Cardiovascular screening of athletes

The sudden death of an athlete causes grave concern among the medical, sporting, and lay communities, considering athletes epitomise the healthiest segment of society. Most decedents are asymptomatic, therefore screening to identify vulnerable individuals seems appropriate, particularly since most aetiologies can be detected during life and several therapeutic interventions can be implemented to minimise the risk. Given the diversity of conditions implicated in exercise related SCD, no single test will detect all disorders. Furthermore, the low incidence of SCD allows for a cost-effective approach using the simplest and most readily available tools. The 12-lead electrocardiogram has emerged as the most effective tool for detecting electrical diseases and raising suspicion of cardiomyopathy. The international recommendations for ECG interpretation allows for physiological remodelling, substantially reducing false positive rates. Nonetheless, the challenge remains, since the ECG will fail to identify up to 20% of diseases implicated in young sudden cardiac death and is of limited value in middle-aged and older athletes, in whom atherosclerotic coronary artery disease dominates. Therefore, mitigation of risk extends beyond screening to encompass timely resuscitation, universal defibrillator access, and education in cardiac awareness. The future of screening for cardiovascular disease in athletes is likely to combine traditional evaluation with artificial intelligence, including the use of wearable monitoring, and equal access for effective screening worldwide.