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. 2023 Mar 21;44(12):1084-1092.
doi: 10.1093/eurheartj/ehad017.

Value of screening for the risk of sudden cardiac death in young competitive athletes

Patrizio Sarto  1 , Alessandro Zorzi  2 , Laura Merlo  1 , Teresina Vessella  1 , Cinzia Pegoraro  1 , Flaviano Giorgiano  1 , Francesca Graziano  2 , Cristina Basso  2 , Jonathan A Drezner  3 , Domenico Corrado  2
Affiliations

Value of screening for the risk of sudden cardiac death in young competitive athletes

Patrizio Sarto et al. Eur Heart J. .

Abstract

Aims: This study aimed to report the long-term findings of the Italian programme of cardiovascular preparticipation screening (PPS) in young, competitive athletes.

Methods and results: The study assessed the diagnostic yield for diseases at risk of sudden cardiac death (SCD), the costs of serial evaluations, and the long-term outcomes of PPS in a large population of Italian children (age range, 7-18 years). The PPS was repeated annually and included medical history, physical examination, resting electrocardiogram, and stress testing; additional tests were reserved for athletes with abnormal findings. Over an 11-year study period, 22 324 consecutive children [62% males; mean age, 12 (interquartile range, 10-14) years at first screening] underwent a total of 65 397 annual evaluations (median 2.9/child). Cardiovascular diseases at risk of SCD were identified in 69 children (0.3%) and included congenital heart diseases (n = 17), channelopathies (n = 14), cardiomyopathies (n = 15), non-ischaemic left ventricular scar with ventricular arrhythmias (n = 18), and others (n = 5). At-risk cardiovascular diseases were identified over the entire age range and more frequently in children ≥12 years old (n = 63, 91%) and on repeat evaluation (n = 44, 64%). The estimated cost per diagnosis was 73 312€. During a follow-up of 7.5 ± 3.7 years, one child with normal PPS findings experienced an episode of resuscitated cardiac arrest during sports activity (event rate of 0.6/100.000 athletes/year).

Conclusion: The PPS programme led to the identification of cardiovascular diseases at risk of SCD over the whole study age range of children and more often on repeat evaluations. Among screened children, the incidence of sport-related cardiac arrest during long-term follow-up was low.

Keywords: Athlete; Cardiac arrest; Cardiomyopathy; Screening; Sports cardiology.

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Conflict of interest statement

Conflict of interest: All authors declare no conflict of interest for this contribution.

Figures

Structured Graphical Abstract
Structured Graphical Abstract
The study enrolled a cohort of 22 324 children who underwent a mean of 2.9 annual preparticipation screening that included history, physical examination, resting ECG, and exercise testing. Cardiovascular diseases at risk of sudden cardiac death were identified in 69 children (0.3%). The diagnostic yield of each screening session was 0.12% at the first evaluation and 0.1% at repeat evaluation. Moreover, it was 0.05% in children 7- to 11-year-old vs. 0.12% in those 12- to 18-year-old. During a follow-up of 7.5 ± 3.7 years, one child with normal preparticipation screening findings experienced an episode of resuscitated cardiac arrest during sports activity. HD, heart disease; LV, left ventricular; IQR, interquartile range.
Figure 1
Figure 1
Distribution of diagnoses of cardiovascular diseases at risk of sudden cardiac death according to the preparticipation cardiovascular evaluations.
Figure 2
Figure 2
Distribution of cardiovascular diseases at risk of sudden cardiac death according to the age at the time of diagnosis.
See this image and copyright information in PMC

Comment in

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