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12-lead ECG key in Europe's presports screen

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  • 12-lead ECG key in Europe's presports screen

    ; Clinical Rounds

    BYLINE: Jancin, Bruce

    BODY:

    MUNICH -- New European Society of Cardiology guidelines on preparticipation
    sports screening of young athletes emphasize the key role of the 12-lead ECG as
    a routine component, Domenico Corrado, M.D., said at the annual congress of the
    ESC.

    The guidelines created by the ESC's Working Group on Cardiac Rehabilitation
    and Exercise Physiology are thus at odds with those of the American Heart
    Association, which state that history and physical examination are sufficient
    for preparticipation cardiovascular screening of young athletes.

    Unfortunately, experience has amply shown that the American approach is
    completely inadequate for preparticipation identification of asymptomatic young
    athletes at increased risk for sudden death due to hypertrophic cardiomyopathy
    and other conditions that predispose to development of lethal ventricular
    arrhythmias on the playing field, said Dr. Corrado of the University of Padua
    (Italy).

    In contrast, the European approach incorporating the 12-lead ECG along with
    history and physical exam has been shown to reduce sports-related sudden deaths
    through more than 25 years of experience in Italy. Medical clearance using this
    screening strategy has been required for all participants in organized sports
    under an Italian law passed in the early 1970s, he explained.

    The importance of conducting a thorough preparticipation screening was
    recently shown in Dr. Corrado's prospective 21-year cohort study conducted in
    the Veneto region of northeast Italy. Sports participation boosted the risk of
    sudden death, with a 2.5-fold increased risk in competitive athletes compared
    with nonathletes (J. Am. Coll. Cardiol. 2003;42:1959-63).

    Autopsy studies have shown that physical exercise triggers sudden death in
    athletes with an underlying cardiovascular condition predisposing to ventricular
    arrhythmias. Up to 80% of these sports-related sudden deaths are due to
    ECG-detectable conditions. The most common are hypertrophic cardiomyopathy,
    which accounts for roughly 40% of sudden deaths in athletes, followed by
    arrhythmogenic right ventricular cardiomyopathy, responsible for 24%.

    The payoff in terms of lives saved through a preparticipation screening
    strategy using the 12-lead ECG was highlighted in Dr. Corrado's prospective
    study of sudden death in 12- to 35-year-olds in Italy's Veneto region during
    1979-96. Of 33,735 screened athletes, 9% were referred for further
    cardiovascular studies. Ultimately, hypertrophic cardiomyopathy was detected
    through screening in 22 athletes, all of whom were disqualified from
    competition. None died during a mean 8.2 years of follow-up. As a result, there
    was just a single death due to hypertrophic cardiomyopathy in screened athletes,
    compared with 16 in a group of unscreened nonathletes (N. Engl. J. Med.
    1998;339:364-9).

    At this year's ESC congress, Dr. Corrado presented evidence that Italian
    physicians are getting better at diagnosing arrhythmogenic right ventricular
    cardiomyopathy, a condition discovered 22 years ago. During 1982-1991 in the
    Padua area, arrhythmogenic right ventricular cardiomyopathy accounted for just
    0.5% of all medical disqualifications from sports participation; during
    1992-2001, the rate rose to 3.3%.

    Italian economic analyses have concluded that a preparticipation screening
    strategy based upon history and physical exam costs 20 euro per athlete. Adding
    a 12-lead ECG study to the screening protocol raises the cost to 30 euro. It is
    estimated that screening via history, physical exam, and 12-lead ECG costs 2,527
    euro per year of life saved, while screening through history and physical exam
    alone COSTS 7,274 euro per year of life saved.

    Adding echocardiography to the preparticipation screening exam adds nothing
    other than further expense, Dr. Corrado said.
    Knowledge is power ... Stay informed!
    YOU can make a difference - all you have to do is try!

    Dx age 12 current age 46 and counting!
    lost: 5 family members to HCM (SCD, Stroke, CHF)
    Others diagnosed living with HCM (or gene +) include - daughter, niece, nephew, cousin, sister and many many friends!
    Therapy - ICD (implanted 97, 01, 04 and 11, medication
    Currently not obstructed
    Complications - unnecessary pacemaker and stroke (unrelated to each other)

  • #2
    If I'm reading this right, the last sentence is not supported by the body of the article. What am I missing?

    Sue

    Comment


    • #3
      I think what they are trying to say is that a 12-lead ekg is sufficient for diagnosis when combined with history and physical exam. An echo does not increase this diagnostic rate. Unfortunately, the evidence for this is not included in this report, so we cannot check his data. Certainly his statistics of 0 deaths in screened athletes compared with 16 in unscreened is fairly persuasive. Since ekg's are relatively inexpensive, perhaps we should look even more carefully at his data.

      Rhoda

      Comment


      • #4
        Got it!

        Thanks, Rhoda. I understand what he was saying now. Seems this may be the data needed to push for changing the mandatory screening requirements in the US. Sue

        Comment

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