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N Maurizi, M Baldi, S Castelletti, C Lisi, M Galli, S Bianchi, F Panzera, I Olivotto, G Parati, N Mochi, F Cecchi, 479
Age-specific prevalence of cardiac structural alterations in a large consecutive cohort of athletes by pre-participation screening, European Heart Journal, Volume 39, Issue suppl_1, August 2018, ehy564.479, https://doi.org/10.1093/eurheartj/ehy564.479Close - Share Icon Share
Extract
Background: Systematic pre-participation screening (PPS) of all subjects embarking in sports activity has the potential to identify those athletes at risk and to reduce mortality. However, its efficacy, the impact of false positive and age-specific strategies are still strongly debated.
Purpose: To evaluate the real-world prevalence of cardiac abnormalities revealed by PPS in athletes referred to a peripheral sport cardiology centre and the age-specific usefulness of echocardiography in selected patients.
Methods: We evaluated 30109 consecutive elite and non-elite athletes who underwent a PPS between 2011–2017. The PPS included familial, clinical history, sport training habits and ECG. ECGs were analyzed according to the original ESC and refined Seattle Criteria as: 1) normal 2) training-related changes 3) abnormal. Patients with abnormal ECG, symptoms/signs of cardiovascular diseases (CVD) or risk factors for CVD underwent echocardiographic evaluation.
Results: A total of 30109 (19±12 years, range 6–85, 70% males) athletes were evaluated (99% Caucasians). Of these, 24640 (82%) were aged <18 years, 4449 (15%) were 18–55 years and 1020 (3%) were aged >55 years. A total of 1870 (6%) athletes were selected for echocardiography: 930 individuals (50%) for ECG abnormalities and 350 (20%) for physical examination abnormalities, 346 (20%) due to the presence of CV risk factors, 120 (7%) because of family history for sudden death/cardiomyopathy and 44 (3%) due to cardiac symptoms. Nine hundred ninety-five (53%) were <18 years; 583 (31%) between 18–55 years; 292 (16%) aged>55. Myocardial structural alterations were found in 284/30109 (0.95%) athletes, 194 (68%) referred due to physical examination abnormalities and 90 (32%) because of ECG alterations. No abnormalities were found in athletes with cardiac symptoms and family history of cardiomyopathy/sudden death. Specific alterations were: 102 (36%) aortic ectasia, 58 (20%) hypertensive heart disease, 48 (17%) mitral valve prolapse, 23 (8%) patent foramen ovale, 21 (7%) bicuspid aortic valve, 12 (4%) hypertrophic cardiomyopathy, 7 (2%) interventricular septal defect, 4 arrhythmogenic cardiomyopathy, 3 ischemic heart disease, 2 left ventricular non-compaction, 2 coronary-pulmonary fistulas, 1 patent ductus arteriosus and 1 pericardial agenesia. Structural alterations identified by Echo were more common in athletes aged >55 (133/1020, 13%), whereas rare in athletes aged 18–55 (96/4449, 2%) and very rare <18 (55/24640, 0.2%) (p for trend <0.01). Sixty-eight athletes (0.2%, 7 aged <18 years, 22 aged 18–55 and 39 aged >55, p<0.01) were disqualified because of structural alterations identified.
