High-Risk Cardiovascular Conditions in Sports-Related Sudden Death: Prevalence in 5,169 Schoolchildren Screened via Cardiac Magnetic Resonance

Abstract

Improving preparticipation screening of candidates for sports necessitates establishing the prevalence of high-risk cardiovascular conditions (hr-CVC) that predispose young people to sudden cardiac death (SCD). Our accurate, novel protocol chiefly involved the use of cardiac magnetic resonance (CMR) to estimate this prevalence. Middle and high school students from a general United States population were screened by means of questionnaires, resting electrocardiograms, and CMR to determine the prevalence of 3 types of hr-CVC: electrocardiographic abnormalities, cardiomyopathies, and anomalous coronary artery origin from the opposite sinus with intramural coronary course (ACAOS-IM). We examined the range of normal left ventricular size and function in the main study cohort (schoolchildren 11–14 yr old). We defined diagnostic criteria for hr-CVC and compared the cardiac measurements of these younger participants with those of older children whom we examined (age, 15–18 yr). From 5,169 completed diagnostic studies (mean participant age, 13.06 ± 1.78 yr), CMR results revealed 76 previously undiagnosed cases of hr-CVC (1.47% of the total cohort): 11 of dilated cardiomyopathy (14.5%), 3 of nonobstructive hypertrophic cardiomyopathy (3.9%), 23 ACAOS-IM cases (30.3%; 6 left-ACAOS and 17 right-ACAOS), 4 Wolff-Parkinson-White patterns (5.3%), 34 prolonged QT intervals (44.7%), and 1 Brugada pattern (1.3%). Cardiomyopathies were significantly more prevalent in the older children. Of note, we identified 959 cases (18.5%) of left ventricular noncompaction. If our estimate is accurate, only 1.47% of school-age sports participants will need focused secondary evaluations; the rest can probably be reassured about their cardiac health after one 30-minute screening study.

Standardized image interpretation and post-processing in cardiovascular magnetic resonance - 2020 update

“…d) Pulmonary veins [85]: i) Assess for atypical insertion, small accessory veins and ostial stenoses. e) Coronary arteries: i) Coronary MRA (either contrast-enhanced or non-contrast MRA using 3D whole heart bSSFP) can play a role in assessment of congenital anomalies [86], but not usually in the context of ischemic heart disease. The origins, branching patterns, and course of coronary arteries is best assessed on source images, MPR or targeted MIP reconstructions.…”

Congenital atresia of the left main coronary artery: Imaging feature in children

“…Coronary artery anomalies have been considered the second most frequent cause of sudden death in young adults participating in completive sports . Timely diagnosis and appropriate management are important for the patients with coronary artery anomalies.…”

Pre-participation screening in young elite athletes: Towards a new algorithm?

“…7 The proposal that has been suggested is to carry out routine MRI screening of high-risk individuals, especially in athletes. 8 Cardiovascular MRI has unrivalled value in excluding localized hypertrophy, in segments that cannot be visualized adequately with echocardiography, such as the LV apex or the anterolateral segments. 5 Recently, Malek et al 9 analyzed whether prolonged and regular physical training in children leads to changes in myocardial systolic deformation and rotational mechanics.…”