Results of voluntary cardiovascular examination of elite athletes in Denmark: Proposal for Nordic collaboration

Abstract

We investigated the cardiovascular status of elite athletes in Denmark, the extent of abnormal cardiac findings--both training related and pathologic--and how participating in cardiac examination was perceived by the athletes. A standardized protocol of questionnaires, physical examination, resting electrocardiogram, and 2D echocardiography was used. In total 1347 elite athletes were invited; 516 athletes (38%) from 30 different sports participated. Results were stored in a web-based database for future research and long-term follow-up. Cardiac pathology was infrequent; eight athletes (1.6%) received a cardiac diagnosis; one athlete (0.2%) diagnosed with long QT syndrome was advised against competition level sports. In total, 60 athletes (11.6%) were referred for additional testing. The athletes presented a very low level of psychological stress before and a slight decrease immediately after the examination as measured by the REST-Q 76 Sport questionnaire. Athletes needing further examinations did not present a higher level of stress after the initial examination compared with athletes with normal test results. Overall, very few athletes were diagnosed with a cardiac condition that increased risk of sudden cardiac death. Less than half of the invited athletes volunteered, but participation was not perceived stressful by the enrolled athletes, not even when additional testing was needed.

Canadian Cardiovascular Society/Canadian Heart Rhythm Society Joint Position Statement on the Cardiovascular Screening of Competitive Athletes

“…12,13 Several prospective, observational studies have compared the results of a medical history and physical examination. [13][14][15] A meta-analysis of 15 studies reported a pooled sensitivity of 20% for history and 9% for physical examination in identifying disease 13 and subsequent studies have reported similar results. [14][15][16] However, these studies did not have a "gold standard" comparator, because denominators were created from total positive screening results.…”

“…[13][14][15] A meta-analysis of 15 studies reported a pooled sensitivity of 20% for history and 9% for physical examination in identifying disease 13 and subsequent studies have reported similar results. [14][15][16] However, these studies did not have a "gold standard" comparator, because denominators were created from total positive screening results. 13 Therefore, false-negative rates and negative predictive values cannot be accurately assessed, supporting the view that such approaches should be considered poor for identifying disease but might assist in identifying athletes at risk of a CV event.…”

“…18 Several studies have included athletes who screened "positive" for conditions associated with no additional risk of SCD (ie, isolated bicuspid aortic valve) and were subsequently cleared for participation. 15,19,20 The reported low sensitivity of history/questionnaire is not surprising because 70%-80% of SCD occurs as the first manifestation of an underlying cardiac disease. 18,21,22 Furthermore, although an important small percentage of the causes of SCD in young athletes are heritable, a positive family history is reported in some cases (8%-40%).…”

“…High rates of "positive" responses (up to 68%) have been reported to occur, before review by a physician or health care professional. 15,23 The high falsepositive rate, low level of sensitivity, and the presence of nonspecific symptoms, in populations at varying risk, combine to limit the diagnostic accuracy of questionnaires.…”

Influence of type of sport on cardiac repolarization assessed by electrocardiographic T-wave morphology combination score

“…The primarily Caucasian athletes participated in a study of voluntary cardiac pre-participation screening [26]…”