Cardiac Screening in Athletes

Craig C. Young, MD Sports Medicine

Medical College of Wisconsin

Goals

! Sudden death and athletic activity ! Preparticipation cardiac evaluation

Incidence

! Sudden cardiac death (SCD) is the leading cause of death in athletes.

! SCD incidence rate " 1:50,000 college athletes " 1:50,000–1:80,000 high school athletes.

! Possible higher risk: " Males, African- Americans basketball

players. Harmon 2014

Death in NCAA Athletes

! 10 years, 4,052,369 athletes

! suicide + drugs 1.3/100,000 athlete participation-years (5 deaths/yr)

! CV disease, 1.2/100,000 athlete participation-years (4 deaths/yr). " 5 times greater in African-

American athletes

Maron 2014

MN high school experience

! Minnesota HS Athletes 1993–2012 ! 1,666,509 unduplicated athletes participating

in ≥1 sports. ! 4 SCDs (2 cross country, 1 basketball, 1

wrestling), all male ! H&P PPE every 3 years ! SCD 0.24 per 100,000 athlete-years over 19

years & 0.11 per 100,000 athlete-years over the past decade

Roberts & Stovitz 2013

Comparing MN to ITA

Maron 09

Israeli experience

Steinvil 2011

♥"

The “athletic heart syndrome”

! Sinus bradycardia (80%+ vs. 19%) ! Sinus arrhythmia (50%+ vs. 9%)

" AV blocks " Junctional rhythms " PVCs - up to 100/d " STTW changes - repolarization

! Voltage changes (85%LVH by voltage)

Incidence of EKG abnormalities

7,764 nonathletes 4,081 athletes Training-related changes

49.1% 87.4%

Potentially pathological 21.8% 33%

! 14 to 35 yo ! 2010 European Society of Cardiology position paper ! Nonathletes

" QTc interval abnormalities (52%) of group 2 changes, " T-wave inversions constituted 11%.

! Males & African/Afro-Caribbean ethnicity strongest association with potentially pathological

Chandra 2014

2010 European Society of Cardiology

Seattle Criteria

Drezner 2013

La Gerche 2013

Potential screening

La Gerche 2013

♥"

Causes of death in young person (< 35 y.o.)

Motor vehicle accidents 14,700 deaths/yr

Drowning 1500

Accidental shooting 500

High school athlete during athletic activity

12

Society recommendations

! American Heart Assoc: H&P without routine ECG

! American Coll of Preventive Med: H&P without routine ECG

! European Society of Cardiologists: H&P & ECG.

! International Olympic Committee: H&P & ECG.

! American Coll of Sports Med: H&P without routine ECG

Horizon Cardiac MRI?

! Mangold 2013 " 95 endurance athletes " Abnormal findings in 6.3%

# 1 benign coronary anomaly # 1 coronary anomaly of unknown significance # 2 with finding of remote myocarditis # 1 with recovering myocarditis from recent EBV # None restricted @ 2 years all still asymptomatic

! Angelini 2013

Summary

! CV screening in athletes is still controversial

! Screening tests are becoming more economical " Less false positives

References !  Chandra N. Bastiaenen R. Papadakis M. Panoulas VF. Ghani S.

Duschl J. Foldes D. Raju H. Osborne R. Sharma S. Prevalence of electrocardiographic anomalies in young individuals: relevance to a nationwide cardiac screening program. J Am Coll Card. 63(19):2028-34, 2014 May 20. UI: 24583300

!  Drezner JA. Ackerman MJ. Anderson J. Ashley E. Asplund CA. Baggish AL. Borjesson M. Cannon BC. Corrado D. DiFiori JP. Fischbach P. Froelicher V. Harmon KG. Heidbuchel H. Marek J. Owens DS. Paul S. Pelliccia A. Prutkin JM. Salerno JC. Schmied CM. Sharma S. Stein R. Vetter VL. Wilson MG. Electrocardiographic interpretation in athletes: the 'Seattle criteria’. Br J Sports Med. 47(3):122-4, 2013 Feb. UI: 23303758

!  Harmon KG. Drezner JA. Wilson MG. Sharma S. Incidence of sudden cardiac death in athletes: a state-of-the-art review. Heart. 100(16):1227-34, 2014 Aug. UI: 25049314

References !  La Gerche A. Baggish AL. Knuuti J. Prior DL. Sharma S.

Heidbuchel H. Thompson PD. Cardiac imaging and stress testing asymptomatic athletes to identify those at risk of sudden cardiac death. Jacc: Cardiovascular Imaging. 6(9):993-1007, 2013 Sep. UI: 24029371

!  Maron BJ. Haas TS. Murphy CJ. Ahluwalia A. Rutten-Ramos S. Incidence and causes of sudden death in U.S. college athletes. J Am Coll Card. 63(16):1636-43, 2014 Apr 29. UI: 24583295

References !  Maron BJ. Haas TS. Doerer JJ. Thompson PD. Hodges JS.

Comparison of U.S. and Italian experiences with sudden cardiac deaths in young competitive athletes and implications for preparticipation screening strategies. Am J Card. 104(2):276-80, 2009 Jul 15. UI: 19576360

!  Roberts WO. Stovitz SD. Incidence of sudden cardiac death in Minnesota high school athletes 1993-2012 screened with a standardized pre-participation evaluation. JJ Am Coll Card. UI: 23850929

!  Steinvil A. Chundadze T. Zeltser D. Rogowski O. Halkin A. Galily Y. Perluk H. Viskin S. Mandatory electrocardiographic screening of athletes to reduce their risk for sudden death proven fact or wishful thinking?. J Am Coll Card. 57(11):1291-6, 2011 Mar 15. UI: 21392644