Is There a Role for Limited Echocardiography During the Preparticipation Physical Examination?

Abstract

Sudden cardiac death (SCD) is the leading cause of death during exercise for athletes younger than 35 years. Structural cardiac abnormalities are responsible for the majority of SCDs among competitive athletes. The screening protocol that is best for detecting athletes at risk for SCD has been the subject of considerable and long-standing debate. The American Heart Association recommends the use of a 14-element history and physical examination (H&P), whereas European standards call for a focused H&P and 12-lead electrocardiogram (ECG). The use of ECG screening has been repeatedly rejected in the United States because of the high rate of false-positive results and an abundance of evidence suggesting that it is a cost-ineffective tool for screening. Attempts have also been made to prescreen athletes for cardiac disease with echocardiography (ECHO) performed by a cardiologist; however, this technique also proved to be cost-ineffective. The use of ECHO performed by a frontline physician reflects recent advancements in ultrasound technology utilization, including the advent of portable ultrasound, and introduces a new, promising screening method to the debate. Portable ECHO by a frontline physician (PEFP) has the ability to directly visualize structural components of the heart that are part of the gold standard ECHO evaluation performed by a cardiologist. The Early Screening for Cardiac Abnormalities with Preparticipation Echocardiography (ESCAPE) protocol developed at Northeastern University is the first attempt to implement the PEFP. Initial inquiries into the reliability and feasibility of the PEFP are promising. Measurements obtained by frontline physicians were not statistically different from those obtained by a cardiologist, focused ECHO was found to reduce the referral rate to cardiology by 33%, and PEFP was completed significantly faster than H&P and an ECG. Early results are encouraging, but continued research to support the widespread use of PEFP for preparticipation examination in all competitive athletes is needed prior to recommending implementation.

Athlete's heart syndrome: A friend or foe?

“…Ovaj parametar može da omogući razlikovanje koncentričnog (relativna debljina zida ≤ 0,45) od ekscentričnog remodelinga (relativna debljina zida < 0,3) (28,29). Poslednje dve decenije istraživači ukazuju i na remodelovanje desne komore u kojoj vladaju niski pritisci (30,31). Strukturno, dinamička fizička aktivnost može da poveća dimenzije desne komore u smislu hipertrofije koja prati hipertofiju leve komore (31).…”

“…Strukturno, dinamička fizička aktivnost može da poveća dimenzije desne komore u smislu hipertrofije koja prati hipertofiju leve komore (31). Zato je važno odrediti i odnos dimenzija leve i desne komore (LV/RV), koji kod vrhunskih sportista ostaje nepromenjen (30). Smanjenje ovog odnosa ukazuje na patološka stanja.…”

“…Najpre treba naglasiti da je za ovo razlikovanje najvažnija primena dijagnostičkih metoda (EKG, ehokardiografija, testovi opterećenja, genetske analize, magnetna rezonanca...). Pojava udruženih simptoma i nalaza, uz pozitivnu anamnezu, ukazuje na patološka stanja (30).…”

“…Hipertrofična kardiomiopatija je udružena i sa smanjenjem end-dijastolnog prečnika leve komore (≤ 45 mm) (30). Konačnu dijagnozu i razlikovanje sindroma sportskog srca i HCM omogućavaju magnentna rezonanca i genetska ispitivanja (31).…”

“…U pitanju je bolest nepoznate etiologije koja se karakteriše infiltracijom srčanog mišića desne komore masnim i vezivnim tkivom (30,31,32). Razlikovanje ARVD od sportskog srca je izuzetno teško zato što u oba slučaja može da postoje uvećanje desne komore i poremećaji repolarizacije i sprovođenja.…”