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Idiazabal-Ayesa U, Guía-Galipienso FDL, Ramírez-Vélez R, Sanz-de la Garza M, Izquierdo M. Diagnostic cost-effectiveness of a two-stage cardiovascular evaluation program in young-adolescent athletes. Role of echocardiography. Curr Probl Cardiol 2024:102724. [PMID: 38925205 DOI: 10.1016/j.cpcardiol.2024.102724] [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: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Sports medical examinations are a tool to detect potentially life-threatening situations during physical activity, but their usefulness and protocols in young athletes remain controversial. The aim was to describe the diagnostic performance of a 2-step ECG and echocardiogram screening model in a large sample of healthy young-adolescent athletes (aged 11-16 years), evaluating its cost-effectiveness for cardiovascular disease (CVD) detection. METHODS Cross-sectional study of 2617 individuals (81% male, mean age 15 years), over 20 federated sports (La Rioja-Spain). A cardiological examination included family and personal history, physical examination, ECG, and transthoracic echocardiogram. The previous ECG, conducted at 11-13 years old, was reviewed in 1589 individuals (60%). ECGs were interpreted according to 2017 international criteria. The prevalence of structural cardiac disease (CD) was investigated, and the diagnostic performance of both tests and the cost of screening was evaluated. RESULTS CVD was diagnosed in 63 athletes (2.4%) and 16 (0.6%) with pathology related to sudden cardiac death (SCD). In 3 cases (0.11%), cessation of sporting activity was indicated, and in 2 cases (0.07%), treatment for congenital CD was indicated. ECG alterations were infrequent (2.5%). Eighty percent of the structural CD diagnosed by echocardiogram had a normal ECG. The cost per CVD detected was €3,080, and for CVD associated with SCD, it was €12,323. CONCLUSIONS Our study shows the diagnostic cost-effectiveness of a two-step cardiac screening protocol, including ECG, and highlights the role of echocardiography in young adolescent athletes, which could be implemented at a low and reasonable cost.
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Affiliation(s)
- Uxua Idiazabal-Ayesa
- Department of Cardiology and Internal Medicine, Hospital García Orcoyen, Estella, Navarra, Spain; Navarrabiomed, University Hospital of Navarre (HUN), Public University of Navarre (UPNA), IdiSNA, Pamplona, Spain
| | - Fernando de la Guía-Galipienso
- Policlínica Glorieta, Dénia, Spain; REMA Clinic - Sports Cardiology, Dénia, Spain; HCB Benidorm Hospital, Alicante, Spain; Department of Pathology, Catholic University of Valencia - San Vicente Mártir, Valencia, Spain.
| | - Robinson Ramírez-Vélez
- Navarrabiomed, University Hospital of Navarre (HUN), Public University of Navarre (UPNA), IdiSNA, Pamplona, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - María Sanz-de la Garza
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mikel Izquierdo
- Navarrabiomed, University Hospital of Navarre (HUN), Public University of Navarre (UPNA), IdiSNA, Pamplona, Spain; Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Palermi S, Vecchiato M, Saglietto A, Niederseer D, Oxborough D, Ortega-Martorell S, Olier I, Castelletti S, Baggish A, Maffessanti F, Biffi A, D'Andrea A, Zorzi A, Cavarretta E, D'Ascenzi F. Unlocking the potential of artificial intelligence in sports cardiology: does it have a role in evaluating athlete's heart? Eur J Prev Cardiol 2024; 31:470-482. [PMID: 38198776 DOI: 10.1093/eurjpc/zwae008] [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: 06/29/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
The integration of artificial intelligence (AI) technologies is evolving in different fields of cardiology and in particular in sports cardiology. Artificial intelligence offers significant opportunities to enhance risk assessment, diagnosis, treatment planning, and monitoring of athletes. This article explores the application of AI in various aspects of sports cardiology, including imaging techniques, genetic testing, and wearable devices. The use of machine learning and deep neural networks enables improved analysis and interpretation of complex datasets. However, ethical and legal dilemmas must be addressed, including informed consent, algorithmic fairness, data privacy, and intellectual property issues. The integration of AI technologies should complement the expertise of physicians, allowing for a balanced approach that optimizes patient care and outcomes. Ongoing research and collaborations are vital to harness the full potential of AI in sports cardiology and advance our management of cardiovascular health in athletes.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, via Pansini 5, 80131 Naples, Italy
| | - Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Andrea Saglietto
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Citta della Salute e della Scienza' Hospital, 10129 Turin, Italy
- Department of Medical Sciences, University of Turin, 10129 Turin, Italy
| | - David Niederseer
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Sandra Ortega-Martorell
- Data Science Research Centre, Liverpool John Moores University, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Ivan Olier
- Data Science Research Centre, Liverpool John Moores University, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Silvia Castelletti
- Cardiology Department, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Alessandro Biffi
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, 00187 Rome, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I Hospital, 84014 Nocera Inferiore, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
- Mediterranea Cardiocentro, 80122 Naples, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
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Marrazzo G, Palermi S, Pastore F, Ragni M, Mauriello A, Zambrano A, Quaranta G, Manto A, D'Andrea A. Enhancing ST-Elevation Myocardial Infarction Diagnosis and Management: The Integral Role of Echocardiography in Patients Rushed to the Cardiac Catheterization Laboratory. J Clin Med 2024; 13:1425. [PMID: 38592271 PMCID: PMC10931949 DOI: 10.3390/jcm13051425] [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: 12/29/2023] [Revised: 02/08/2024] [Accepted: 02/29/2024] [Indexed: 04/10/2024] Open
Abstract
Coronary artery disease (CAD) remains a significant global health concern, necessitating timely and precise diagnosis, especially for acute coronary syndromes (ACSs). Traditional diagnostic methods like electrocardiograms (ECGs) are critical, yet the advent of echocardiography has revolutionized cardiac care by providing comprehensive insights into heart function. This article examines the integration of echocardiography in the cardiac catheterization laboratory, emphasizing its role in augmenting traditional diagnostics, enhancing patient outcomes, and preparing for targeted interventions. Specifically, we argue for the routine use of focused echocardiographic evaluations in patients presenting with ST-Elevation Myocardial Infarction (STEMI) to the cath lab, illustrating how this practice can significantly refine diagnostic accuracy, identify concurrent life-threatening conditions, and inform the management of STEMI and its complications.
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Affiliation(s)
- Gemma Marrazzo
- Department of Cardiology, Umberto I° Hospital, 84014 Salerno, Italy
| | - Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Fabio Pastore
- Department of Cardiology, Umberto I° Hospital, 84014 Salerno, Italy
| | - Massimo Ragni
- Department of Cardiology, Umberto I° Hospital, 84014 Salerno, Italy
| | - Alfredo Mauriello
- Department of Cardiology, Luigi Vanvitelli University, 81100 Naples, Italy
| | - Aniello Zambrano
- Department of Cardiology, Umberto I° Hospital, 84014 Salerno, Italy
| | - Gaetano Quaranta
- Department of Cardiology, Umberto I° Hospital, 84014 Salerno, Italy
| | - Andrea Manto
- Department of Neuroradiology, Umberto I° Hospital, 84014 Salerno, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I° Hospital, 84014 Salerno, Italy
- Department of Cardiology, Luigi Vanvitelli University, 81100 Naples, Italy
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Palermi S, Sperlongano S, Mandoli GE, Pastore MC, Lisi M, Benfari G, Ilardi F, Malagoli A, Russo V, Ciampi Q, Cameli M, D’Andrea A. Exercise Stress Echocardiography in Athletes: Applications, Methodology, and Challenges. J Clin Med 2023; 12:7678. [PMID: 38137747 PMCID: PMC10743501 DOI: 10.3390/jcm12247678] [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: 10/24/2023] [Revised: 11/23/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
This comprehensive review explores the role of exercise stress echocardiography (ESE) in assessing cardiovascular health in athletes. Athletes often exhibit cardiovascular adaptations because of rigorous physical training, making the differentiation between physiological changes and potential pathological conditions challenging. ESE is a crucial diagnostic tool, offering detailed insights into an athlete's cardiac function, reserve, and possible arrhythmias. This review highlights the methodology of ESE, emphasizing its significance in detecting exercise-induced anomalies and its application in distinguishing between athlete's heart and other cardiovascular diseases. Recent advancements, such as LV global longitudinal strain (GLS) and myocardial work (MW), are introduced as innovative tools for the early detection of latent cardiac dysfunctions. However, the use of ESE also subsumes limitations and possible pitfalls, particularly in interpretation and potential false results, as explained in this article.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy;
| | - Simona Sperlongano
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (S.S.); (V.R.)
| | - Giulia Elena Mandoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (M.L.); (M.C.)
| | - Maria Concetta Pastore
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (M.L.); (M.C.)
| | - Matteo Lisi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (M.L.); (M.C.)
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy;
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy;
| | - Alessandro Malagoli
- Division of Cardiology, Nephro-Cardiovascular Department, Baggiovara Hospital, University of Modena and Reggio Emilia, 41126 Modena, Italy;
| | - Vincenzo Russo
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (S.S.); (V.R.)
| | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, 82100 Benevento, Italy;
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy; (G.E.M.); (M.C.P.); (M.L.); (M.C.)
| | - Antonello D’Andrea
- Department of Cardiology, Umberto I Hospital, 84014 Nocera Inferiore, Italy
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Idiazabal-Ayesa U, Ramírez-Vélez R, Sanz-de la Garza M, Izquierdo M. Electrocardiographic findings in pediatric versus young-adolescent athletes: A comparative analysis using general international criteria. Int J Cardiol 2023; 390:131201. [PMID: 37482093 DOI: 10.1016/j.ijcard.2023.131201] [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: 06/23/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The inclusion of electrocardiogram (ECG) in medical examinations for sports practice serves as a valuable tool for identifying potential life-threatening conditions during physical exercise. However, its applicability in young individuals remains a subject of controversy, primarily due to relatively high rates of false positives and the associated costs of further investigations. Furthermore, the validation of International Criteria for athletes below 12 years of age in optimizing pre-participation screening for young athletes is yet to be established. In light of these considerations, this study aims to describe the prevalence of ECG findings in a sample of children and young-adolescent athletes aged 11-16 years, employing refined Seattle interpretation criteria. Additionally, we seek to compare these findings based on age group and sex. METHODS This was a retrospective and observational study of 3747 athletes 11-16 year-olds. Evaluation included interviewer-administered questionnaires for relevant history, physical examination and resting 12 - lead ECG for each participant. The primary outcome measure was abnormal ECG findings according to the International Recommendations for Electrocardiographic Interpretation in Athletes. RESULTS Among the evaluated population of pediatric and young adolescent athletes (77.5% boys; >99% Caucasian), the vast majority exhibited normal electrocardiogram (ECG) results, with adaptive findings related to sports participation being more frequent among young adolescents and males. The presence of significant ECG abnormalities in young-adolescent athletes was uncommon (2.05%; 1.92% children and 2.32% young-adolescent) and required additional examinations. 0.27% of the total population were diagnosed with a previously unknown cardiac pathology only through the ECG. CONCLUSIONS This study provides valuable insights into the prevalence of normal, borderline, and abnormal electrocardiogram (ECG) findings in a large population of pediatric and young-adolescent athletes. These findings serve as guidance in detecting potentially serious cardiac alterations within this specific group, considering variations based on age and sex. The study confirms that ECG screening is a useful tool for identifying cardiac abnormalities in pediatric and young-adolescent athletes, even though the prevalence of significant findings in this population is relatively low. Furthermore, our findings support the utilization of the refined Seattle criteria as a sensitive and specific technique for screening pediatric and young-adolescent athletes, further enhancing the accuracy of ECG-based evaluations.
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Affiliation(s)
- Uxua Idiazabal-Ayesa
- Servicio de Cardiología y Medicina Interna, Hospital García Orcoyen, Estella, Navarra, Spain; Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - María Sanz-de la Garza
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
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