Preparticipation Cardiovascular Screening for US Collegiate Student-Athletes

Pfister, Glen C.; Puffer, James C.; Maron, Barry J.

doi:10.1001/jama.283.12.1597

Cited by 103 publications

(49 citation statements)

References 16 publications

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“…The existing protocols ail include a medical history and a physical examination, in some cases diagnostic tests, of varying content. The persan performing the screening is also variable, some places allowing non-physicians [19,68,70,72,74,76,78,79,89,90] to conduct the examination, which decreases the chances of positive findings. One wonders what the results will be when technicians, nurses, chiropractors, or athletic trainers perform the cardiovascular screening.…”

Section: Discussionmentioning

confidence: 99%

Sudden cardiac death in athletes: the Lausanne Recommendations

Bille

Figueiras

Schamasch

et al. 2006

European Journal of Cardiovascular Prevention & Rehabilitat

214

190

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Objectives This study reports on sudden cardiac death (SCD) in sport in the literature and aims at achieving a generally acceptable preparticipation screening protocol (PPSP) endorsed by the consensus meeting of the International Olympie Committee (IOC). Background The sudden death of athletes under 35 years engaged in competitive sports is a well-known occurrence; the incidence is higher in athletes ( ~ 2/1OO000 per year) than in non-athletes (2.5: 1 ), and the cause is cardiovascular in over 90%.Methods A systematic review of the literature identified causes of SCD, sex, age, underlying cardiac disease and the type of sport and PPSP in use. Methods necessary to detect pre-existing cardiac abnormalities are discussed to formulate a PPSP for the Medical Commission of the IOC.Results SCD occurred in 1101 (1966-2004) reported cases in athletes under 35 years, 50% had congenital anatomical heart disease and cardiomyopathies and 10% had early-onset atherosclerotic heart disease. Forty percent occurred in athletes un der 18 years, 33% under 16 years; the female/male ratio was 1 /9. SCD was reported in almost ail sports; most frequently involved were soccer (30%), basketball (25%) and running (15%). The PPSP were of varying quality and content. The IOC consensus meeting accepted the proposed Lausanne Recommendations based on this research and expert opinions (http://multimedia.olympic.org/pdf/en_report_886.pdf). Conclusion SCD occurs more frequently in young athletes, even those under the age of 18 years, than expected and is predominantly caused by pre-existing congenital cardiac abnormalities. Premature atherosclerotic disease forms another important cause in these young adults. A generally acceptable PPSP has been achieved by the IOC's acceptance of the Lausanne Recommendations. Eur J Cardiovasc Prev Rehabil 13:000-000

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Section: Discussionmentioning

confidence: 99%

Sudden cardiac death in athletes: the Lausanne Recommendations

Bille

Figueiras

Schamasch

et al. 2006

European Journal of Cardiovascular Prevention & Rehabilitat

214

190

View full text Add to dashboard Cite

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“…Over the past several years, there has been heightened interest in and focus on preventive strategies such as preparticipation cardiovascular screening 2,4,6,7,[17][18][19][20] and utilization of disqualification criteria, 4,11 as well as availability of automated external defibrillators for secondary prevention. 21 However, prior estimates of the frequency with which these catastrophes occur have been particularly low, 9,22,23 which has impacted the debate over this public health problem significantly, specifically with regard to the most effective and practical strategies for mass screening.…”

Section: Editorial P 1072 Clinical Perspective P 1092mentioning

confidence: 99%

“…9 It has been our intuition that the previous estimates for sudden deaths in young people engaged in competitive sports (ie, Յ20 per year) 9,22,23 had underestimated the true magnitude of this public health issue. Furthermore, such a mischaracterization has the potential to dampen enthusiasm for important and related initiatives focused on the prevention of sudden death in athletes (eg, detection of cardiovascular abnormalities by mass preparticipation screening, 2,6,[17][18][19][20]24,25,31 application of standards for disqualification, 4,11 dissemination of automatic external defibrillators, 21 and novel design of protective equipment to minimize trauma-related deaths 32 ).…”

Section: Maron Et Al Sudden Death In Young Athletesmentioning

confidence: 99%

Sudden Deaths in Young Competitive Athletes

et al. 2009

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Background-Sudden deaths in young competitive athletes are highly visible events with substantial impact on the physician and lay communities. However, the magnitude of this public health issue has become a source of controversy. Methods and Results-To estimate the absolute number of sudden deaths in US competitive athletes, we have assembled a large registry over a 27-year period using systematic identification and tracking strategies. , with an average of 66 deaths per year (range 50 to 76) over the last 6 years; 29% occurred in blacks, 54% in high school students, and 82% with physical exertion during competition/training, whereas only 11% occurred in females (although this increased with time; Pϭ0.023). The most common cardiovascular causes were hypertrophic cardiomyopathy (36%) and congenital coronary artery anomalies (17%). Conclusions-In this national registry, the absolute number of cardiovascular sudden deaths in young US athletes was somewhat higher than previous estimates but relatively low nevertheless, with a rate of Ͻ100 per year. These data are relevant to the current debate surrounding preparticipation screening programs with ECGs and also suggest the need for systematic and mandatory reporting of athlete sudden deaths to a national registry.

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“…For the evaluation of wall motion abnormalities and myocardial hypertrophy, 2 D cine steady-state free precession (SSFP) sequences were acquired in a 4-chamber view, left ventricular long axis view (ECG-retrogating, repetition time (TR) 39.75, echo time (TE) 1.12 ms, angle of excitation (FA) 70°, field of view (FOV) adapted to each athlete, pixel spacing 1.8 × 1.8, matrix 156 × 192, slice thickness (SL) 6 mm, bandwidth (BW) 930 Hz/pixel) as well as in short axis angulation (ECG-retrogating, TR 58.96 ms, TE 1. 13 tracking. The respiratory navigator was localized at the lung-liver interface of the right hemidiaphragm with a 2 mm gating window.…”

Section: Cardiac Magnetic Resonance Imaging Protocolmentioning

confidence: 99%

Detection of Cardiovascular Disease in Elite Athletes Using Cardiac Magnetic Resonance Imaging

Mangold

Krämer

Franzen

et al. 2013

Fortschr Röntgenstr

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Purpose: Sudden cardiac death [SCD] in competitive athletes is caused by a diverse set of cardiovascular diseases such as hypertrophic and dilated cardiomyopathy [HCM/DCM], myocarditis, coronary anomalies or even coronary artery disease. In order to identify potential risk factors responsible for SCD, elite athletes underwent cardiac magnetic resonance [CMR] imaging. Materials and Methods: 73 male [M] and 22 female [F] athletes (mean age 35.2???11.4 years) underwent CMR imaging. ECG-gated breath-hold cine SSFP sequences were used for the evaluation of wall motion abnormalities and myocardial hypertrophy as well as for quantitative analysis (left and right ventricular [LV, RV] end-diastolic and end-systolic volume [EDV, ESV], stroke volume [SV], ejection fraction [EF] and myocardial mass [MM]). Furthermore, left and right atrial sizes were assessed by planimetry and delayed enhancement imaging was performed 10 minutes after the application of contrast agent. Coronary arteries were depicted using free-breathing Flash-3?D MR angiography. Results: The quantitative analyses showed eccentric hypertrophy of the left ventricle (remodeling index [MM/LV-EDV]: M 0.75, F 0.665), enlargement of the RV volumes (RV-EDV: M 122.6???19.0?ml/m?, F 99.9???7.2?ml/m?) and an increased SV (LV-SV: M?64.7???10.0?ml/m?, F 56.5???5.7?ml/m?; RV-SV; M?66.7???10.4?ml/m?, F 54.2???7.1?ml/m?). Abnormal findings were detected in 6 athletes (6.3?%) including one benign variant of coronary anomaly and abnormal late gadolinium enhancement in 2 cases. None of the athletes showed wall motion abnormalities or signs of myocardial ischemia. Conclusion: CMR imaging of endurance athletes revealed abnormal findings in more than 5?% of the athletes. However, the prognostic significance remains unclear. Thus, cardiac MRI cannot be recommended as a routine examination in the care of athletes. Key points: Citation Format:

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Preparticipation Cardiovascular Screening for US Collegiate Student-Athletes

Abstract: The preparticipation screening process used by many US colleges and universities may have limited potential to detect (or raise the suspicion of) cardiovascular abnormalities capable of causing sudden death in competitive student-athletes.

Cited by 103 publications

References 16 publications

Sudden cardiac death in athletes: the Lausanne Recommendations

Sudden cardiac death in athletes: the Lausanne Recommendations

Sudden Deaths in Young Competitive Athletes

Detection of Cardiovascular Disease in Elite Athletes Using Cardiac Magnetic Resonance Imaging

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