番茄社区

MUNICH -- Cardiovascular screening of young Swiss athletes that included electrocardiography was able to detect asymptomatic anomalies at a low cost, researchers reported.

In a study of more than 1,000 competitive athletes ages 14 to 35, a new cardiac diagnosis was made in about 2% of the athletes at a total mean cost of about $143 per athlete, according to Andrea Menafoglio, MD, of Ospedale San Giovanni in Bellinzona, Switzerland, and colleagues.

"Cardiovascular screening with ECG in young athletes is feasible with few subsequent examinations," Menafoglio said during a press conference at the annual meeting of the European Society of Cardiology.

In 2012, the ESC released recommendations for interpreting ECG in athletes, but screening this population remains controversial, Menafoglio acknowledged.

"ECG examination in young athletes requires specific competence and considerable experience in applying rigorous criteria. Otherwise it could cause an explosion of costs. The European recommendation is to screen every 1 to 3 years," he said.

His group enrolled 1,070 competitive athletes with a mean age of 19.9 years. The majority (75%) were men and ice hockey players (12%). They put in a mean of 7.9 hours training weekly for a mean period of 9 years.

They were examined using the . Further examination was proposed in case of positive findings. The cost of the screening and all subsequent exams was calculated for each subject according to Swiss medical rates.

Menafoglio said 6.3% of the screened athletes required further evaluation; in 4% the ECG was abnormal while 1.4% underwent additional exam because of family history. Less than 1% required more tests based on physical examination.

The majority of follow-up studies were done with echocardiograms followed by exercise stress tests. Some athletes underwent cardiac MRI, family screening with ECG, or genetic testing for long QT syndrome.

A new cardiac diagnosis was established in 1.8% of patients, including idiopathic ventricular arrhythmia, idiopathic atrial arrhythmia, and Wolff-Parkinson-White ECG-pattern. There was one case each of long QT syndrome type 1, mitral valve prolapse, bicuspid aortic valve, and systemic hypertension.

The authors stated that their data were preliminary but that the findings "should aid the implementation of this policy in [Switzerland]".

"ECG screening in athletes, which has been mandated in Italy for 28 years, has been shown to detect athletes with serious electrical faults of the heart. The Achilles' heel for all of us is the cost of this screening because you have to screen numerous athletes to identify one or two who may die," commented ESC press conference moderator, Sanjay Sharma, MD, of St George's Healthcare NHS Trust in London.

In addition to the cost of the actual studies, the cost associated with training cardiologists to read ECGs needs to be considered, said Sharma, who is also the medical director of the London Marathon.

"We all need to be aware ... that while sudden death is rare in sport -- about one in 50,000 athletes -- there are between 1 in 250 to 1 in 500 athletes who are walking around today [harboring] a condition that could potentially kill them," he said.

While screening athletes may be cost effective in smaller countries, in the U.S., "there are millions of high school and college athletes, and the cost would be very high," said Alfred Bove, MD, PhD, from Temple University in Philadelphia. "We are not quite sure what we are going to get out of it."

Bove told 番茄社区 that the Italian legislation that requires screening was based on a one-time spike in sudden death events, and that rate returned to normal following implementation of the screening requirement.

"The things they found [in the Swiss study], such as abnormalities in the bicuspid aortic valve, would not prohibit an athlete from competition; mitral prolapse and hypertension wouldn't prohibit an athlete from competition," said Bove, who is also a spokesperson for the American College of Cardiology.

"If you are looking at an average athletic population, I don't think it is worth screening," he said. "You run the risk of stigmatizing a kid with having a heart problem when they don't. The U.S. at this point in time has decided not to screen."

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