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Tseng ZH, Nakasuka K. Out-of-Hospital Cardiac Arrest in Apparently Healthy, Young Adults. JAMA 2025; 333:981-996. [PMID: 39976933 DOI: 10.1001/jama.2024.27916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2025]
Abstract
Importance Out-of-hospital cardiac arrest incidence in apparently healthy adults younger than 40 years ranges from 4 to 14 per 100 000 person-years worldwide. Of an estimated 350 000 to 450 000 total annual out-of-hospital cardiac arrests in the US, approximately 10% survive. Observations Among young adults who have had cardiac arrest outside of a hospital, approximately 60% die before reaching a hospital (presumed sudden cardiac death), approximately 40% survive to hospitalization (resuscitated sudden cardiac arrest), and 9% to 16% survive to hospital discharge (sudden cardiac arrest survivor), of whom approximately 90% have a good neurological status (Cerebral Performance Category 1 or 2). Autopsy-based studies demonstrate that 55% to 69% of young adults with presumed sudden cardiac death have underlying cardiac causes, including sudden arrhythmic death syndrome (normal heart by autopsy, most common in athletes) and structural heart disease such as coronary artery disease. Among young adults, noncardiac causes of cardiac arrest outside of a hospital may include drug overdose, pulmonary embolism, subarachnoid hemorrhage, seizure, anaphylaxis, and infection. More than half of young adults with presumed sudden cardiac death had identifiable cardiovascular risk factors such as hypertension and diabetes. Genetic cardiac disease such as long QT syndrome or dilated cardiomyopathy may be found in 2% to 22% of young adult survivors of cardiac arrest outside of the hospital, which is a lower yield than for nonsurvivors (13%-34%) with autopsy-confirmed sudden cardiac death. Persons resuscitated from sudden cardiac arrest should undergo evaluation with a basic metabolic profile and serum troponin; urine toxicology test; electrocardiogram; chest x-ray; head-to-pelvis computed tomography; and bedside ultrasound to assess for pericardial tamponade, aortic dissection, or hemorrhage. Underlying reversible causes, such as ST elevation myocardial infarction, coronary anomaly, and illicit drug or medication overdose (including QT-prolonging medicines) should be treated. If an initial evaluation does not reveal the cause of an out-of-hospital cardiac arrest, transthoracic echocardiography should be performed to screen for structural heart disease (eg, unsuspected cardiomyopathy) or valvular disease (eg, mitral valve prolapse) that can precipitate sudden cardiac death. Defibrillator implant is indicated for young adult sudden cardiac arrest survivors with nonreversible cardiac causes including structural heart disease and arrhythmia syndromes. Conclusions and Relevance Cardiac arrest in apparently healthy adults younger than 40 years may be due to inherited or acquired cardiac disease or noncardiac causes. Among young adults who have had cardiac arrest outside of a hospital, only 9% to 16% survive to hospital discharge. Sudden cardiac arrest survivors require comprehensive evaluation for underlying causes of cardiac arrest and cardiac defibrillator should be implanted in those with nonreversible cardiac causes of out-of-hospital cardiac arrest.
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Affiliation(s)
- Zian H Tseng
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Kosuke Nakasuka
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco
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Fabritz L, Fortmueller L, Gehmlich K, Kant S, Kemper M, Kucerova D, Syeda F, Faber C, Leube RE, Kirchhof P, Krusche CA. Endurance Training Provokes Arrhythmogenic Right Ventricular Cardiomyopathy Phenotype in Heterozygous Desmoglein-2 Mutants: Alleviation by Preload Reduction. Biomedicines 2024; 12:985. [PMID: 38790949 PMCID: PMC11117820 DOI: 10.3390/biomedicines12050985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 04/20/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
Desmoglein-2 mutations are detected in 5-10% of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Endurance training accelerates the development of the ARVC phenotype, leading to earlier arrhythmic events. Homozygous Dsg2 mutant mice develop a severe ARVC-like phenotype. The phenotype of heterozygous mutant (Dsg2mt/wt) or haploinsufficient (Dsg20/wt) mice is still not well understood. To assess the effects of age and endurance swim training, we studied cardiac morphology and function in sedentary one-year-old Dsg2mt/wt and Dsg20/wt mice and in young Dsg2mt/wt mice exposed to endurance swim training. Cardiac structure was only occasionally affected in aged Dsg20/wt and Dsg2mt/wt mice manifesting as small fibrotic foci and displacement of Connexin 43. Endurance swim training increased the right ventricular (RV) diameter and decreased RV function in Dsg2mt/wt mice but not in wild types. Dsg2mt/wt hearts showed increased ventricular activation times and pacing-induced ventricular arrhythmia without obvious fibrosis or inflammation. Preload-reducing therapy during training prevented RV enlargement and alleviated the electrophysiological phenotype. Taken together, endurance swim training induced features of ARVC in young adult Dsg2mt/wt mice. Prolonged ventricular activation times in the hearts of trained Dsg2mt/wt mice are therefore a potential mechanism for increased arrhythmia risk. Preload-reducing therapy prevented training-induced ARVC phenotype pointing to beneficial treatment options in human patients.
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Affiliation(s)
- Larissa Fabritz
- University Center of Cardiovascular Science and Department of Cardiology, University Heart and Vascular Center, University Hospital Hamburg Eppendorf, 20246 Hamburg, Germany; (L.F.); (P.K.)
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK; (K.G.); (M.K.); (F.S.)
- Department of Cardiology, Section of Rhythmology, University Hospital Muenster, 48149 Münster, Germany;
| | - Lisa Fortmueller
- University Center of Cardiovascular Science and Department of Cardiology, University Heart and Vascular Center, University Hospital Hamburg Eppendorf, 20246 Hamburg, Germany; (L.F.); (P.K.)
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany
- Department of Cardiology, Section of Rhythmology, University Hospital Muenster, 48149 Münster, Germany;
| | - Katja Gehmlich
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK; (K.G.); (M.K.); (F.S.)
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Sebastian Kant
- Institute for Molecular and Cellular Anatomy (MOCA), RWTH Aachen University, 52074 Aachen, Germany; (S.K.); (R.E.L.)
| | - Marcel Kemper
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK; (K.G.); (M.K.); (F.S.)
- Department of Cardiology, Section of Rhythmology, University Hospital Muenster, 48149 Münster, Germany;
| | - Dana Kucerova
- Department of Cardiology, Section of Rhythmology, University Hospital Muenster, 48149 Münster, Germany;
| | - Fahima Syeda
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK; (K.G.); (M.K.); (F.S.)
| | - Cornelius Faber
- Clinic of Radiology, Translational Research Imaging Center (TRIC), University of Muenster, 48149 Münster, Germany;
| | - Rudolf E. Leube
- Institute for Molecular and Cellular Anatomy (MOCA), RWTH Aachen University, 52074 Aachen, Germany; (S.K.); (R.E.L.)
| | - Paulus Kirchhof
- University Center of Cardiovascular Science and Department of Cardiology, University Heart and Vascular Center, University Hospital Hamburg Eppendorf, 20246 Hamburg, Germany; (L.F.); (P.K.)
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 20246 Hamburg, Germany
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK; (K.G.); (M.K.); (F.S.)
| | - Claudia A. Krusche
- Institute for Molecular and Cellular Anatomy (MOCA), RWTH Aachen University, 52074 Aachen, Germany; (S.K.); (R.E.L.)
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Cusano A, Inclan PM, Jackson T, Weiss LJ, Barnes RP, Kinderknecht JJ, Taylor SA, Rodeo SA. Team Approach: Diagnosis, Management, and Prevention of Sudden Cardiac Arrest in the Athlete. JBJS Rev 2024; 12:01874474-202403000-00002. [PMID: 38446913 DOI: 10.2106/jbjs.rvw.23.00225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
» Sudden cardiac events during sports competition are rare but tragic occurrences that require a timely, comprehensive response by well-prepared athletic trainers and medical providers. This sequence should prioritize prompt emergency medical system activation, immediate initiation of cardiopulmonary resuscitation (CPR), automated early defibrillation (AED), and comprehensive advanced life support efforts.» Exercise-induced cardiac remodeling, referred to as the "athlete's heart," refers to a host of adaptive changes that increase cardiac chamber size and wall thickness to allow for greater pressures and volumes during exercise. This remodeling phenotype may overlap with other inherited cardiomyopathies and cardiac abnormalities, which can complicate clinical care. The long-term implications of this electrical and structural remodeling on cardiac function are unknown.» Although the best screening strategies to optimize primary prevention of sudden cardiac arrest is an evolving topic, the effectiveness of CPR and early defibrillation use in treating out-of-hospital sudden cardiac arrest has been well-established, despite their reported underuse.
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Affiliation(s)
- Antonio Cusano
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York
| | - Paul M Inclan
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York
| | - Tyler Jackson
- Primary Sports Medicine, Hospital for Special Surgery, New York, New York
| | - Leigh J Weiss
- New York Football Giants, East Rutherford, New Jersey
| | | | | | - Samuel A Taylor
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York
| | - Scott A Rodeo
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York
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Goff NK, Hutchinson A, Koek W, Kamat D. Meta-analysis on the Effectiveness of ECG Screening for Conditions Related to Sudden Cardiac Death in Young Athletes. Clin Pediatr (Phila) 2023; 62:1158-1168. [PMID: 36797841 PMCID: PMC10478328 DOI: 10.1177/00099228231152857] [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] [Indexed: 02/18/2023]
Abstract
Controversy exists over the use of electrocardiograms (ECGs) in sports pre-participation screening. We performed a meta-analysis comparing the effectiveness of history and physical examination (H&P) with ECG at detecting both cardiac disease and sudden cardiac death-associated conditions (SCD-AC). Pre-participation studies published from 2015 to 2020 with athletes 10 to 35 years old were included. This yielded 28 011 athletes screened and 124 cardiac diagnoses, 103 of which were SCD-AC. A meta-analysis of log odds ratios (ORs) was conducted using a random-effects model. The ORs for the association between H&P and detecting both cardiac disease and SCD-AC were not statistically significant (OR = 3.4, P = .076; OR = 2.9, P = .078). The ORs for the association between ECG and detecting both cardiac disease and SCD-AC were statistically significant (60, P < .001; 148, P < .0001). In conclusion, the odds of detecting both cardiac disease and conditions related to SCD with ECG are greater than with H&P during sports pre-participation screening.
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Affiliation(s)
- Nicolas K. Goff
- Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | | | - Wouter Koek
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Deepak Kamat
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Donovan DJ, Nelson JE, Monaco MA. The cardiac preparticipation sports evaluation. Curr Opin Pediatr 2023; 35:546-552. [PMID: 37555798 DOI: 10.1097/mop.0000000000001284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
PURPOSE OF REVIEW Sudden cardiac death (SCD) is the leading cause of death in young athletes during sports participation. Preparticipation cardiovascular screening aims to identify those at an increased risk of SCD. This review aims to provide a background of SCD in young athletes, to discuss the various screening recommendations of major medical societies, and to review recent evidence and current practice. RECENT FINDINGS Numerous studies have evaluated various preparticipation screening practices, particularly regarding the inclusion of ECG as part of an initial evaluation to identify conditions with an increased risk of SCD. Some analyses have shown ECG inclusion to provide increased screening sensitivity and specificity, though others have shown no benefit when compared with evaluation with history and physical examination alone. Furthermore, in countries for which more extensive screening protocols have been employed, postimplementation statistics have not shown a significant decrease in SCD. SUMMARY SCD in young athletes primarily results from underlying cardiac disease. Various preparticipation screening recommendations exist globally, with the common goal of decreasing the rates of SCD by identifying youth at risk during sports participation. Current guidelines in the United States support universal preparticipation evaluation using history and physical examination, with cardiology referral if abnormalities are identified.
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Affiliation(s)
- Denis J Donovan
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, New York, USA
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D'Ascenzi F, Ragazzoni GL, Boncompagni A, Cavigli L. Sports cardiology: A glorious past, a well-defined present, a bright future. Clin Cardiol 2023; 46:1015-1020. [PMID: 37503665 PMCID: PMC10540010 DOI: 10.1002/clc.24112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 07/29/2023] Open
Abstract
The attention towards sports cardiology has dramatically grown after the introduction of preparticipation screening and the need for specific education on electrocardiogram interpretation in athletes, given the differences between athletes and the general population. The present article stresses the need for specific skills, knowledge, and clinical expertise in sports cardiology, which are essential for appropriately screening competitive athletes to prevent sudden cardiac death and avoid overdiagnosis. However, disqualification from sports competitions may lead to sports inactivity, and athletes may enter a gray zone where little or no information is provided about what they can or cannot do to stay active. However, modern sports cardiology cannot neglect the patient's needs and the importance of the safe practice of regular exercise. In this context, the personalized exercise prescription plays a crucial role in the core curriculum and the clinical activity of professionals involved in sports cardiology programs. Given its specificities, sports cardiology requires a formal education plan for medical school students and all residents. Additional education and practice are required for young colleagues who want to focus their professional lives on sports cardiology. The future directions of emerging modern sports cardiology should not neglect the importance of a scientific community that works together, designing multicenter international outcomes-based research to address the many remaining areas of uncertainty.
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Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of CardiologyUniversity of SienaSienaItaly
| | - Gian L. Ragazzoni
- Department of Medical Biotechnologies, Division of CardiologyUniversity of SienaSienaItaly
| | - Alex Boncompagni
- Department of Medical Biotechnologies, Division of CardiologyUniversity of SienaSienaItaly
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of CardiologyUniversity of SienaSienaItaly
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Major Z, Medvegy Z, Tulit TT, Simonyi G, Pavlik G, Medvegy M. [Analysis of sudden cardiac death in competitive athletes, possibilities for reducing cases]. Orv Hetil 2023; 164:1155-1163. [PMID: 37481770 DOI: 10.1556/650.2023.32806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/02/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Sudden cardiac death in athletes is rare (0.5 to 1 per 100 000 athlete years), but sudden cardiac death in known athletes causes general shock. OBJECTIVE Our research aim was to collect and study as many sudden cardiac death cases as possible, judge the role of stress and look for ways to reduce fatal tragedies. METHOD From registers and newspaper articles found on the Internet, we collected 360 (including 14 women) athletes' sudden cardiac death cases where the sport, age and place of death (during training/competition/after) could be determined. From these, a single database has been prepared in order of the year of death. The cases were grouped and analyzed by sports. Based on our results and literature data, we made recommendations to reduce fatalities. RESULTS AND CONCLUSION There were more sudden cardiac deaths in competitions than in trainings (239 vs. 99), but tragedies also happened during warm-ups and chess without physical exertion, furthermore, there was no sudden cardiac death in the stakeless training of marathon/half marathon/triathlon athletes; all these prove the role of stress, so we recommend a psychological conversation before a high-stakes race. There were also a lot of sudden cardiac deaths (79/360) during team sports trainings, so we recommend reanimation readiness there as well. After training/competition, sudden cardiac death happened mainly in sports requiring high static effort, where post-competition monitoring is also recommended. Those who died in training were younger than those who died during the race (p<0.01), so young people should be monitored more closely for medical and (under)fitness. Marathon runners and triathletes were older than team athletes (p<0.005) and only died in competition, so for them a basic examination and an ECG within 1 month before competition are recommended. Conclusions drawn from literature data: sports medicine examination should be standardized and documented in an accessible way; since resuscitation started earlier and professionally is more effective, all competitors should receive reanimation training. Orv Hetil. 2023; 164(29): 1155-1163.
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Affiliation(s)
| | - Zoltán Medvegy
- 2 Magyar Testnevelési és Sporttudományi Egyetem Budapest Magyarország
| | - Tímea Terézia Tulit
- 3 Kistarcsai Flór Ferenc Kórház, Kardiológiai Osztály Kistarcsa Magyarország
| | - Gábor Simonyi
- 4 Dél-budai Centrumkórház - Szent Imre Egyetemi Oktatókórház, Anyagcsere Központ Budapest Magyarország
| | - Gábor Pavlik
- 2 Magyar Testnevelési és Sporttudományi Egyetem Budapest Magyarország
| | - Mihály Medvegy
- 3 Kistarcsai Flór Ferenc Kórház, Kardiológiai Osztály Kistarcsa Magyarország
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Turska-Kmieć A, Neunhaeuserer D, Mazur A, Dembiński Ł, del Torso S, Grossman Z, Barak S, Hadjipanayis A, Peregud-Pogorzelski J, Kostka T, Bugajski A, Huss G, Kowalczyk-Domagała M, Wyszyńska J. Sport activities for children and adolescents: the Position of the European Academy of Paediatrics and the European Confederation of Primary Care Paediatricians 2023-Part 1. Pre-participation physical evaluation in young athletes. Front Pediatr 2023; 11:1125958. [PMID: 37425260 PMCID: PMC10323832 DOI: 10.3389/fped.2023.1125958] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
The European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP) emphasize the importance of promoting healthy lifestyles within the pediatric population. Many health professionals have questions concerning adequate levels of physical activity for both the healthy pediatric population and for those who may have specific complications. Unfortunately, the academic literature that provides recommendations for participation in sport activities within the pediatric population that have been published during the last decade in Europe is limited and is mainly dedicated to specific illnesses or advanced athletes and not toward the general population. The aim of part 1 of the EAP and ECPCP position statement is to assist healthcare professionals in implementing the best management strategies for a pre-participation evaluation (PPE) for participation in sports for individual children and adolescents. In the absence of a uniform protocol, it is necessary to respect physician autonomy for choosing and implementing the most appropriate and familiar PPE screening strategy and to discuss the decisions made with young athletes and their families. This first part of the Position Statement concerning Sport Activities for Children and Adolescents is dedicated to healthy young athletes.
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Affiliation(s)
- Anna Turska-Kmieć
- Department of Cardiology, Children’s Memorial Health Institute, Warsaw, Poland
- Polish PaediatricSociety, Warsaw, Poland
- Working Group on Sports Cardiology, Polish Cardiac Society, Warsaw, Poland
| | - Daniel Neunhaeuserer
- Sports and Exercise Medicine Division, University of Padova Department of Medicine, Padova, Italy
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Artur Mazur
- Polish PaediatricSociety, Warsaw, Poland
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów, Poland
| | - Łukasz Dembiński
- Polish PaediatricSociety, Warsaw, Poland
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- Department of Paediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Stefano del Torso
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- Childcare Worldwide, Padova, Italy
| | - Zachi Grossman
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- Adelson School of Medicine, Ariel University, Ariel, Israel
- Maccabi Health Services, Pediatric Clinic, Tel Aviv, Israel
| | - Shimon Barak
- The European Confederation of Primary Care Paediatricians (ECPCP), Lyon, France
- Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Adamos Hadjipanayis
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- School of Medicine, European University Cyprus, Nicosia, Cyprus
- Paediatric Department, Larnaca General Hospital, Larnaca, Cyprus
| | - Jarosław Peregud-Pogorzelski
- Polish PaediatricSociety, Warsaw, Poland
- Department of Paediatrics, Paediatric Oncology and Immunology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Kostka
- Department of Geriatrics, Medical University of Lodz, Lodz, Poland
- The Polish Society of Sports Medicine, Wroclaw, Poland
| | - Andrzej Bugajski
- The Polish Society of Sports Medicine, Wroclaw, Poland
- Department of Physiotherapy, College of Physiotherapy, Wroclaw, Poland
| | - Gottfried Huss
- The European Confederation of Primary Care Paediatricians (ECPCP), Lyon, France
- Kinder-Permanence Hospital Zollikerberg, Zollikerberg, Switzerland
| | - Monika Kowalczyk-Domagała
- Department of Cardiology, Children’s Memorial Health Institute, Warsaw, Poland
- Working Group on Paediatric Cardiology, Polish Cardiac Society, Warsaw, Poland
| | - Justyna Wyszyńska
- Institute of Health Sciences, Medical College of Rzeszów University, Rzeszów, Poland
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Agrawal H, Lamari-Fisher A, Hasbani K, Philip S, Fraser CD, Mery CM. Decision making in anomalous aortic origin of a coronary artery. Expert Rev Cardiovasc Ther 2023; 21:177-191. [PMID: 36846957 DOI: 10.1080/14779072.2023.2184799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
INTRODUCTION There are many uncertainties surrounding anomalous aortic origin of a coronary artery (AAOCA) including the pathophysiology of sudden cardiac death, how to best risk stratify patients, how to best evaluate patients, who would benefit from exercise restriction, who should undergo surgical intervention, and which operation to perform. AREAS COVERED The goal of this review is to provide a comprehensive but succinct overview of AAOCA to help clinicians with the difficult task of navigating optimal evaluation and treatment of an individual patient with AAOCA. EXPERT OPINION Beginning in year 2012, some of our authors proposed an integrated, multi-disciplinary working group which has become the standard management strategy for patients diagnosed with AAOCA. A multi-disciplinary team with a focus on shared decision-making with the patients/families is likely necessary to optimize outcomes. Long-term follow-up and research are needed to improve our understanding of AAOCA.
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Affiliation(s)
- Hitesh Agrawal
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Alexandra Lamari-Fisher
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Keren Hasbani
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Stephanie Philip
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Charles D Fraser
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Carlos M Mery
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
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Certainties and Uncertainties of Cardiac Magnetic Resonance Imaging in Athletes. J Cardiovasc Dev Dis 2022; 9:jcdd9100361. [PMID: 36286312 PMCID: PMC9604894 DOI: 10.3390/jcdd9100361] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/16/2022] Open
Abstract
Prolonged and intensive exercise induces remodeling of all four cardiac chambers, a physiological process which is coined as the “athlete’s heart”. This cardiac adaptation, however, shows overlapping features with non-ischemic cardiomyopathies, such as dilated, arrhythmogenic and hypertrophic cardiomyopathy, also associated with athlete’s sudden cardiac death. Cardiac magnetic resonance (CMR) is a well-suited, highly reproducible imaging modality that can help differentiate athlete’s heart from cardiomyopathy. CMR allows accurate characterization of the morphology and function of cardiac chambers, providing full coverage of the ventricles. Moreover, it permits an in-depth understanding of the myocardial changes through specific techniques such as mapping or late gadolinium enhancement. In this narrative review, we will focus on the certainties and uncertainties of the role of CMR in sports cardiology. The main aspects of physiological adaptation due to regular and intensive sports activity and the application of CMR in highly trained athletes will be summarized.
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Hajduczok AG, Ruge M, Emery MS. Risk Factors for Sudden Death in Athletes, Is There a Role for Screening? CURRENT CARDIOVASCULAR RISK REPORTS 2022; 16:97-109. [PMID: 35813032 PMCID: PMC9251040 DOI: 10.1007/s12170-022-00697-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/15/2022]
Abstract
Purpose of Review Sudden cardiac death (SCD) in a young athlete is an infrequent yet devastating event often associated with substantial media attention. Screening athletes for conditions associated with SCD is a controversial topic with debate surrounding virtually each component including the ideal subject, method, and performer/interpreter of such screens. In fact, major medical societies such as the American College of Cardiology/American Heart Association and the European Society of Cardiology have discrepant recommendations on the matter, and major sporting associations have enacted a wide range of screening policies, highlighting the confusion on this subject. This review seeks to summarize the literature in this area to address the complex and disputed subject of screening young athletes for SCD. Recent Findings The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause myocarditis, which is one acquired cardiac disease associated with SCD. The coronavirus 2019 (COVID-19) pandemic has therefore resulted in an increased incidence of an otherwise less common condition, providing an expanded dataset for further study of this condition. Recent findings indicate that cardiac complications of athletes with myocardial involvement of SARS-CoV-2 infection are rare. Other contemporary work in SCD screening has been focused on the implementation of various screening protocols and measuring their effectiveness. Summary No universal consensus exists for athlete screening for conditions associated with SCD with varying guidelines and protocols across cardiology and sport-specific organizations. No screening program will prevent all SCD; however, small programs managed by physicians familiar with the examination of an athlete that carefully personalize screening to the individual may maximize detection of dangerous cardiac conditions while minimizing false positives.
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Affiliation(s)
- Alexander G. Hajduczok
- Division of Cardiology, Jefferson Heart Institute, Thomas Jefferson University Hospital, Philadelphia, PA USA
| | - Max Ruge
- Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA USA
| | - Michael S. Emery
- Sports Cardiology Center, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute; Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH Desk J2-4 USA
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12
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Lear A, Patel N, Mullen C, Simonson M, Leone V, Koshiaris C, Nunan D. Screening Electrocardiogram in Young Athletes and Military Members: A Systematic Review and Meta-Analysis. J Athl Train 2022; 57:444-451. [PMID: 34038955 PMCID: PMC9205557 DOI: 10.4085/1062-6050-0746.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the effect of electrocardiogram (ECG) screening on the prevention of sudden cardiac arrest and death in young athletes and military members. DATA SOURCES MEDLINE, Embase, CENTRAL, Web of Science, BIOSIS, Scopus, SPORTDiscus, PEDro, and ClinicalTrials.gov were searched from inception to dates between February 21 and July 29, 2019. STUDY SELECTION Randomized and nonrandomized controlled trials in which preparticipation examination including ECG was the primary intervention used to screen athletes or military members aged ≤40 years. Acceptable control groups were those receiving no screening, usual care, or preparticipation examination without ECG. Three published studies and 1 conference abstract were identified for inclusion. DATA EXTRACTION In all 4 studies, risk of bias was assessed using the Cochrane risk-of-bias tool and was found to be generally high. Two studies had data extracted for random effects meta-analysis, and the remaining study and conference abstract were included in the narrative review. The overall quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. DATA SYNTHESIS We included 4 nonrandomized studies (11 689 172 participants), of which all had a high risk of bias. Pooled data from 2 studies (n = 3 869 274; very low-quality evidence) showed an inconclusive 42% relative decrease in risk of sudden cardiac death (relative risk = 0.58; 95% CI = 0.23, 1.45), equating to an absolute risk reduction of 0.0016%. The findings were consistent with a potential 77% relative decreased risk to a 45% relative increased risk in participants screened using ECG. Heterogeneity was found to be high, as measured using I2 statistic (71%). Data from the remaining study and abstract were similarly inconclusive. CONCLUSIONS Existing evidence for the effect of ECG screening is inconclusive and of very low quality. In our meta-analysis, we observed that screening ECG may result in a considerable benefit or harm to participants. Higher-quality studies are needed to reduce this uncertainty.
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Affiliation(s)
| | | | | | | | - Vince Leone
- Northeast Ohio Medical University (NEOMED), Akron, OH
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13
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Brunetti G, Cipriani A, Perazzolo Marra M, De Lazzari M, Bauce B, Calore C, Rigato I, Graziano F, Vio R, Corrado D, Zorzi A. Role of Cardiac Magnetic Resonance Imaging in the Evaluation of Athletes with Premature Ventricular Beats. J Clin Med 2022; 11:426. [PMID: 35054118 PMCID: PMC8781801 DOI: 10.3390/jcm11020426] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/18/2021] [Accepted: 01/06/2022] [Indexed: 12/19/2022] Open
Abstract
Premature ventricular beats (PVBs) in athletes are not rare. The risk of PVBs depends on the presence of an underlying pathological myocardial substrate predisposing the subject to sudden cardiac death. The standard diagnostic work-up of athletes with PVBs includes an examination of family and personal history, resting electrocardiogram (ECG), 24 h ambulatory ECG (possibly with a 12-lead configuration and including a training session), maximal exercise testing and echocardiography. Despite its fundamental role in the diagnostic assessment of athletes with PVBs, echocardiography has very limited sensitivity in detecting the presence of non-ischemic left ventricular scars, which can be revealed only through more in-depth studies, particularly with the use of contrast-enhanced cardiac magnetic resonance (CMR) imaging. The morphology, complexity and exercise inducibility of PVBs can help estimate the probability of an underlying heart disease. Based on these features, CMR imaging may be indicated even when echocardiography is normal. This review focuses on interpreting PVBs, and on the indication and role of CMR imaging in the diagnostic evaluation of athletes, with a special focus on non-ischemic left ventricular scars that are an emerging substrate of cardiac arrest during sport.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy; (G.B.); (A.C.); (M.P.M.); (M.D.L.); (B.B.); (C.C.); (I.R.); (F.G.); (R.V.); (A.Z.)
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14
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Pathology of sudden death, cardiac arrhythmias, and conduction system. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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15
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Electrocardiogram Before Tricyclic Antidepressant Use: Minimal Impact in Pediatric Functional Gastrointestinal Disorders. J Pediatr Gastroenterol Nutr 2021; 73:523-528. [PMID: 34546995 DOI: 10.1097/mpg.0000000000003226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim of this study was to determine the effect of electrocardiogram (ECG) findings on the initiation of tricyclic antidepressants (TCAs) for functional gastrointestinal disorders (FGIDs) and to evaluate cardiac outcomes related to low dose TCA use. METHODS We performed a retrospective chart review of all pediatric outpatients at a tertiary pediatric hospital with an ECG ordered by a pediatric gastroenterologist when considering initiation of a TCA between January 2011 and February 2018. We collected demographics, previous cardiovascular testing results, TCA dosing, and pertinent outcomes, including cardiology referrals, emergency department, and hospital admissions, and death during the study period. All ECGs were reviewed for corrected QT (QTc) interval, heart rate, and other abnormalities. RESULTS Of 233 patients with screening ECGs, most (84.1%) were prescribed a TCA. Functional abdominal pain or dyspepsia account for 82.0% of diagnoses. Initial TCA dosing of amitriptyline varied widely, 10-50 mg/day, and the dose was not associated with QTc intervals. TCAs were not started in only 1.7% (4/233) due to ECG results. A significant ECG abnormality prompting cardiology referral was found in eight (3.4%) with a prolonged QTc interval in one (0.4%). In 10.7% (25/233) of patients, screening ECG was obtained despite available ECG in the chart. No deaths and no emergency department or hospital visits for arrhythmia or drug overdose occurred. CONCLUSION Screening ECGs infrequently influence TCA initiation and may lead to increased resource utilization. The overall frequency of cardiology referral due to ECG results is low. Serious adverse cardiac events are unlikely with low dose TCA administration.
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16
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Kleiven Ø, Edvardsen T, Ørn S. Echocardiography in the pre-participation evaluation of asymptomatic athletes: the never-ending story. Eur J Prev Cardiol 2021; 28:1068-1070. [PMID: 32580569 DOI: 10.1177/2047487320932269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Øyunn Kleiven
- Cardiology Department, Stavanger University Hospital, Norway
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Norway
- Faculty of Medicine, University of Oslo, Norway
| | - Stein Ørn
- Cardiology Department, Stavanger University Hospital, Norway
- Department of Electrical Engineering and Computer Science, University of Stavanger, Norway
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17
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Rizzo S, De Gaspari M, Frescura C, Padalino M, Thiene G, Basso C. Sudden Death and Coronary Artery Anomalies. Front Cardiovasc Med 2021; 8:636589. [PMID: 33869302 PMCID: PMC8044928 DOI: 10.3389/fcvm.2021.636589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/18/2021] [Indexed: 11/29/2022] Open
Abstract
Congenital coronary artery anomalies (CAA) include a wide spectrum of malformations present at birth with various clinical manifestations and degrees of severity. Patients may be asymptomatic, and CAA may be an incidental finding during cardiac imaging or at autopsy. However, in other cases, ischemia-related signs and symptoms, leading to an increased risk of sudden cardiac death (SCD), often as first presentation may occur. In this chapter, we discuss the normal anatomy of the coronary arteries (CA) and the pathology of CAA at risk of SCD, including our experience with victims of SCD among the young population (age <40 years) and among athletes.
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Affiliation(s)
- Stefania Rizzo
- Cardiovascular Pathology, Azienda Ospedaliera, Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Monica De Gaspari
- Cardiovascular Pathology, Azienda Ospedaliera, Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Carla Frescura
- Cardiovascular Pathology, Azienda Ospedaliera, Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Massimo Padalino
- Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Gaetano Thiene
- Cardiovascular Pathology, Azienda Ospedaliera, Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Cristina Basso
- Cardiovascular Pathology, Azienda Ospedaliera, Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padua, Padua, Italy
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18
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Sokunbi OJ, Okoromah CAN, Ekure EN, Olawale OA, Eke WS. Electrocardiographic pattern of apparently healthy African adolescent athletes in Nigeria. BMC Pediatr 2021; 21:97. [PMID: 33632178 PMCID: PMC7905616 DOI: 10.1186/s12887-021-02557-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 02/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background Strategies to prevent sudden cardiac death (SCD) among young athletes have become topical worldwide and unrecognized cardiac pathology has been identified as a leading cause. Black ethnicity has been reported as an independent predictor of abnormal electrocardiography (ECG) findings among athletes and the frequency and significance of training-related ECG findings versus findings suggestive of an underlying pathology in the young African athletes is crucial. Methods This cross sectional study aimed to determine the prevalence and distribution of ECG patterns in young athletes and controls. A total of 360 participants (180 athletes and 180 controls) were recruited from six secondary schools in Lagos, Nigeria between November 2014 and July 2015. Evaluation included interviewer-administered questionnaires for relevant history, physical examination and resting 12 - lead ECG for each participant. Results Abnormal ECG patterns were found in 48.3% of athletes and 35.6% of controls. Training-related ECG findings occurred in 33.3% of athletes and 18.3% of controls. Athletes and controls had 7.7% prevalence of training un-related ECG patterns respectively. Left ventricular hypertrophy was the most common ECG finding among the athletes and male athletes had a higher prevalence of ECG abnormalities compared to females. Conclusion Adolescent athletes in Nigeria have a high prevalence of training-related ECG patterns and athletes and non-athletes alike have similar proportions of ECG findings suggestive of underlying structural heart disease. Cardiovascular evaluation including ECG should be performed for young athletes prior to competition at any level and should also be considered as part of pre-school entry assessment for all children. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02557-8.
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Affiliation(s)
- Ogochukwu J Sokunbi
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Lagos / Lagos University Teaching Hospital, Lagos, Nigeria.
| | - Christy A N Okoromah
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Lagos / Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ekanem N Ekure
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Lagos / Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olajide A Olawale
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Lagos / Lagos University Teaching Hospital, Lagos, Nigeria
| | - Wuraola S Eke
- Department of Nursing Services, Lagos University Teaching Hospital, Lagos, Nigeria
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19
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Egger F, Scharhag J, Kästner A, Dvořák J, Bohm P, Meyer T. FIFA Sudden Death Registry (FIFA-SDR): a prospective, observational study of sudden death in worldwide football from 2014 to 2018. Br J Sports Med 2020; 56:80-87. [PMID: 33361135 DOI: 10.1136/bjsports-2020-102368] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To investigate the underlying causes and regional patterns of sudden death in football (soccer) players worldwide to inform and improve existing screening and prevention measures. METHODS From 2014 to 2018 cases of sudden cardiac death (SCD), survived sudden cardiac arrest (SCA) and traumatic sudden death were recorded by media monitoring (Meltwater), a confidential web-based data platform and data synchronisation with existing national Sudden Death Registries (n=16). Inclusion criteria were met when sudden death occurred during football-specific activity or up to 1 hour afterwards. Death during other activities was excluded. RESULTS A total of 617 players (mean age 34±16 years, 96% men) with sudden death were reported from 67 countries; 142 players (23%) survived. A diagnosis by autopsy or definite medical reports was established in 211 cases (34%). The leading cause in players >35 years was coronary artery disease (76%) and in players ≤35 years was sudden unexplained death (SUD, 22%). In players ≤35 years the leading cause of SCD varied by region: cardiomyopathy in South America (42%), coronary artery anomaly in North America (33%) and SUD in Europe (26%). Traumatic sudden death including commotio cordis occurred infrequently (6%). Cardiopulmonary resuscitation (CPR) resulted in a survival rate of 85% with the use of an automated external defibrillator (AED) compared with 35% without. CONCLUSIONS Regional variation in SCD aetiology should be verified by expansion of national registries and uniform autopsy protocols. Immediate access to an AED at training and competition sites, as well as CPR training for players, coaches and staff members, is needed to improve survival from SCA.
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Affiliation(s)
- Florian Egger
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Jürgen Scharhag
- Department of Sports Science, University of Vienna, VIenna, Austria
| | - Andreas Kästner
- University Heart Center, Freiburg University Hospital, Freiburg, Germany
| | - Jiří Dvořák
- Department of Neurology and Swiss Concussion Center, Schulthess Klinik, Zurich, Switzerland
| | - Philipp Bohm
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
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20
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Lawrenz W. Keine ausreichende Evidenz für das EKG als obligater Bestandteil der sportmedizinischen Vorsorgeuntersuchung bei Kindern und Jugendlichen. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-00955-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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French preparticipation physical evaluation for children in 2020: What has changed? Arch Pediatr 2020; 27:338-341. [PMID: 32736913 DOI: 10.1016/j.arcped.2020.06.006] [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: 02/27/2020] [Revised: 04/30/2020] [Accepted: 06/23/2020] [Indexed: 11/21/2022]
Abstract
At the end of 2019, there was discussion in France about whether to abolish the obligatory medical certificate of no contraindication for a minor to obtain a sports license. It was finally decided not to abolish the certificate, but it raises the question of which steps should be taken to assess the physical capacities of children. General practitioners or pediatricians are responsible for the preparticipation physical evaluation of children wishing to obtain a sports license, in particular involving over 20 mandatory consultations between the ages of 0 and 18. The purpose of the article is to propose a course of action to be taken considering the French legislation and general pediatric resources concerning the medical examination and warning signs that should lead to vigilance.
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22
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Pieles GE, Oberhoffer R. The Assessment of the Paediatric Athlete. J Cardiovasc Transl Res 2020; 13:306-312. [PMID: 32367344 PMCID: PMC7360531 DOI: 10.1007/s12265-020-10005-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 04/15/2020] [Indexed: 12/27/2022]
Abstract
The success of systematic early age talent development has led to the professionalisation of youth sports academies used by clubs and governing bodies alike, and sports physicians are nowadays commonly confronted with paediatric cardiological problems. Medical cardiac care of the paediatric athlete is however in its infancy, and the international guidelines that are present for adult athletes, are not yet available. Similarly, reference data for ECG and echocardiography are incomplete. The aim of this article is to provide and introduction to the cardiac care of the paediatric athlete to facilitate healthy and above all, safe talent development, but also provide guidance on how to distinguish adaptive, beneficial cardiovascular remodelling from underlying pathology of congenital or inherited cardiovascular disease. Differences in presentation, diagnosis and treatment between childhood and adult athletes are highlighted and can educate the reader in the emerging field of paediatric sports cardiology.
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Affiliation(s)
- Guido E Pieles
- Congenital Heart Unit, Bristol Heart Institute, Upper Maudlin Street, Bristol, BS2 8BJ, UK.
| | - Renate Oberhoffer
- Department of Sports and Health Sciences, Technical University Munich, Georg Brauchle Ring, 80992, Munich, Germany
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23
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Kato T. A Diversified Approach for the Prevention of Pediatric Sudden Cardiovascular Death in Japan. Circ J 2020; 84:544-545. [PMID: 32173686 DOI: 10.1253/circj.cj-20-0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2024]
Affiliation(s)
- Taichi Kato
- Department of Pediatrics/Developmental Pediatrics, Nagoya University Graduate School of Medicine
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24
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Abstract
Although the specific content has been recommended, debated, and extensively reviewed over the past several decades, the preparticipation evaluation (PPE) has become standard of care for athletes as they prepare for organized athletic participation. The PPE seeks to detect conditions that predispose the athlete to injury or limit full participation in certain activities. Of particular interest, underlying cardiovascular and musculoskeletal conditions are sought because they are frequently associated with mortality and morbidity in athletes.
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25
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Turkoglu E, Güngör H, Ergene O, Pelliccia A. Preparticipation screening of athletic participant: A proposal for the cardiologist. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2020. [DOI: 10.4103/ijca.ijca_11_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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27
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Maron BJ, Thompson PD, Maron MS. There is No Reason to Adopt ECG s and Abandon American Heart Association/American College of Cardiology History and Physical Screening for Detection of Cardiovascular Disease in the Young. J Am Heart Assoc 2019; 8:e013007. [PMID: 31286811 PMCID: PMC6662134 DOI: 10.1161/jaha.119.013007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
See Article Williams et al.
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28
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Abstract
Distinguishing between adaptive and maladaptive cardiovascular response to exercise is crucial to prevent the unnecessary termination of an athlete's career and to minimize the risk of sudden death. This is a challenging task essentially due to the substantial phenotypic overlap between electrical and structural changes seen in the physiological athletic heart remodeling and pathological changes seen in inherited or acquired cardiomyopathies. Stress testing is an ideal tool to discriminate normal from abnormal cardiovascular response by unmasking subtle pathologic responses otherwise undetectable at rest. Treadmill or bicycle electrocardiography, transthoracic echocardiography, and cardiopulmonary exercise testing are common clinical investigations used in sports cardiology, specifically among participants presenting with resting electrocardiographic abnormalities, frequent premature ventricular beats, or non-sustained ventricular arrhythmias. In this setting, as well as in cases of left ventricular hypertrophy or asymptomatic left ventricular dysfunction, stress imaging and myocardial tissue characterization by cardiovascular magnetic resonance show promise. In this review, we aimed to reappraise current diagnostic schemes, screening strategies and novel approaches that may be used to distinguish adaptive remodeling patterns to physical exercise from early phenotypes of inherited or acquired pathological conditions commanding prompt intervention.
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29
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Paterick ZR, Paterick TE. Preparticipation Cardiovascular Screening of Student-Athletes with Echocardiography: Ethical, Clinical, Economic, and Legal Considerations. Curr Cardiol Rep 2019; 21:16. [PMID: 30820677 DOI: 10.1007/s11886-019-1101-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW To identify whether the use of echocardiography is a viable approach for the screening of athletes for the prevention of sudden cardiac death when considering ethical, clinical, economic, and legal issues. RECENT FINDINGS Ethical musings, echocardiographic findings, economic calculations, and legal analysis suggest that echocardiographic screening may reduce sudden cardiac death on the athletic field. Ethical, clinical, economic, and legal considerations suggest echocardiographic screening is a viable option to meet the societal goal to prevent athletic field sudden death.
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30
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Padalino MA, Franchetti N, Sarris GE, Hazekamp M, Carrel T, Frigiola A, Horer J, Roussin R, Cleuziou J, Meyns B, Fragata J, Telles H, Polimenakos AC, Francois K, Veshti A, Salminen J, Rocafort AG, Nosal M, Vedovelli L, Protopapas E, Tumbarello R, Merola A, Pegoraro C, Motta R, Boccuzzo G, Sojak V, Rito ML, Caldaroni F, Corrado D, Basso C, Stellin G. Anomalous aortic origin of coronary arteries: Early results on clinical management from an international multicenter study. Int J Cardiol 2019; 291:189-193. [PMID: 30772012 DOI: 10.1016/j.ijcard.2019.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/04/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Anomalous aortic origin of coronary arteries (AAOCA) is a rare abnormality, whose optimal management is still undefined. We describe early outcomes in patients treated with different management strategies. METHODS This is a retrospective clinical multicenter study including patients with AAOCA, undergoing or not surgical treatment. Patients with isolated high coronary take off and associated major congenital heart disease were excluded. Preoperative, intraoperative, anatomical and postoperative data were retrieved from a common database. RESULTS Among 217 patients, 156 underwent Surgical repair (median age 39 years, IQR: 15-53), while 61 were Medical (median age 15 years, IQR: 8-52), in whom AAOCA was incidentally diagnosed during screening or clinical evaluations. Surgical patients were more often symptomatic when compared to medical ones (87.2% vs 44.3%, p < 0.001). Coronary unroofing was the most frequent procedure (56.4%). Operative mortality was 1.3% (2 patients with preoperative severe heart failure). At a median follow up of 18 months (range 0.1-23 years), 89.9% of survivors are in NYHA ≤ II, while only 3 elderly surgical patients died late. Return to sport activity was significantly higher in Surgical patients (48.1% vs 18.2%, p < 0.001). CONCLUSIONS Surgery for AAOCA is safe and with low morbidity. When compared to Medical patients, who remain on exercise restriction and medical therapy, surgical patients have a benefit in terms of symptoms and return to normal life. Since the long term-risk of sudden cardiac death is still unknown, we currently recommend accurate long term surveillance in all patients with AAOCA.
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Affiliation(s)
- Massimo A Padalino
- Section of Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Medical School, Italy.
| | - Nicola Franchetti
- Section of Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Medical School, Italy
| | - George E Sarris
- Athens Heart Surgery Institute and Iaso Children's Hospital, Athens, Greece
| | - Mark Hazekamp
- Department for Cardiovascular Surgery, University Medical Center, Leiden, the Netherlands
| | - Thierry Carrel
- Department for Cardiovascular Surgery, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Alessandro Frigiola
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Jurgen Horer
- Department of Pediatric Cardiology and Congenital Heart Disease, Hôpital Marie Lannelongue, Université Paris-Sud, Le Plessis-Robinson, France
| | - Regine Roussin
- Department of Pediatric Cardiology and Congenital Heart Disease, Hôpital Marie Lannelongue, Université Paris-Sud, Le Plessis-Robinson, France
| | | | - Bart Meyns
- Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jose Fragata
- Cardiothoracic Surgery Hospital de Santa Marta Rua de Santa Marta Lisbon, Portugal
| | - Helena Telles
- Cardiothoracic Surgery Hospital de Santa Marta Rua de Santa Marta Lisbon, Portugal
| | - Anastasios C Polimenakos
- Department of Pediatric Cardiothoracic Surgery, Children's Hospital of Georgia, Augusta, GA, USA
| | - Katrien Francois
- Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium
| | - Altin Veshti
- Division of Cardiac Surgery, University Hospital Center of Tirana, Tirana, Albania
| | - Jukka Salminen
- Department of Pediatric Cardiac Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | | | - Matej Nosal
- Department of Pediatric Cardiac Surgery, National Institute of Cardio-Vascular Diseases - Childrens Heart Center, Bratislava, Slovakia
| | - Luca Vedovelli
- PCare Laboratory, Fondazione Istituto di Ricerca Pediatrica Città della Speranza, Padova, Italy
| | | | | | - Assunta Merola
- Division of Pediatric Cardiology, Ospedale Brotzu, Cagliari, Italy
| | - Cinzia Pegoraro
- Division of Sport Medicine, Ospedale Ca Foncello, Treviso, Italy
| | - Raffaella Motta
- Radiology Clinic, University of Padova, Medical School, Italy
| | - Giovanna Boccuzzo
- Department of Statistics, University of Padova, Medical School, Italy
| | - Vladimir Sojak
- Department for Cardiovascular Surgery, University Medical Center, Leiden, the Netherlands
| | - Mauro Lo Rito
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Federica Caldaroni
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Domenico Corrado
- Section of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Medical School, Italy
| | - Cristina Basso
- Section of Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Medical School, Italy
| | - Giovanni Stellin
- Section of Pediatric and Congenital Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Medical School, Italy
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Modaff DS, Hegde SM, Wyman RA, Rahko PS. Usefulness of Focused Screening Echocardiography for Collegiate Athletes. Am J Cardiol 2019; 123:169-174. [PMID: 30348435 DOI: 10.1016/j.amjcard.2018.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/05/2018] [Accepted: 09/11/2018] [Indexed: 12/18/2022]
Abstract
Sudden cardiac death in a young healthy athlete is a rare but catastrophic event. The American Heart Association preparticipation screening guidelines recommend a focused history and physical without routine imaging or electrocardiogram screening. We hypothesized that a focused echocardiogram can identify structural abnormalities that may lead to sudden cardiac death in athletes, which might otherwise go undetected by history and physical. We retrospectively reviewed the charts of all incoming collegiate athletes at a single university from 2005 to 2013, all of whom had undergone a focused, 5-minute echocardiogram along with a guideline-based preparticipation history and physical (PPS H&P). Abnormal findings prompted further testing or referral. We report the prevalence of abnormal findings and the relation between an abnormal PPS H&P and screening echocardiogram. A total of 2,898 athletes were screened and 159 (5%) had findings. Forty athletes underwent further testing and evaluation. Of these athletes, 3 had newly diagnosed abnormalities that warranted restriction of participation: 1 apical-variant hypertrophic cardiomyopathy, 1 large bidirectional atrial septal defect with right ventricular dysfunction, and 1 dilated ascending aorta. Two of these athletes had a normal PPS H&P. Conversely, of the 661 athletes with an abnormal PPS H&P, only 1 (0.15%) had an abnormal screening echocardiogram. In conclusion, although the overall number was low, the 5-minute screening echocardiogram detected athletes at risk for sudden cardiac death not discovered on PPS H&P.
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Longmuir PE, Jackson J, Ertel E, Bhatt M, Doja A, Duffy C, Gardin L, Jurencak R, Katz SL, Lai L, Lamontagne C, Lee S, Lougheed J, McCormick A, McMillan H, Pohl D, Roth J, Theoret-Douglas C, Watanabe Duffy K, Wong D, Zemek R. Sensitivity, specificity, and reliability of the Get Active Questionnaire for identifying children with medically necessary special considerations for physical activity. Appl Physiol Nutr Metab 2018; 44:736-743. [PMID: 30500268 DOI: 10.1139/apnm-2018-0314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Physical activity is promoted for optimal health but may carry risks for children who require medically necessary activity restrictions. The sensitivity, specificity, and reliability of the Get Active Questionnaire (GAQ) for identifying children needing special considerations during physical activity was evaluated among parents of 207 children aged 3 to 14 years (97 (47%) female, mean age of 8.4 ± 3.7 years). GAQ responses were compared with reports obtained directly from the treating physician (n = 192/207) and information in the medical chart (clinic notes/physician letter, n = 111/207). Parent GAQ responses (either "No to all questions" or "Yes to 1 or more questions") agreed with physician (κ = 0.16, p = 0.003) and medical record (κ = 0.15, p = 0.003) reports regarding the need for special consideration during physical activity (Yes/No). Sensitivity was 71% (20/28) and specificity was 59% (96/164), with few false-negative responses. The GAQ was most effective for rheumatology and cardiology patients. False positives were 29% to 46%, except among chronic pain (80%) and rehabilitation (75%) patients. Test-retest reliability was moderate (Cronbach's α = 0.70) among 57 parents who repeated the GAQ 1 week later. The GAQ effectively identified children not requiring physical activity restrictions and those with medical conditions similar to those of concern among adults. Additional questions from a qualified exercise professional, as recommended for a "Yes" response on the GAQ, should reduce the false-positive burden. Indicating the timeframe of reference for each question and including an option to describe other special considerations (e.g., medication, supervision) are recommended.
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Affiliation(s)
- Patricia E Longmuir
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Julia Jackson
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
| | - Emily Ertel
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
| | - Maala Bhatt
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Asif Doja
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Ciarán Duffy
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Letizia Gardin
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Roman Jurencak
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Sherri Lynne Katz
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Lillian Lai
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Christine Lamontagne
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Suzie Lee
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Jane Lougheed
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Anna McCormick
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Hugh McMillan
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Daniela Pohl
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Johannes Roth
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Carol Theoret-Douglas
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Karen Watanabe Duffy
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Derek Wong
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - Roger Zemek
- a Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada.,b Department of Paediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada.,c Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
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Berge HM, Andersen TE, Bahr R. Cardiovascular incidents in male professional football players with negative preparticipation cardiac screening results: an 8-year follow-up. Br J Sports Med 2018; 53:1279-1284. [PMID: 30442719 DOI: 10.1136/bjsports-2018-099845] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Preparticipation cardiac screening of athletes aims to detect cardiovascular disease at an early stage to prevent sudden cardiac arrests and deaths. Few studies have described the cardiovascular outcomes in athletes classified as negative on screening. OBJECTIVE To identify cardiovascular incidents in a cohort of male professional football players who were cleared to play after a negative screening result. METHODS This is a retrospective 8-year follow-up study of 595 professional male football players in Norway who underwent preparticipation cardiac screening by experienced cardiologists, including electrocardiography (ECG) and echocardiography, in 2008. We performed a media search to identify sudden cardiovascular incidents between January 2008 and February 2016. Incidents were cross-checked with medical records. RESULTS Six of the 595 players (1%), all classified as negative on cardiac screening, experienced severe cardiovascular incidents during follow-up. Retrospective review revealed abnormal ECG findings in one case, not recognised at the time of screening. Three players suffered a sudden cardiac arrest (all resuscitated successfully), one a myocardial infarction, one a transient ischaemic attack and one atrial flutter. Three of the players ignored chest pain, paresis, dyspnoea or near-syncope, two completed a match with symptoms before seeking medical assistance, one player's symptoms were misinterpreted and received inappropriate treatment initially, and two players were discharged from hospital without proper follow-up, despite having serious cardiovascular symptoms. CONCLUSIONS A comprehensive preparticipation cardiac screening did not identify a subset of 6 of 595 players who experienced subsequent cardiovascular incidents as being at risk. It is important to remind athletes that a normal cardiac screening exam does not protect against all cardiac diseases. Timely reporting of symptoms is essential.
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Affiliation(s)
- Hilde Moseby Berge
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Thor Einar Andersen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Roald Bahr
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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Cater C, MacDonald M, Lithwick D, Sidhu K, Isserow S, McKinney J. Perspectives on pre-participation cardiovascular screening in young competitive athletes: U SPORTS. PHYSICIAN SPORTSMED 2018; 46:509-514. [PMID: 30148661 DOI: 10.1080/00913847.2018.1516107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To investigate the pre-participation cardiovascular screening (PPS) protocols currently implemented at U SPORTS (the governing body of university sport in Canada) sanctioned schools as well as the attitudes toward PPS as reported by Canadian University medical and athletic personnel. METHODS A 15-question survey was sent to the U SPORTS athletic directors in both French and English. The survey focused on the current practices of PPS within the respondents' universities as well as attitudes regarding PPS. Athletic directors distributed the instructions to participate in the voluntary survey at their own discretion to coaches, athletic therapists, physicians, and associated personnel working within U SPORTS-sanctioned schools. RESULTS Twenty-three athletic therapists, 12 coaches, 6 physicians, and 5 associated personnel completed the survey (46 in total). Half of the respondents (52%) reported that some form of PPS was conducted at their institution. Eighty percent of respondents agreed with the implementation of mandatory PPS, and 60% reported that they believe their athletes have a neutral attitude toward PPS. Three respondents documented having witnessed an athlete's sudden cardiac arrest/death. CONCLUSION Members of the athletic care teams at U SPORTS-sanctioned schools display an overall positive attitude toward the implementation of mandatory PPS. Based on concerns raised by survey respondents, PPS procedures would need to be developed in a time- and cost-effective manner if PPS were to be expanded.
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Affiliation(s)
- Carlee Cater
- a SportsCardiologyBC, Division of Cardiology , University of British Columbia , Vancouver , Canada
| | - Mackenzie MacDonald
- a SportsCardiologyBC, Division of Cardiology , University of British Columbia , Vancouver , Canada
| | - Daniel Lithwick
- a SportsCardiologyBC, Division of Cardiology , University of British Columbia , Vancouver , Canada.,b Weill Cornell Graduate School of Medical Sciences , New York City , United States of America
| | - Kamal Sidhu
- c Faculty of Medicine , University of British Columbia , Vancouver , Canada
| | - Saul Isserow
- a SportsCardiologyBC, Division of Cardiology , University of British Columbia , Vancouver , Canada.,d Division of Cardiology , University of British Columbia , Vancouver , Canada
| | - James McKinney
- a SportsCardiologyBC, Division of Cardiology , University of British Columbia , Vancouver , Canada.,d Division of Cardiology , University of British Columbia , Vancouver , Canada
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Vilardell P, Brugada J, Aboal J, Loma-Osorio P, Falces C, Andrea R, Figueras-Coll M, Brugada R. Characterization of electrocardiographic findings in young students. ACTA ACUST UNITED AC 2018; 73:139-144. [PMID: 30287239 DOI: 10.1016/j.rec.2018.06.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/26/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES The resting 12-lead electrocardiogram (ECG) has been used in the evaluation of young asymptomatic individuals to detect pre-existing heart disease, but systematic ECG use is controversial and there are no data on this population in our environment. We aimed to determine the prevalence and spectrum of electrocardiographic findings in a population of secondary school students. METHODS We conducted an observational, cross-sectional study of resting ECG findings in all 13 to 14-year-old secondary school students in a region of the province of Gerona between 2009 and 2017. ECG findings were classified into 3 groups according to the modified criteria of Corrado et al.: normal ECG findings, ECG findings suggestive of adaptive changes, and pathologic findings. Students with pathologic ECG findings were referred to a tertiary hospital, and complementary tests were performed according to a pre-established protocol. RESULTS A total of 1911 ECGs were obtained, with a participation rate of 79% of all high school students. In all, 1321 students (69%) had a normal ECG, 554 (29%) showed ECG findings suggestive of adaptive changes, and 36 (2%) had pathologic ECG findings. Among the group with pathologic findings, 5 (14%) had cardiovascular disease. The prevalence of heart disease in this group of asymptomatic secondary school students was 0.3%. CONCLUSIONS One third of the students had ECG findings that were mostly suggestive of physiological adaptation. One seventh of the students with pathologic ECG findings had pre-existing heart disease, although the overall prevalence of pre-existing heart disease was low.
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Affiliation(s)
- Pau Vilardell
- Servicio de Cardiología, Hospital Universitario Josep Trueta de Girona, Girona, Spain.
| | - Josep Brugada
- Servicio de Cardiología, Instituto del Tórax, Hospital Clínic, Barcelona, Spain
| | - Jaime Aboal
- Servicio de Cardiología, Hospital Universitario Josep Trueta de Girona, Girona, Spain; Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain
| | - Pablo Loma-Osorio
- Servicio de Cardiología, Hospital Universitario Josep Trueta de Girona, Girona, Spain; Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain
| | - Carlos Falces
- Servicio de Cardiología, Instituto del Tórax, Hospital Clínic, Barcelona, Spain
| | - Rut Andrea
- Servicio de Cardiología, Instituto del Tórax, Hospital Clínic, Barcelona, Spain
| | - Marc Figueras-Coll
- Servicio de Pediatría, Hospital Universitario Josep Trueta de Girona, Girona, Spain
| | - Ramon Brugada
- Servicio de Cardiología, Hospital Universitario Josep Trueta de Girona, Girona, Spain; Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Centro de Genética Cardiovascular, Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
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Dhutia H, MacLachlan H. Cardiac Screening of Young Athletes: a Practical Approach to Sudden Cardiac Death Prevention. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:85. [PMID: 30155696 PMCID: PMC6132782 DOI: 10.1007/s11936-018-0681-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE OF REVIEW We aim to report on the current status of cardiovascular screening of athletes worldwide and review the up-to-date evidence for its efficacy in reducing sudden cardiac death in young athletes. RECENT FINDINGS A large proportion of sudden cardiac death in young individuals and athletes occurs during rest with sudden arrhythmic death syndrome being recognised as the leading cause. The international recommendations for ECG interpretation have reduced the false-positive ECG rate to 3% and reduced the cost of screening by 25% without compromising the sensitivity to identify serious disease. There are some quality control issues that have been recently identified including the necessity for further training to guide physicians involved in screening young athletes. Improvements in our understanding of young sudden cardiac death and ECG interpretation guideline modification to further differentiate physiological ECG patterns from those that may represent underlying disease have significantly improved the efficacy of screening to levels that may make screening more attractive and feasible to sporting organisations as a complementary strategy to increased availability of automated external defibrillators to reduce the overall burden of young sudden cardiac death.
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Affiliation(s)
- Harshil Dhutia
- Cardiovascular Sciences Research Centre, St George's University of London, London, UK.
- Department of Cardiology, Glenfield Hospital, Leicester, UK.
| | - Hamish MacLachlan
- Cardiovascular Sciences Research Centre, St George's University of London, London, UK
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Weissler-Snir A, Adler A, Williams L, Gruner C, Rakowski H. Prevention of sudden death in hypertrophic cardiomyopathy: bridging the gaps in knowledge. Eur Heart J 2018; 38:1728-1737. [PMID: 27371714 DOI: 10.1093/eurheartj/ehw268] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 06/01/2016] [Indexed: 12/12/2022] Open
Abstract
Sudden cardiac death (SCD) is the most devastating complication of hypertrophic cardiomyopathy (HCM). Although the annual rate of SCD in the general HCM population is <1% per year according to contemporary series, there is still a small subset of patients who are at increased risk of SCD. The greatest challenge in the management of HCM is identifying those at increased risk as an implantable cardioverter defibrillator is a potentially life-saving therapy. In this review, we sought to summarize the available data on SCD in HCM and provide a clinical perspective on the current differing and somewhat conflicting European and American recommendations on risk stratification, with balanced guidance with regards to rational clinical decision making. Additionally, we sought to learn more on the actual implementation of the guidelines by HCM experts worldwide.
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Affiliation(s)
- Adaya Weissler-Snir
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Arnon Adler
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Lynne Williams
- Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, UK
| | - Christiane Gruner
- Division of Cardiology, Cardiovascular Centre, University Hospital Zurich, Zurich, Switzerland
| | - Harry Rakowski
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
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Aschieri D, Penela D, Pelizzoni V, Guerra F, Vermi AC, Rossi L, Torretta L, Losi G, Villani GQ, Capucci A. Outcomes after sudden cardiac arrest in sports centres with and without on-site external defibrillators. Heart 2018; 104:1344-1349. [DOI: 10.1136/heartjnl-2017-312441] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 01/21/2018] [Accepted: 01/23/2018] [Indexed: 12/20/2022] Open
Abstract
ObjectiveSudden cardiac arrest (SCA) is a rare but tragic event during amateur sports activities. Our aim is to analyse whether availability of automated external defibrillators (AEDs) in amateur sports centres could impact on SCA survival.MethodsThis is an observational study. During an 18-year period, data regarding exercise-related SCA in sports centres were prospectively collected. Survival rates and time to response were compared between centres with an AED already available and centres where an AED was not already present.ResultsOut of 252 sports facilities, 207 (82%) acquired an AED during follow-up while 45 (18%) did not. From 1999 to 2014, there were 26 SCAs (24 (92%) men, 54±17 years old) with 15 (58%) of them in centres with on-site AED. Neurologically intact survival rates were 93% in centres with on-site AED and 9% in centres without (P<0.001). Presence of on-site AED, presence of shockable rhythm, first assistance by a lay bystander and time to defibrillation were all related to neurological intact survival, but the presence of on-site AED was the only independent predictor in the multivariate analysis. The use of on-site AED resulted in a lower time to first shock when compared with emergency medical system-delivered AED (3.3±1.4min vs 7.3±3.2 min; P=0.001).ConclusionsThe presence of on-site AEDs is associated with neurologically intact survival after an exercise-related SCA. Continuous efforts are recommended in order to introduce AEDs in sports and fitness centres, implement educational programmes and increase common awareness about SCA.
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Reuter C, Grove ME, Orland K, Spoonamore K, Caleshu C. Clinical Cardiovascular Genetic Counselors Take a Leading Role in Team-based Variant Classification. J Genet Couns 2017; 27:751-760. [DOI: 10.1007/s10897-017-0175-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/07/2017] [Indexed: 01/08/2023]
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Raukar N, Arciero E, Noyes A, Drezner J, Weiss J. Cardiovascular pre-participation screening in the young athlete: addressing concerns. PHYSICIAN SPORTSMED 2017; 45:365-369. [PMID: 28816570 DOI: 10.1080/00913847.2017.1363622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Neha Raukar
- a Department of Emergency Medicine, Division of Sports Medicine , Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Emily Arciero
- b Department of Pediatric Surgery , Massachusetts General Hospital , Boston , MA , USA
| | - Adam Noyes
- c Department of Cardiology , Warren Alpert Medical School of Brown University, Fellow , Providence , RI , USA
| | - Jonathan Drezner
- d University of Washington, Department of Family Medicine , Center for Sports Cardiology , Seattle , WA , USA
| | - Joseph Weiss
- e Department of Cardiology , Warren Alpert Medical School of Brown University , Providence , RI , USA
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Zorzi A, Calore C, Vio R, Pelliccia A, Corrado D. Accuracy of the ECG for differential diagnosis between hypertrophic cardiomyopathy and athlete’s heart: comparison between the European Society of Cardiology (2010) and International (2017) criteria. Br J Sports Med 2017; 52:667-673. [DOI: 10.1136/bjsports-2016-097438] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/21/2017] [Accepted: 05/29/2017] [Indexed: 01/01/2023]
Abstract
BackgroundInterpretation of the athlete’s ECG is based on differentiation between benign ECG changes and potentially pathological abnormalities. The aim of the study was to compare the 2010 European Society of Cardiology (ESC) and the 2017 International criteria for differential diagnosis between hypertrophic cardiomyopathy (HCM) and athlete’s heart.MethodsThe study populations included 200 patients with HCM and 563 athletes grouped as follows: ‘group 1’, including normal ECG and isolated increase of QRS voltages, which are considered non-pathologic according to ESC and International criteria; ‘group 2’, including left atrial enlargement or left axis deviation in isolation and Q-waves with an amplitude ≥4 mm but <25% of the ensuing R-wave and a duration <0.04 s which are considered pathologic according to the ESC but not according to the International criteria; and ‘group 3’, including abnormalities which are considered pathologic according to ESC and International criteria.ResultsOverall, the 2010 ESC criteria showed a sensitivity of 95.5% and a specificity of 86.9%. Considering group 2 ECG changes as normal according to the International criteria led to a statistically significant (p<0.001) increase of specificity to 95.9%, associated with a non-significant (p=0.47) reduction of sensitivity to 93%. Among patients with HCM, there was a significant increase of maximal left ventricular wall thickness from group 1 to 3 (p=0.02).ConclusionsThe use of 2017 International criteria is associated with a substantial increase in specificity and a marginal decrease in sensitivity for differential diagnosis between HCM and athlete’s heart.
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Abstract
In adults with structurally normal hearts, the early repolarization pattern (ERP) on electrocardiogram (ECG) may be associated with an increased risk of sudden cardiac death. The prevalence and significance of the ERP in children is unknown. This study examines the prevalence of the ERP, the population in which it is found, and whether there exists any correlation with increased LV mass or family history of significant cardiac events. This was a secondary review of data obtained from healthy adolescents undergoing a limited ECG and transthoracic echocardiogram (TTE) as part of a cardiac screening study. Subjects were excluded if ECG revealed known arrhythmic syndromes or TTE revealed structural abnormalities. ERP was defined as (1) notching or slurring of the terminal QRS; (2) elevation of the QRS-ST junction ≥1 mV; and (3) upwardly concave positive T-wave. Left ventricular (LV) mass was defined as mass/height2.7. Patient demographics, LV mass, family history of sudden death, arrhythmia, and/or ICD/pacemaker placement were compared for subjects with and without ERP on ECG. Data from 575 subjects (median age 15, range 13-18; 36% female; 93% Caucasian) were reviewed. The incidence of ERP was 40% (n = 228) and was seen in the inferior, lateral, or combination of these leads in 42, 10, and 48% of subjects with ERP, respectively. There was no difference in gender (p = 0.7), race (p = 0.7), age (p = 0.3), history of syncope (p = 0.2), LV mass (p = 0.8), family history of (a) sudden death (p = 0.5), (b) arrhythmia (p = 0.2), or (c) ICD/pacemaker requirement (p = 0.8) in subjects with ERP versus those without. However, a greater percentage of patients with ERP were noted to play football, when compared to those without ERP (34 vs. 13%, p < 0.001). ERP is common in healthy adolescents, and does not correlate with concerning personal/family history or elevated LV mass. Longitudinal studies are required to determine whether ERP in childhood confers an increased mortality risk.
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Oliva A, Grassi VM, Campuzano O, Brion M, Arena V, Partemi S, Coll M, Pascali VL, Brugada J, Carracedo A, Brugada R. Medico-legal perspectives on sudden cardiac death in young athletes. Int J Legal Med 2017; 131:393-409. [PMID: 27654714 DOI: 10.1007/s00414-016-1452-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/08/2016] [Indexed: 01/11/2023]
Abstract
Sudden cardiac death (SCD) in a young athlete represents a dramatic event, and an increasing number of medico-legal cases have addressed this topic. In addition to representing an ethical and medico-legal responsibility, prevention of SCD is directly correlated with accurate eligibility/disqualification decisions, with an inappropriate pronouncement in either direction potentially leading to legal controversy. This review summarizes the common causes of SCD in young athletes, divided into structural (hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, congenital coronary artery anomalies, etc.), electrical (Brugada, congenital LQT, Wolf-Parkinson-White syndrome, etc.), and acquired cardiac abnormalities (myocarditis, etc.). In addition, the roles of hereditary cardiac anomalies in SCD in athletes and the effects of a positive result on them and their families are discussed. The medico-legal relevance of pre-participation screening is analyzed, and recommendations from the American Heart Association and European Society of Cardiology are compared. Finally, the main issues concerning the differentiation between physiologic cardiac adaptation in athletes and pathologic findings and, thereby, definition of the so-called gray zone, which is based on exact knowledge of the mechanism of cardiac remodeling including structural or functional adaptions, will be addressed.
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Affiliation(s)
- Antonio Oliva
- Institute of Public Health, Section of Legal Medicine, Catholic University, School of Medicine, Largo Francesco Vito 1, 00168, Rome, Italy.
| | - Vincenzo M Grassi
- Institute of Public Health, Section of Legal Medicine, Catholic University, School of Medicine, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Oscar Campuzano
- Cardiovascular Genetics Center, Gencardio Institut d'Investigacions Biomèdiques de Girona (IDIBGI), Girona, Spain
| | - Maria Brion
- Grupo de Xenética de enfermidades cardiovasculares e oftalmolóxicas, IDIS, RIC Santiago de Compostela, Santiago de Compostela, Spain
- Fundación Pública Galega de Medicina Xenómica, SERGAS, Santiago de Compostela, Spain
| | - Vincenzo Arena
- Institute of Pathological Anatomy, Catholic University, School of Medicine, Rome, Italy
| | - Sara Partemi
- Institute of Public Health, Section of Legal Medicine, Catholic University, School of Medicine, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Monica Coll
- Cardiovascular Genetics Center, Gencardio Institut d'Investigacions Biomèdiques de Girona (IDIBGI), Girona, Spain
| | - Vincenzo L Pascali
- Institute of Public Health, Section of Legal Medicine, Catholic University, School of Medicine, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Josep Brugada
- Arrhythmias Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Angel Carracedo
- Grupo de Xenética de enfermidades cardiovasculares e oftalmolóxicas, IDIS, RIC Santiago de Compostela, Santiago de Compostela, Spain
- Fundación Pública Galega de Medicina Xenómica, SERGAS, Santiago de Compostela, Spain
| | - Ramon Brugada
- Cardiovascular Genetics Center, Gencardio Institut d'Investigacions Biomèdiques de Girona (IDIBGI), Girona, Spain
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44
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Sanchis-Gomar F, Pérez LM, Joyner MJ, Löllgen H, Lucia A. Endurance Exercise and the Heart: Friend or Foe? Sports Med 2016; 46:459-66. [PMID: 26586557 DOI: 10.1007/s40279-015-0434-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Although low- to moderate-intensity exercise has well-known cardiovascular benefits, it has been increasingly suggested that prolonged strenuous endurance exercise (SEE) could have potential deleterious cardiac effects. In effect, the term 'cardiac overuse injury' (or 'over-exercise') has been recently reported to group all the possible deleterious cardiac consequences of repeated exposure to SEE or 'over-exercise'. In this article, we provide a balanced overview of the current state of knowledge regarding the 'pros' and 'cons' of SEE from a cardiological point of view.
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Affiliation(s)
- Fabian Sanchis-Gomar
- Research Institute Hospital 12 de Octubre ('i+12'), Edificio Actividades Ambulatorias, 6ª Planta, Avda. de Córdoba s/n, 28041, Madrid, Spain.
| | - Laura M Pérez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - Herbert Löllgen
- European Federation of Sports Medicine Associations (EFSMA) and German Federation of Sports Medicine, Remscheid, Germany
| | - Alejandro Lucia
- Research Institute Hospital 12 de Octubre ('i+12'), Edificio Actividades Ambulatorias, 6ª Planta, Avda. de Córdoba s/n, 28041, Madrid, Spain.,European University, Madrid, Spain
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45
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Mont L, Pelliccia A, Sharma S, Biffi A, Borjesson M, Brugada Terradellas J, Carré F, Guasch E, Heidbuchel H, La Gerche A, Lampert R, McKenna W, Papadakis M, Priori SG, Scanavacca M, Thompson P, Sticherling C, Viskin S, Wilson M, Corrado D, Lip GYH, Gorenek B, Blomström Lundqvist C, Merkely B, Hindricks G, Hernández-Madrid A, Lane D, Boriani G, Narasimhan C, Marquez MF, Haines D, Mackall J, Manuel Marques-Vidal P, Corra U, Halle M, Tiberi M, Niebauer J, Piepoli M. Pre-participation cardiovascular evaluation for athletic participants to prevent sudden death: Position paper from the EHRA and the EACPR, branches of the ESC. Endorsed by APHRS, HRS, and SOLAECE. Eur J Prev Cardiol 2016; 24:41-69. [DOI: 10.1177/2047487316676042] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Lluís Mont
- Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Mats Borjesson
- Inst of Neuroscience and Physiology and Food, Nutrition and Sport Science and Östra University Hospital, Goteborg, Sweden
| | | | | | - Eduard Guasch
- Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | | | - André La Gerche
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | | | | | | | - Mauricio Scanavacca
- Instituto do Coração (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Bela Merkely
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | | | - Antonio Hernández-Madrid
- Unidad De Arritmias, Servicio De Cardiologia, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Deirdre Lane
- Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | | | - Manlio F Marquez
- Departamento de Electrocardiología, Instituto Nacional de Cardiologia Ignacio Chavez, Tlalpan, Mexico
| | - David Haines
- Department of Cardiovascular Medicine, Beaumont Health System, Royal Oak, MI, USA
| | - Judith Mackall
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | | | - Ugo Corra
- IRCCS Rehabilitation Medical Center, Cardiology Department, Salvatore Maugeri Foundation, Veruno, Italy
| | - Martin Halle
- Prevention and Sports Medicine, Technical University Munich, Munich, Germany
| | | | - Josef Niebauer
- Sports Medicine, Prevention & Rehabilitation, Paracelsus Medical University, Salzburg, Austria
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46
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Mont L, Pelliccia A, Sharma S, Biffi A, Borjesson M, Terradellas JB, Carré F, Guasch E, Heidbuchel H, Gerche AL, Lampert R, McKenna W, Papadakis M, Priori SG, Scanavacca M, Thompson P, Sticherling C, Viskin S, Wilson M, Corrado D, Lip GYH, Gorenek B, Lundqvist CB, Merkely B, Hindricks G, Hernández-Madrid A, Lane D, Boriani G, Narasimhan C, Marquez MF, Haines D, Mackall J, Marques-Vidal PM, Corra U, Halle M, Tiberi M, Niebauer J, Piepoli M. Pre-participation cardiovascular evaluation for athletic participants to prevent sudden death: Position paper from the EHRA and the EACPR, branches of the ESC. Endorsed by APHRS, HRS, and SOLAECE. Europace 2016; 19:139-163. [PMID: 27815371 DOI: 10.1093/europace/euw243] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Lluís Mont
- Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Mats Borjesson
- Inst of Neuroscience and Physiology and Food, Nutrition and Sport Science and Östra University Hospital, Göteborg, Sweden
| | | | | | - Eduard Guasch
- Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | | | - André La Gerche
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | | | | | | | - Mauricio Scanavacca
- Instituto do Coração (InCor) do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Bela Merkely
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | | | - Antonio Hernández-Madrid
- Unidad De Arritmias, Servicio De Cardiologia, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Manlio F Marquez
- Departamento de Electrocardiología, Instituto Nacional de Cardiologia Ignacio Chavez, Tlalpan, Mexico
| | - David Haines
- Department of Cardiovascular Medicine, Beaumont Health System, Royal Oak, MI, USA
| | - Judith Mackall
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | | | - Ugo Corra
- IRCCS Rehabilitation Medical Center, Cardiology Department, Salvatore Maugeri Foundation, Veruno, Italy
| | - Martin Halle
- Prevention and Sports Medicine, Technical University Munich, Munich, Germany
| | | | - Josef Niebauer
- Sports Medicine, Prevention & Rehabilitation, Paracelsus Medical University, Salzburg, Austria
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47
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Tiziano FD, Palmieri V, Genuardi M, Zeppilli P. The Role of Genetic Testing in the Identification of Young Athletes with Inherited Primitive Cardiac Disorders at Risk of Exercise Sudden Death. Front Cardiovasc Med 2016; 3:28. [PMID: 27617263 PMCID: PMC5000131 DOI: 10.3389/fcvm.2016.00028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/16/2016] [Indexed: 12/23/2022] Open
Abstract
Although relatively rare, inherited primitive cardiac disorders (IPCDs) in athletes have a deep social impact since they often present as sudden cardiac death (SCD) of young and otherwise healthy persons. The diagnosis of these conditions is likely underestimated due to the lack of shared clinical criteria and to the existence of several borderline clinical pictures. We will focus on the clinical and molecular diagnosis of the most common IPCDs, namely hypertrophic cardiomyopathies, long QT syndrome, arrhythmogenic right ventricular cardiomyopathy, and left ventricular non-compaction. Collectively, these conditions account for the majority of SCD episodes and/or cardiologic clinical problems in athletes. In addition to the clinical and instrumental tools for the diagnosis of IPCD, the viral technological advances in genetic testing have facilitated the molecular confirmation of these conditions. However, genetic testing presents several issues: the limited sensitivity (globally, around 50%), the low prognostic predictive value, the probability to find pathogenic variants in different genes in the same patient, and the risk of non-interpretable results. In this review, we will analyze the pros and cons of the different clinical approaches for the presymptomatic identification, the diagnosis and management of IPCD athletes, and we will discuss the indications to the genetic testing for patients and their relatives, particularly focusing on the most complex scenarios, such as presymptomatic tests, uncertain results, and unexpected findings.
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Affiliation(s)
| | - Vincenzo Palmieri
- Unità di Medicina dello Sport, Fondazione Policlinico "A. Gemelli", Università Cattolica del Sacro Cuore , Roma , Italy
| | - Maurizio Genuardi
- Istituto di Medicina Genomica, Università Cattolica del Sacro Cuore , Roma , Italy
| | - Paolo Zeppilli
- Unità di Medicina dello Sport, Fondazione Policlinico "A. Gemelli", Università Cattolica del Sacro Cuore , Roma , Italy
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48
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Drezner JA, Harmon KG, Asif IM, Marek JC. Why cardiovascular screening in young athletes can save lives: a critical review. Br J Sports Med 2016; 50:1376-1378. [PMID: 27418320 DOI: 10.1136/bjsports-2016-096606] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2016] [Indexed: 11/03/2022]
Abstract
Cardiovascular (CV) screening in young athletes remains challenging and a topic of considerable debate. Recent criticisms of ECG screening have perpetuated arguments that ECG screening is neither indicated nor effective by applying outdated incidence data and flawed methodology. In response, this article provides a critical review of the arguments in favour of ECG screening in athletes and the early detection of CV disorders at elevated risk of sudden cardiac death (SCD). Importantly, no study to date has demonstrated that screening by history and physical examination alone is effective in detecting athletes at risk or in preventing SCD. ECG screening using current athlete-specific interpretation standards provides a low false-positive rate and improves detection of potentially lethal CV conditions. Further, risk reduction in athletes identified with CV disorders can be effectively achieved through modern strategies for risk stratification and disease-specific management. By every definition of the purpose of CV screening, ECG-inclusive programmes will better meet the stated objective of early detection when proper ECG interpretation and adequate cardiology resources are available. Less debate on screening protocols and more emphasis on advancing physician skills and infrastructure in sports cardiology is needed to more effectively screen targeted athlete populations.
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Affiliation(s)
- Jonathan A Drezner
- Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
| | - Kimberly G Harmon
- Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
| | - Irfan M Asif
- Department of Family Medicine, University of South Carolina, Greenville, South Carolina, USA
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49
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Risgaard B, Tfelt-Hansen J, Winkel BG. Sports-related sudden cardiac death: How to prove an effect of preparticipation screening? Heart Rhythm 2016; 13:1560-2. [DOI: 10.1016/j.hrthm.2016.03.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Indexed: 02/08/2023]
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50
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Thompson PD, Molossi S, Lee DC, Emery MS, Eijsvogels TMH. Reply: Exercise at the Extremes. J Am Coll Cardiol 2016; 67:2911. [PMID: 27311536 DOI: 10.1016/j.jacc.2016.03.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 03/21/2016] [Indexed: 11/18/2022]
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