Usefulness of combined history, physical examination, electrocardiogram, and limited echocardiogram in screening adolescent athletes for risk for sudden cardiac death

Jeffrey B. Anderson, Michelle Grenier, Nicholas M. Edwards, Nicolas L. Madsen, Richard J. Czosek, David S. Spar, Allison Barnes, Jesse Pratt, Eileen King, Timothy K. Knilans

Research output: Contribution to journalArticlepeer-review

28 Scopus citations

Abstract

Sudden cardiac death in the young (SCDY) is the leading cause of death in young athletes during sport. Screening young athletes for high-risk cardiac defects is controversial. The purpose of this study was to assess the utility and feasibility of a comprehensive cardiac screening protocol in an adolescent population. Adolescent athletes were recruited from local schools and/or sports teams. Each subject underwent a history and/or physical examination, an electrocardiography (ECG), and a limited echocardiography (ECHO). The primary outcome measure was identification of cardiac abnormalities associated with an elevated risk for sudden death. We secondarily identified cardiac abnormalities not typically associated with a short-term risk of sudden death. A total of 659 adolescent athletes were evaluated; 64% men. Five subjects had cardiac findings associated with an elevated risk for sudden death: prolonged QTc >500 ms (n = 2) and type I Brugada pattern (n = 1), identified with ECG; dilated cardiomyopathy (n = 1) and significant aortic root dilation; and z-score = +5.5 (n = 1). History and physical examination alone identified 76 (11.5%) subjects with any cardiac findings. ECG identified 76 (11.5%) subjects in which a follow-up ECHO or cardiology visit was recommended. Left ventricular mass was normal by ECHO in all but 1 patient with LVH on ECG. ECHO identified 34 (5.1%) subjects in whom a follow-up ECHO or cardiology visit was recommended. In conclusion, physical examination alone was ineffective in identification of subjects at elevated risk for SCDY. Screening ECHO identified patients with underlying cardiac disease not associated with immediate risk for SCDY. Cost of comprehensive cardiac screening is high.

Original languageEnglish (US)
Pages (from-to)1763-1767
Number of pages5
JournalAmerican Journal of Cardiology
Volume114
Issue number11
DOIs
StatePublished - Dec 1 2014

Bibliographical note

Funding Information:
Funding: This study was supported in part by a grant from Simon's Fund.

Funding Information:
This study was funded partially by a grant from Simon's Fund , a nonprofit group, with the remainder of the funding from the Heart Institute at Cincinnati Children's Hospital Medical Center .

Publisher Copyright:
© 2014 Elsevier Inc.

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