Preparticipation screening in young female elite ice hockey players

Abstract

Objectives: The occurrence of sudden cardiac death (SCD) in competitive athletes has led to a discussion about appropriate preparticipation screening models. The role of an electrocardiogram (ECG) in routine testing remains controversial in current guidelines. Furthermore, data on cardiac findings and the prognostic utility of screening strategies in young female elite ice hockey is scarce.

Methods: Female elite ice hockey players were enrolled in the open prospective "General Evaluation Program for Arrhythmia-Related Death in Athletes" (GEPARD) registry from 2008 to 2018. A staged preparticipation screening was performed. The main goal was to determine the prevalence of SCD conditions and identify effective screening tools. The secondary aim was to study baseline results and follow-ups on a unique subgroup of young female ice hockey players.

Results: A total of 88 female ice hockey players, mean age 16 ± 1 years, were prospectively enrolled. The prevalence of conditions potentially leading to SCD during competition was 3.4% (3/88). The 12-lead ECG led to the diagnosis of one congenital long QT and one acute myocarditis and showed a number needed to screen of 44, with a specificity of 98%. One athlete demonstrated a relevant pericardial effusion on echocardiography, which was related to acute toxoplasmosis. No cases of SCD occurred during long-term follow-up.

Conclusion: The subgroup of young female ice hockey players showed a notable prevalence of athletes "at risk" of 3.4%, which indicates the importance of preparticipation screening that features a 12-lead ECG as the most important component.

Keywords: athletes; females; ice hockey; preparticipation screening; prevention; sudden cardiac death.

Figure 1

GEPARD multi-stage screening model. CT, computed tomography; ECG, electrocardiogram; EPS, electrophysiology study; MRI, magnetic resonance imaging.

Figure 2

Graphical summary of the final results including cardiac MRI. Grey: player without pathologies at stage I; red: players with relevant diagnosis; blue = players with pathological findings in stage I showing normal results at stage II. CMR, cardiac magnetic resonance imaging; FH, family history; SCD, sudden cardiac death.

Figure 3

Cardiac MRI. Cardiac MRI of a young female ice-hockey player demonstrating late gadolinium enhancement of the lateral wall and global edema, following ECG-detected T-wave inversions, strongly suggesting myocarditis. MRI, magnetic resonance imaging.

Figure 4

Pathological findings of 12-lead-electrocardigrams. The pathological 12-lead-ECGs from 2 out of 4 players lead to relevant diagnoses. (A) Shows the ECG of an athlete with a newly diagnosed Long-QT ECG pattern; (B) shows inverted T-waves in more than 2 leads leading to the final diagnosis of acute myocarditis following cardiac MRI.

Figure 5

Box-whisker-plots of main exercise related measures. (A) Cardiac output at spiroergometry in ml/min; (B) lactate at maximum workload in mmol/L; (C) maximum oxygen uptake (Vo2max) in ml/min/kg; (D) aerobic and anaerobic threshold in watt.