Experts call for add-on to athletes’ cardiac screening

By Piriya Mahendra

Modified echocardiography should be included as part of the screening process for athletes at risk for sudden cardiac death (SCD), say researchers presenting at the annual meeting of the American Society of Echocardiography in Cincinnati, Ohio, USA.

The modified echo would take the form of a 15-image protocol and serve as an add-on to the traditional screening process, which involves obtaining an electrocardiogram (ECG), family history of cardiac disease, and physical exam.

The protocol consists of anatomy by 2D and color flow, valve dynamics by color flow and pulsed wave Doppler, cardiac dimensions, and function. The proposed process allows the cardiologist to render a realtime qualitative interpretation (RTQI) at the screening, say the authors.

"ECG is a good tool, but may not be sensitive enough to catch problems that could lead to sudden death," commented investigator Michelle Grenier (Cincinnati Children's Heart Institute) in a press statement.

"We found that an abbreviated echo is a fiscally responsible addition that will yield useful information when screening student athletes for structural heart disease and cardiomyopathies - heart muscle diseases that are the major cause of sudden death in athletes."

They found that 10 (12%) of the 85 teen athletes involved in the study had abnormal echoes when read in realtime and were referred for further assessment.

The researchers observed that these participants had a normal history, physical exam, and EKG. All RTQI echoes were substantiated both by offline reassessment and by complete echo.

There were no additional abnormal echoes identified after realtime read, and all abnormal echoes were confirmed to be abnormal.

"The number of patients with asymptomatic, congenital heart disease was higher than expected, but the rate of cardiomyopathy - the main cause of sudden death in athletes - is probably closer to the published rate," remarked Grenier.

"Our goal is to provide useful information to care providers, who may then better counsel athletes and their families on full participation on sports."

She continued: "The cost-effectiveness and impact on reducing the rate of SCD aren't yet known, but the impact on quality of life in reassurance of cardiac health during exercise is priceless."

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