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Malhotra A, Dhutia H, Finocchiaro G, Gati S, Beasley I, Clift P, Cowie C, Kenny A, Mayet J, Oxborough D, Patel K, Pieles G, Rakhit D, Ramsdale D, Shapiro L, Somauroo J, Stuart G, Varnava A, Walsh J, Yousef Z, Tome M, Papadakis M, Sharma S. Outcomes of Cardiac Screening in Adolescent Soccer Players. N Engl J Med 2018; 379:524-534. [PMID: 30089062 DOI: 10.1056/nejmoa1714719] [Citation(s) in RCA: 161] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Reports on the incidence and causes of sudden cardiac death among young athletes have relied largely on estimated rates of participation and varied methods of reporting. We sought to investigate the incidence and causes of sudden cardiac death among adolescent soccer players in the United Kingdom. METHODS From 1996 through 2016, we screened 11,168 adolescent athletes with a mean (±SD) age of 16.4±1.2 years (95% of whom were male) in the English Football Association (FA) cardiac screening program, which consisted of a health questionnaire, physical examination, electrocardiography, and echocardiography. The FA registry was interrogated to identify sudden cardiac deaths, which were confirmed with autopsy reports. RESULTS During screening, 42 athletes (0.38%) were found to have cardiac disorders that are associated with sudden cardiac death. A further 225 athletes (2%) with congenital or valvular abnormalities were identified. After screening, there were 23 deaths from any cause, of which 8 (35%) were sudden deaths attributed to cardiac disease. Cardiomyopathy accounted for 7 of 8 sudden cardiac deaths (88%). Six athletes (75%) with sudden cardiac death had had normal cardiac screening results. The mean time between screening and sudden cardiac death was 6.8 years. On the basis of a total of 118,351 person-years, the incidence of sudden cardiac death among previously screened adolescent soccer players was 1 per 14,794 person-years (6.8 per 100,000 athletes). CONCLUSIONS Diseases that are associated with sudden cardiac death were identified in 0.38% of adolescent soccer players in a cohort that underwent cardiovascular screening. The incidence of sudden cardiac death was 1 per 14,794 person-years, or 6.8 per 100,000 athletes; most of these deaths were due to cardiomyopathies that had not been detected on screening. (Funded by the English Football Association and others.).
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Affiliation(s)
- Aneil Malhotra
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Harshil Dhutia
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Gherardo Finocchiaro
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Sabiha Gati
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Ian Beasley
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Paul Clift
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Charlotte Cowie
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Antoinette Kenny
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Jamil Mayet
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - David Oxborough
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Kiran Patel
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Guido Pieles
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Dhrubo Rakhit
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - David Ramsdale
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Leonard Shapiro
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - John Somauroo
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Graham Stuart
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Amanda Varnava
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - John Walsh
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Zaheer Yousef
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Maite Tome
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Michael Papadakis
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
| | - Sanjay Sharma
- From the Cardiology Clinical Academic Group, St. George's, University of London (A.M., H.D., G.F., S.G., M.T., M.P., S.S.), the Department of Sports Medicine, Bartholomew's and London Hospital (I.B.), and the Department of Cardiology, Imperial College NHS Trust (J.M., A.V.), London, the Football Association, Burton Upon Trent (A.M., C.C.), the Department of Cardiology, Queen Elizabeth Hospital, Birmingham (P.C.), the Department of Cardiology, Freeman Hospital, Newcastle Upon Tyne (A.K.), the Faculty of Science, Liverpool John Moores University (D.O., J.S.), and the Department of Cardiology, Liverpool Heart and Chest Hospital (D. Ramsdale), Liverpool, the Department of Cardiology, Good Hope Hospital, Sutton Coldfield (K.P.), Bristol Heart Institute, Bristol (G.P., G.S.), University Hospital Southampton, Southampton (D. Rakhit), the Department of Cardiology, Papworth Hospital, Papworth (L.S.), Nottingham City Hospital, Nottingham (J.W.), and the University Hospital of Wales, Cardiff (Z.Y.) - all in the United Kingdom
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