Detecting Underlying Cardiovascular Disease in Young Competitive Athletes

MedicalResearch.com Interview with:
Dr. James McKinney MD MSc FRCP(C)
Division of Cardiology
University of British Columbia

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Sudden cardiac death (SCD) is the leading medical cause of death in young athletes. Sporting activity may predispose athletes with underlying cardiovascular conditions to develop life threatening ventricular arrhythmias during physical exercise. Despite being a relatively rare event, the death of a young healthy person is a tragic event that is difficult to comprehend. The prevalence of an underlying cardiovascular disorder in young athletes that predisposes to SCD is approximately 0.3%.

Sudden cardiac death is often the first clinical manifestation of an underlying cardiovascular condition; up to 80% of athletes are previously asymptomatic. Pre-participation screening is the systematic practice of medically evaluating athletes for the purpose of identifying (or raising suspicion of) abnormalities that could provoke sudden death. There is agreement amongst sporting and medical bodies that athletes should undergo some form of pre-participation screening. An Achilles’ heel of screening is the significant number of false-positive screens that require subsequent costly secondary testing to rule out disease. Prevention of sudden cardiac death among athletes is a common goal, however the optimal strategy for its achievement is uncertain.

1419 young competitive athletes (ages 12-35) were screened consecutively. In phase 1, 714 participants were screened using modified American Heart Association (AHA) 12-element recommendations, a physical examination, and a resting 12-lead ECG. The second phase of the study consisted of our novel SportsCardiologyBC (SCBC) questionnaire, no physical examination, and an ECG. The SCBC questionnaire was constructed using evidence-based questions in efforts to better delineate an athlete’s symptoms as either concerning or benign, and to be administered without a physician present. In both phases of the study ECGs were interpreted using the Seattle criteria. 

The prevalence of conditions associated with SCD in young Canadian athletes was low (0.52%), and consistent with prior American and European studies. The ECG (as interpreted by Seattle Criteria), was effective at identifying clinically relevant subclinical conditions associated with SCD that were not detected in the history or physical examination. The ECG identified 85.7% (6 of 7) of our disease cases, whereas only 28.6% (2 of 7) would have been detected using history and physical examination (1 athlete had an abnormal ECG examination and family history). The physical examination failed to identify any athletes with disease.

The ECG was the single most effective screening tool, with a PPV of 28.6%. The SCBC questionnaire and ECG (with no physical examination or physician present) was associated with fewer false positive screens; 3.7% compared with 8.1% in phase 1 (AHA questionnaire, physical examination, and ECG).

The cost to screen athletes using the SCBC protocol (SCBC questionnaire, no physical examination, and an ECG) is less than the (AHA) protocol which includes a physical examination. Costs are reduced by the elimination of an on-site physician and a more specific questionnaire. 

MedicalResearch.com: What should readers take away from your report? 

Response: The ECG was the most effective tool at identifying disease in our study, and provides further evidence to support the use of the ECG as an important tool in the screening of YCAs. Our novel SportsCardiologyBC evidence-based questionnaire, in conjunction with elimination of the physical examination reduced the absolute number of false positive screens. The SCBC protocol is a promising, efficient, and feasible means of screening young athletes.

MedicalResearch.com: What recommendations do you have for future research as a result of this study? 

Response: The ultimate goal of preparticipation screening is to prevent SCD amongst young athletes. However, the optimal method to screen young athletes is a dynamic and evolving process. The SportsCardiologyBC protocol will be continued to evaluated and refined in populations of young athletes. 

Citation:

James McKinney, Daniel Lithwick, Barbara N. Morrison, Hamed Nazzari, Michael Luong, Christopher B. Fordyce, Jack Taunton, Andrew D. Krahn, Brett Heilbron, Saul Isserow.
Detecting Underlying Cardiovascular Disease in Young Competitive Athletes. Canadian Journal of Cardiology, 2016; DOI: 10.1016/j.cjca.2016.06.007

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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