Medical Centre, AMC, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands. .,Sports Medical Centre Papendal, Arnhem, the Netherlands.
| | | | - André L M Verbeek
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Jan J Piek
- Heart Centre, Amsterdam University Medical Centre, AMC, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - Ron J G Peters
- Heart Centre, Amsterdam University Medical Centre, AMC, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
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Olufade OA, Patel A, Cherian C, Waterbrook AL, Zaremski JL, Sussman WI, Bowers R, Hrubes M, Myers RA. Suggested Curricular Guidelines for Musculoskeletal and Sports Medicine in Physical Medicine and Rehabilitation Residency Training. Curr Sports Med Rep 2021; 20:366-373. [PMID: 34234092 DOI: 10.1249/jsr.0000000000000862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT A sports medicine physician manages musculoskeletal (MSK) injuries and sport-related medical and MSK conditions of patients of all ages and abilities. Physical medicine and rehabilitation physicians (physiatrists) must be adequately trained to provide this care for all patients including, but not limited to, athletes participating in organized sports, the weekend warrior as well as athletes with disabilities. Accreditation Council of Graduate Medical Education core requirements and basic guidelines help physiatry residency training programs develop and implement residency curriculums. The goal of this article is to provide suggested curricular guidelines to optimize physiatrist training in MSK and sports medicine.
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Affiliation(s)
| | | | - Chris Cherian
- Department of Sports Medicine, Rothman Orthopaedic Institute, Paramus, NJ
| | - Anna L Waterbrook
- Emergency and Sports Medicine, The University of Arizona Tucson, Arizona
| | - Jason L Zaremski
- Divisions of PM&R, Sports Medicine & Research, Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL
| | | | | | - Melody Hrubes
- Department of Sports Medicine, Rothman Orthopaedic Institute, New York, NY
| | - Rebecca A Myers
- Department of Family Medicine, University of Colorado Longs Peak Family and Sports Medicine, Longmont, CO
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36
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Guía ESC 2020 sobre cardiología del deporte y el ejercicio en pacientes con enfermedad cardiovascular. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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37
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Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, Collet JP, Corrado D, Drezner JA, Halle M, Hansen D, Heidbuchel H, Myers J, Niebauer J, Papadakis M, Piepoli MF, Prescott E, Roos-Hesselink JW, Graham Stuart A, Taylor RS, Thompson PD, Tiberi M, Vanhees L, Wilhelm M. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. Eur Heart J 2021; 42:17-96. [PMID: 32860412 DOI: 10.1093/eurheartj/ehaa605] [Citation(s) in RCA: 766] [Impact Index Per Article: 255.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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38
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Coleman N, Beasley M, Briskin S, Chapman M, Cuff S, Demorest RA, Halstead M, Hornbeck K, Kinsella SB, Logan K, Liu R, Mooney C, Myers RA, Ruparell S, Santana J, Walter KD, Waterbrook AL, Wolf SF. Musculoskeletal and Sports Medicine Curriculum Guidelines for Pediatric Residents. Curr Sports Med Rep 2021; 20:218-228. [PMID: 33790194 DOI: 10.1249/jsr.0000000000000830] [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: 11/21/2022]
Abstract
ABSTRACT Musculoskeletal (MSK) and sports-related conditions are relatively common in the pediatric population. Pediatric residencies should provide residents with the knowledge and skills to assess and manage both acute and chronic MSK and sports injuries and complaints. Residents should develop the competencies and attitudes to safeguard and promote a healthy and active lifestyle for youth. Programs can use a variety of educational tools, both in the clinic and on the field, to provide a well-rounded MSK curriculum throughout the residency years. This article provides a review of general pediatric sports medicine curriculum guidelines and suggested implementation strategies.
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Affiliation(s)
- Nailah Coleman
- Children's National Hospital, The Goldberg Center for Community Pediatric Health, Washington, DC
| | - Michael Beasley
- Boston Children's Hospital, Sports Medicine Division, Boston, MA
| | - Susannah Briskin
- Rainbow Babies and Children's Hospital, Division of Sports Medicine, Solon, OH
| | | | - Steven Cuff
- Nationwide Children's Hospital, Sports Medicine, Westerville, OH
| | - Rebecca A Demorest
- Webster Orthopedics, Pediatric and Young Adult Sports Medicine, Dublin, CA
| | | | - Kimberly Hornbeck
- Medical College of Wisconsin, Children's Wisconsin Primary Care Sports Medicine, Milwaukee, WI
| | | | - Kelsey Logan
- Cincinnati Children's Hospital Medical Center, Division of Sports Medicine, Cincinnati, OH
| | - Ruikang Liu
- Penn State Health-Children's Hospital, Department of Pediatrics, Hershey, PA
| | | | - Rebecca A Myers
- University of Colorado, Department of Family Medicine, Longmont, CO
| | - Sonia Ruparell
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Chicago, IL
| | - Jonathan Santana
- Baylor College of Medicine, Department of Pediatrics, Section of Adolescent and Sports Medicine, Houston, TX
| | - Kevin D Walter
- Medical College of Wisconsin, Departments of Orthopaedic Surgery & Pediatrics, Children's Wisconsin Primary Care Sports Medicine, Delafield, WI
| | - Anna L Waterbrook
- The University of Arizona, Department of Emergency Medicine, Tucson, AZ
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Chin TJ, Lee ACL, Fulcher ML. Professional footballers have a limited understanding of the precompetition medical assessment and the possible outcomes including disqualification: a cross-sectional survey. BMJ Open Sport Exerc Med 2021; 7:e001006. [PMID: 33768962 PMCID: PMC7944969 DOI: 10.1136/bmjsem-2020-001006] [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] [Accepted: 02/22/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives To determine professional footballers’ level of understanding of the purpose of the precompetition medical assessment (PCMA) and to evaluate their knowledge of potential outcomes following a PCMA, including disqualification. Methods Professional footballers from the Australasian A-League and Westfield W-League were asked to complete a 25-question survey. The relationship between dichotomised outcomes and explanatory variables was analysed with multivariate logistic regression; p<0.05 was considered statistically significant. Results A total of 212 players participated (response rate=48.8%). Most respondents selected ‘To detect medical conditions that may affect performance’ and ‘To detect current injuries’ (n=137, 64.6%; n=130, 61.3%) as the purpose of a PCMA. Approximately one-third (n=74, 38.1%) were neutral or believed that a normal PCMA prevented cardiac arrest. Receiving more PCMAs (p<0.0003) and receiving an explanation during their PCMA (p=0.0175) led to greater awareness of the assessment’s limitations. Most participants did not know the definitions of syncope (n=181, 93.3%) or Marfan syndrome (n=183, 94.3%). Fifty players (28.1%) did not know that disqualification was a possible outcome of a PCMA, and younger players were less aware of this possible outcome (p=0.0216). Conclusion Professional footballers appear to have a limited understanding of the purpose of a PCMA, emphasising the musculoskeletal system and performance. They also appear unfamiliar with the components of the PCMA and medical terms. Finally, many are unaware that disqualification can result from an abnormal PCMA. Player health knowledge must be improved; the informed consent process appears an ideal time to provide this education.
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Affiliation(s)
- Thomas J Chin
- Anglesea Sports Medicine, Hamilton, New Zealand.,Summit Sports Medicine, Mount Maunganui, New Zealand
| | - Arier C L Lee
- Department of Epidemiology and Biostatistics, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Mark L Fulcher
- Axis Sports Medicine Specialists, Auckland, New Zealand.,University of Auckland, Auckland, New Zealand
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Moorman AJ, Dean LS, Yang E, Drezner JA. Cardiovascular Risk Assessment in the Older Athlete. Sports Health 2021; 13:622-629. [PMID: 33733939 DOI: 10.1177/19417381211004877] [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: 12/24/2022] Open
Abstract
CONTEXT Limited data are available to guide cardiovascular screening in adult or masters athletes (≥35 years old). This review provides recommendations and the rationale for the cardiovascular risk assessment of older athletes. EVIDENCE ACQUISITION Review of available clinical guidelines, original investigations, and additional searches across PubMed for articles relevant to cardiovascular screening, risk assessment, and prevention in adult athletes (1990-2020). STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 3. RESULTS Atherosclerotic coronary artery disease (CAD) is the leading cause of exercise-induced acute coronary syndromes, myocardial infarction, and sudden cardiac death in older athletes. Approximately 50% of adult patients who experience acute coronary syndromes and sudden cardiac arrest do not have prodromal symptoms of myocardial ischemia. The risk of atherosclerotic cardiovascular disease (ASCVD) can be estimated by using existing risk calculators. ASCVD 10-year risk is stratified into 3 categories: low-risk (≤10%), intermediate-risk (between 10% and 20%), and high-risk (≥20%). Coronary artery calcium (CAC) scoring with noncontrast computed tomography provides a noninvasive measure of subclinical CAD. Evidence supports a significant association between elevated CAC and the risk of future cardiovascular events, independent of traditional risk factors or symptoms. Statin therapy is recommended for primary prevention if 10-year ASCVD risk is ≥10% (intermediate- or high-risk patients) or if the Agatston score is >100 or >75th percentile for age and sex. Routine stress testing in asymptomatic, low-risk patients is not recommended. CONCLUSION We propose a comprehensive risk assessment for older athletes that combines conventional and novel risk factors for ASCVD, a 12-lead resting electrocardiogram, and a CAC score. Available risk calculators provide a 10-year estimate of ASCVD risk allowing for risk stratification and targeted management strategies. CAC scoring can refine risk estimates to improve the selection of patients for initiation or avoidance of pharmacological therapy.
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Affiliation(s)
- Alec J Moorman
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
| | - Larry S Dean
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
| | - Eugene Yang
- Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington
| | - Jonathan A Drezner
- Department of Family Medicine, Sports Medicine Section and UW Medicine Center for Sports Cardiology, University of Washington, Seattle, Washington
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Scheer V, Costa RJS, Doutreleau S, Knechtle B, Nikolaidis PT, Roberts WO, Stoll O, S Tenforde A, Krabak B. Recommendations on Youth Participation in Ultra-Endurance Running Events: A Consensus Statement. Sports Med 2021; 51:1123-1135. [PMID: 33704697 DOI: 10.1007/s40279-021-01441-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2021] [Indexed: 12/28/2022]
Abstract
Participation in ultra-endurance running (UER) events continues to grow across ages, including youth athletes. The 50- and 100-km are the most popular distances among youth athletes. Most youth athletes are between 16-18 years; however, some runners younger than 12 years have successfully completed UER events. Parents, athletes, coaches, race directors, and medical professionals often seek advice regarding the safety of youth athletes participating in these events, especially with regard to potential short and long-term health consequences. UER may impact key organ systems during growth and development. We propose a decision-making process, based on current knowledge and the experience of the consensus group that addresses age regulations, medical and psychological well-being, training status and race-specific factors (such as distance, elevation change, remoteness, ambient temperatures, level of medical assistance, and type of provisions provided by the race organizers) to use until evidence of long-term consequences of UER in youth athletes is available. These recommendations are aimed at safe participation in UER events for youth athletes with a proper and individualized assessment.
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Affiliation(s)
- Volker Scheer
- Ultra Sports Science Foundation, 109 Boulevard de l'Europe, 69310, Pierre-Benite, France. .,Health Science Department, Universidad a Distancia de Madrid (UDIMA), Madrid, Spain.
| | - Ricardo J S Costa
- Department of Nutrition Dietetics and Food, Monash University, Melbourne, Australia
| | | | - Beat Knechtle
- Medbase St. Gallen am Vadianplatz, St. Gallen, Switzerland.,Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | | | - William O Roberts
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Oliver Stoll
- Institute of Sport Science, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Adam S Tenforde
- Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Brian Krabak
- University of Washington and Seattle Children's Sports Medicine, Seattle, WA, USA
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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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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: 7] [Impact Index Per Article: 2.3] [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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Nabhan D, Taylor D, Lewis M, Bahr R. Protecting the world's finest athletes: periodic health evaluation practices of the top performing National Olympic Committees from the 2016 Rio or 2018 PyeongChang Olympic Games. Br J Sports Med 2021; 55:961-967. [PMID: 33468453 DOI: 10.1136/bjsports-2020-103481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 11/03/2022]
Abstract
AIM To describe the periodic health evaluation (PHE) practices of the top performing National Olympic Committees (NOCs). METHODS We sent a survey to NOCs finishing in the top 8 for medal count at the 2016 Rio Olympic Games or 2018 PyeongChang Olympic Games. The survey included four sections: (1) PHE staff composition and roles, (2) beliefs regarding the PHE, (3) a ranking of risk factors for future injury and (4) details on the elements of the PHE. RESULTS All 14 NOCs with top 8 finishes at the 2016 Rio Olympic Games or 2018 PyeongChang Olympic Games completed the survey. NOCs included a median of seven staff specialties in the PHE, with physicians and physiotherapists having the highest level of involvement. There was agreement that PHEs are effective in identifying current health conditions (13/14) and that athletes should receive individualised action plans after their PHE (14/14), but less agreement (6/14) that PHEs can predict future injury. The practices of NOCs were diverse and often specific to the athlete population being tested, but always included the patient's health history, laboratory studies, cardiovascular screening and assessments of movement capacity. The top three risk factors for future injury were thought to be previous injury, age and training experience. CONCLUSIONS Among the top performing NOCs, the PHE is a comprehensive, multidisciplinary process aimed to identify existing conditions and provide baseline health and performance profiles in the event of future injury. Research linking PHEs to injury prevention is needed.
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Affiliation(s)
- Dustin Nabhan
- Sports Medicine, United States Olympic and Paralympic Committee, Colorado Springs, Colorado, USA .,US Coalition for Prevention of Illness and Injury in Sport, Colorado Springs, Colorado, USA
| | - David Taylor
- Sports Medicine, United States Olympic and Paralympic Committee, Colorado Springs, Colorado, USA.,US Coalition for Prevention of Illness and Injury in Sport, Colorado Springs, Colorado, USA
| | - Melie Lewis
- Sports Medicine, United States Olympic and Paralympic Committee, Colorado Springs, Colorado, USA.,US Coalition for Prevention of Illness and Injury in Sport, Colorado Springs, Colorado, USA
| | - Roald Bahr
- Oslo Sports Trauma Research Center, Oslo, Norway
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Drezner JA, Malhotra A, Prutkin JM, Papadakis M, Harmon KG, Asif IM, Owens DS, Marek JC, Sharma S. Return to play with hypertrophic cardiomyopathy: are we moving too fast? A critical review. Br J Sports Med 2021; 55:1041-1047. [PMID: 33472848 PMCID: PMC8408577 DOI: 10.1136/bjsports-2020-102921] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2020] [Indexed: 12/31/2022]
Abstract
The diagnosis of a potentially lethal cardiovascular disease in a young athlete presents a complex dilemma regarding athlete safety, patient autonomy, team or institutional risk tolerance and medical decision-making. Consensus cardiology recommendations previously supported the ‘blanket’ disqualification of athletes with hypertrophic cardiomyopathy (HCM) from competitive sport. More recently, epidemiological studies examining the relative contribution of HCM as a cause of sudden cardiac death (SCD) in young athletes and reports from small cohorts of older athletes with HCM that continue to exercise have fueled debate whether it is safe to play with HCM. Shared decision-making is endorsed within the sports cardiology community in which athletes can make an informed decision about treatment options and potentially elect to continue competitive sports participation. This review critically examines the available evidence relevant to sports eligibility decisions in young athletes diagnosed with HCM. Histopathologically, HCM presents an unstable myocardial substrate that is vulnerable to ventricular tachyarrhythmias during exercise. Studies support that young age and intense competitive sports are risk factors for SCD in patients with HCM. We provide an estimate of annual mortality based on our understanding of disease prevalence and the incidence of HCM-related SCD in different athlete populations. Adolescent and young adult male athletes and athletes participating in a higher risk sport such as basketball, soccer and American football exhibit a greater risk. This review explores the potential harms and benefits of sports disqualification in athletes with HCM and details the challenges and limitations of shared decision-making when all parties may not agree.
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Affiliation(s)
- Jonathan A Drezner
- Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
| | - Aneil Malhotra
- Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Jordan M Prutkin
- Department of Internal Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Michael Papadakis
- Cardiology, Clinical Academic Group, St George's, University of London, London, UK
| | - Kimberly G Harmon
- Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
| | - Irfan M Asif
- Center for Health Promotion, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David S Owens
- Department of Internal Medicine, Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Joseph C Marek
- Cardiology, Advocate Heart Institute, Downers Grove, Illinois, USA
| | - Sanjay Sharma
- Cardiology, Clinical Academic Group, St George's, University of London, London, UK
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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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Zogović B, Stašević M, Radić I. The role of the electrocardiogram in identifying the risk of sudden cardiac death. PRAXIS MEDICA 2021. [DOI: 10.5937/pramed2104001z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Introduction: Sudden cardiac death (SCD) represents the unexpected and sudden death of young apparently healthy people. Alarge number of examined cases referred to professional athletes. There is not enough data in the literature related to those who performed sports in a sporadic and recreational manner. In order to prevent SCD, a screening protocol was determined, in which, an ECG performed at rest plays a important role. Based on the established criteria, changes on the ECG can be treated as normal, borderline and abnormal. An abnormal result indicates a risk of SCD. Objective: The aim of this study was to determine the risk of SCD in students who practice physical activity recreationally. Methods: The research involved 500 students (both sexes) of the 1st and 3rd year of study on the University of Pristina situated in Kosovska Mitrovica. As part of the regular systematic examination, an ECG was performed at rest. The risk of SCD was determined by analyzing the changes on the ECG and grouping them based on screening recommendations. Results: The obtained results show that 44% of students had changes on the ECG and that 8% of students had an abnormal result indicated a possible risk of sudden cardiac death. Conclusion: Therefore, timely recognizing and interpreting ECG changes in accordance with screening recommendations is an imperative for identification and possible prevention of SCD.
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van Hattum JC, Verwijs SM, Rienks R, Bijsterveld NR, de Vries ST, Pinto YM, Wilde AAM, Jørstad HT. The Netherlands Sports Cardiology Map: a step towards sports cardiology network medicine for patient and athlete care. Neth Heart J 2020; 29:129-134. [PMID: 33355906 PMCID: PMC7904973 DOI: 10.1007/s12471-020-01530-x] [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: 12/03/2020] [Indexed: 12/22/2022] Open
Abstract
Sports cardiology is a rapidly evolving subspecialty of cardiology, with a growing demand for expertise. To improve patient care, clinicians, patients, and athletes (recreational to elite) should be able to easily identify specialised care pathways, expertise centres and clinicians with sports cardiology expertise. To this purpose, several international societies and organisations recommend establishing a local and national sports cardiology infrastructure. We therefore aimed to establish The Netherlands Sports Cardiology Map. We conducted a web-based survey, which was published on the Netherlands Society of Cardiology home page (2019–2020) and in which each cardiology department or clinic was asked to provide information on sports cardiology expertise and the current infrastructure. Of the 46 respondent centres, 28 (61%) reported that they had expertise in sports cardiology, of which 22 (79%) had specific expertise in one or more specific types of sports. Integrated multidisciplinary meetings were reported by 43% of the centres (n = 12/28). Only two centres reported ongoing research projects that had been approved by an institutional review board. The Netherlands Sports Cardiology Map is an important step towards improving the existing infrastructure and developing network medicine for sports cardiology.
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Affiliation(s)
- J C van Hattum
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
| | - S M Verwijs
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - R Rienks
- CardioExpert, Amsterdam, The Netherlands
| | - N R Bijsterveld
- Department of Cardiology, Flevo Hospital, Almere, The Netherlands
| | - S T de Vries
- Department of Cardiology, Tjongerschans Hospital, Heerenveen, The Netherlands
| | - Y M Pinto
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - A A M Wilde
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - H T Jørstad
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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Peterson DF, Kucera K, Thomas LC, Maleszewski J, Siebert D, Lopez-Anderson M, Zigman M, Schattenkerk J, Harmon KG, Drezner JA. Aetiology and incidence of sudden cardiac arrest and death in young competitive athletes in the USA: a 4-year prospective study. Br J Sports Med 2020; 55:1196-1203. [PMID: 33184114 PMCID: PMC8551972 DOI: 10.1136/bjsports-2020-102666] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2020] [Indexed: 11/23/2022]
Abstract
Objective To investigate the aetiology and incidence of sudden cardiac arrest and death (SCA/D) in US competitive athletes. Methods Prospective surveillance was conducted from 1 July 2014 to 30 June 2018 through the National Center for Catastrophic Sports Injury Research in collaboration with national sports organisations. Autopsy reports, death certificates, and medical records were reviewed by an expert panel to determine aetiology. Athlete participation statistics from the National Federation of State High School Associations and the National Collegiate Athletic Association (NCAA) were used to calculate incidence rates per athlete-years (AY). Comparisons of incidence rates were calculated using incidence rate ratios (IRR) with 95% CIs. Results 331 cases of confirmed SCA/D (158 survivors; 173 fatalities) were identified; 15.4% in middle school, 61.6% in high school and 16.6% in college and professional athletes. Average age was 16.7 (11–29) years, and the majority were in male (83.7%), basketball (28.7%) or American football (25.4%) athletes. Common causes included hypertrophic cardiomyopathy (20.6%), idiopathic left ventricular hypertrophy (13.4%), coronary artery anomalies (12.0%) and autopsy-negative sudden unexplained death (9.6%). Coronary anomalies were more common in middle school athletes (28%), while cardiomyopathies (hypertrophic, arrhythmogenic, dilated, non-compaction or restricted) accounted for 47% of cases in college and professional athletes. Incidence was higher in male versus female athletes at the high school (1:43 932 AY (95% CI 1:38 101 to 1:50 907) vs 1:203 786 AY (95% CI 1:145 251 to 1:293 794); IRR 4.6 (95% CI 3.1 to 7.2)) and NCAA (1:34 906 AY (95% CI 1:25 385 to 1:49 173) vs 1:123 278 AY (95% CI 1:66 078 to 1:249 853); IRR 3.5 (95% CI 1.5 to 9.5)) levels. African American male NCAA Division I basketball players had the highest annual incidence rate of SCA/D (1:2087 AY (95% CI 1:1073 to 1:4 450)). Conclusions Cardiomyopathies account for nearly half of SCA/D cases in college and professional athletes, while coronary artery anomalies play a more prominent role than expected in middle school athletes. Over half of SCA cases in athletes result in sudden death, calling for improved prevention strategies.
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Affiliation(s)
- Danielle F Peterson
- Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
| | - Kristen Kucera
- Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Leah Cox Thomas
- Duke Cancer Institute, Duke Medicine, Durham, North Carolina, USA
| | - Joseph Maleszewski
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - David Siebert
- Family Medicine, University of Washington, Seattle, Washington, USA
| | | | - Monica Zigman
- Family Medicine, University of Washington, Seattle, Washington, USA
| | - Jared Schattenkerk
- University of Rochester School of Medicine & Dentistry, Rochester, New York, USA
| | | | - Jonathan A Drezner
- Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
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Krabak BJ, Roberts WO, Tenforde AS, Ackerman KE, Adami PE, Baggish AL, Barrack M, Cianca J, Davis I, D'Hemecourt P, Fredericson M, Goldman JT, Harrast MA, Heiderscheit BC, Hollander K, Kraus E, Luke A, Miller E, Moyer M, Rauh MJ, Toresdahl BG, Wasfy MM. Youth running consensus statement: minimising risk of injury and illness in youth runners. Br J Sports Med 2020; 55:305-318. [PMID: 33122252 DOI: 10.1136/bjsports-2020-102518] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2020] [Indexed: 01/25/2023]
Abstract
Despite the worldwide popularity of running as a sport for children, relatively little is known about its impact on injury and illness. Available studies have focused on adolescent athletes, but these findings may not be applicable to preadolescent and pubescent athletes. To date, there are no evidence or consensus-based guidelines identifying risk factors for injury and illness in youth runners, and current recommendations regarding suitable running distances for youth runners at different ages are opinion based. The International Committee Consensus Work Group convened to evaluate the current science, identify knowledge gaps, categorise risk factors for injury/illness and provide recommendations regarding training, nutrition and participation for youth runners.
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Affiliation(s)
- Brian J Krabak
- Rehabilitation, Orthopedics and Sports Medicine, Univesrity of Washington, Seattle, Washington, USA
| | - William O Roberts
- Family Medicine and Community Health, University of Minnesota, St Paul, Minnesota, USA
| | - Adam S Tenforde
- Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | | | - Paolo Emilio Adami
- Health and Science, IAAF Health & Science Department, International Association of Athletics Federations (IAAF), Monaco
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michelle Barrack
- Family and Consumer Sciences, California State University, Long Beach, Long Beach, California, USA
| | - John Cianca
- Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Irene Davis
- Physical Medicine and Rehabilitation, National Running Center, Cambridge, Massachusetts, USA
| | | | | | - Joshua T Goldman
- Sports Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Mark A Harrast
- Rehabilitation, Orthopedics and Sports Medicine, Univesrity of Washington, Seattle, Washington, USA
| | - Bryan C Heiderscheit
- Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Emily Kraus
- Orthopaedic Surgery, Stanford Hospital and Clinics, Stanford, California, USA
| | - Anthony Luke
- Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Emily Miller
- Sports Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Melissa Moyer
- Sports Physical Therapy, Sanford Health, Sioux Falls, South Dakota, USA
| | - Mitchell J Rauh
- School of Exercise and Nutritional Sciences, Doctor of Physical Therapy Program, San Diego State University, San Diego, California, USA
| | - Brett G Toresdahl
- Primary Care Sports Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Meagan M Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
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