Key result
Second-line echocardiography after abnormal pre-participation screening identified subclinical heart diseases in 0.8% of athletes, with a higher yield in those >35 years (11%) vs <18 years (0.2%).
Why the study?
Limited evidence exists concerning the diagnostic yield of echocardiography as a second-line exam in athletes with abnormal pre-participation screening.
Does echocardiography as a second-line investigation have an age-dependent diagnostic yield in athletes with abnormalities at preparticipation screening?
Observational (n=30,109)
No
Does echocardiography as a second-line investigation have an age-dependent diagnostic yield in athletes with abnormalities at preparticipation screening?
p-value: p=< 0.01
The diagnostic yield of second-line echocardiography following abnormal pre-participation screening in athletes is highly age-dependent, suggesting age-specific protocols could optimize resources.
May support age-targeted second-line echocardiography in athlete screening; leaves open prospective validation of outcomes.
AIMS: Systematic pre-participation screening of subjects practicing sports activity has the potential to identify athletes at risk of sudden cardiac death. However, limited evidence are present concerning the yield of echocardiography as a second-line exam in athletes with abnormal pre-participation screening. METHODS: Consecutive athletes were screened (2011-2017) in a community-based sports medicine center in Tuscany, with familial history, physical examination and ECG. Patients with abnormal/>1 borderline ECG findings, symptoms/signs of cardiovascular diseases, cardiovascular risk factors or family history of juvenile/genetic cardiac disease underwent echocardiography. RESULTS: A total of 30109 athletes (age 21 [15;31]) were evaluated. Of these, 6234 (21%) were aged 8-11 years, 18309 (61%) 12-18 years, 4442 (15%) 19-35 years, 1124 (4%) >35 years. A total of 2569 (9%) athletes were addressed to echocardiography. Referral rates increased significantly with age (5% in preadolescents to 38% in master athletes, P< 0.01). Subclinical heart diseases were found in 290/30109 (0.8%) and were common >35 years (135/1124, 11%), but rare at 19-35 years (91/4442, 2%), very rare <18 years (64/24 543, 0.2%; P< 0.01). Seventy-four (0.3%) athletes were disqualified because of the structural alterations identified, 29 (0.1%) with cardiac structural diseases at risk for sudden death. CONCLUSIONS: Italian community-based pre-participation screening showed an age-dependent yield, with a three-fold increase in referral in athletes >35 years. Subclinical structural abnormalities potentially predisposing to sudden death were rare (0.01%), mostly in post-pubertal and senior athletes. Age-specific pre-participation screening protocols may help optimize resources and improve specificity.
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Maurizi et al. (2021) conducted an observational in Athletes undergoing pre-participation screening (n=30,109). Second-line echocardiography for abnormal pre-participation screening was evaluated on Detection of subclinical heart diseases (p=< 0.01). Second-line echocardiography after abnormal pre-participation screening identified subclinical heart diseases in 0.8% of athletes, with a higher yield in those >35 years (11%) vs <18 years (0.2%).
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