Mandatory ECG screening of athletes: Is this question now resolved?

Sports Medicine

Volumn 41, Issue 12, 2011, Pages 989-1002

  Shephard, Roy J ^a  

^a UNIVERSITY OF TORONTO   (Canada)

Author keywords

Cardiovascular disorders; ECG; Sports; Sports medicine

Indexed keywords

ATHLETE; ECONOMICS; ELECTROCARDIOGRAPHY; ETHICS; FEMALE; HUMAN; LABORATORY DIAGNOSIS; MALE; MANDATORY TESTING; MASS SCREENING; PREVALENCE; PROGNOSIS; REVIEW; SUDDEN DEATH;

ATHLETES; DEATH, SUDDEN, CARDIAC; ELECTROCARDIOGRAPHY; FALSE POSITIVE REACTIONS; FEMALE; HUMANS; MALE; MANDATORY TESTING; MASS SCREENING; PREVALENCE; PROGNOSIS;

EID: 80755171443     PISSN: 01121642     EISSN: 11792035     Source Type: Journal    
DOI: 10.2165/11595470-000000000-00000     Document Type: Article

References (105)

1. Pelliccia A, Zipes DP, Maron BJ. Bethesda Conference #36 and the European Society of Cardiology Consensus Recommendations revisited: a comparison of U.S. and European criteria for eligibility and disqualification of competitive athletes with cardiovascular abnormalities. J Am Coll Cardiol 2008; 52: 1990-6
2. Bahr R. Can electrocardiographic screening prevent sudden death: No. BMJ 2010; 341: c4914
3. Chaitman BR. An electrocardiogram should not be included in routine preparticipation screening of young athletes. Circulation 2007; 116: 2610-5
4. Corrado D, Pelliccia A, Bjornstad HH, et al. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Eur Heart J 2005; 26: 516-24
5. De Ceuninck M, D'Hooghe M, D'Hooghe P. FIFA Sports Medical Committee: sudden cardiac death in football (based on chapter 4.5 from Football Medicine Manual). Zü rich, FIFA, 2005 [online]. Available from URL: eur.i1. yimg.com/eur.yimg.com/i/eu/fifa/do/commi.pdf [Accessed 2011 Sep 12]
6. Douglas PS. Saving athletes' lives: a reason to find common ground? J Am Coll Cardiol 2008; 52: 1997-9
7. Drezner J, Khan K. Sudden cardiac death in young athletes [editorial]. BMJ 2008; 337: a309
8. International Olympic Committee Medical Commission. Sudden cardiovascular death in sport. Lausanne: International Olympic Committee, 2004
9. Ljungqvist A, Jenoure P, Engebretsen L, et al. The International Olympic Committee (IOC) Consensus statement on periodic health examination of elite athletes. Br J Sports Med 2009; 43: 631-43
10. Maron BJ, Chaitman BR, Ackerman MJ, et al. Recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular diseases. Circulation 2004; 109: 2807-16 (Pubitemid 38744555)
11. Maron BJ, Zipes D. 36th Bethesda Conference, introduction: eligibility recommendations for competitive athletes with cardiovascular abnormalities-general considerations. J Am Coll Cardiol 2005; 45: 81318-27
12. Maron BJ, Thompson PD, Ackerman MJ, et al. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism. Endorsed by the American College of Cardiology Foundation. Circulation 2007; 115: 1643-55 (Pubitemid 46648650)
13. Myerburg RJ, Vetter VL. Electrocardiograms should be included in preparticipation screening of athletes. Circulation 2007; 116: 2616-26
14. Papadakis M, Whyte G, Sharma S. Preparticipation screening for cardiovascular abnormalities in young competitive athletes. BMJ 2008; 337: 806-12
15. Pelliccia A, Corrado D. Can electrocardiographic screening prevent sudden death: Yes. BMJ 2010; 341: c4923
16. Pigozzi F, Spataro A, Fagnani F, et al. Preparticipation screening for the detection of cardiovascular abnormalities that may cause sudden death in competitive athletes. Br J Sports Med 2003; 37: 4-5 (Pubitemid 36152795)
17. Rowland T. Prevention of sudden cardiac death in young athletes: controversies and conundrums. In: ArmstrongN, McManus AM, editors. The elite young athlete. Basel: S. Karger, 2011: 171-86
18. Shephard RJ. Preparticipation screening of young athletes: an effective investment? In: Shephard RJ, et al., editors. Year book of Sports Medicine, 2005. Philadelphia (PA): Elsevier/Mosby, 2005: xix-xxv
19. Shephard RJ. Mass ECG screening of young athletes. Br J Sports Med 2008; 42: 707-8
20. Sofi F, Capalbo A, Pucci N, et al. Cardiovascular evaluation, including resting and exercise electrocardiography, before participation in competitive sports: cross sectional study [editorial]. BMJ 2008; 337: a346
21. Viskin S. Antagonist: routine screening of all athletes prior to participation in competitive sports should be mandatory to prevent sudden cardiac death. Heart Rhythm 2007; 4: 525-8 (Pubitemid 46610413)
22. Wilson JMG, Jungner G. Principles and practice of screening for disease. Geneva: WHO, 1968
23. Andermann A, Blancquaert I, Beauchamp S, et al. Revisiting Wilson and Jungner in the genomic age: a review of screening criteria over the past 40 years. BullWHO2008; 86: 317-9 (Pubitemid 351521860)
24. Bayes T, Price R. An essay towards solving a problem in the doctrine of chance. Phil Trans Roy Soc Lond 1763; 53: 370-418
25. Barnard G. Studies in the history of probability and statistics: IX. Thomas Bayes's essay towards solving a problem in the doctrine of chances. Biometrika 1958; 45: 296-315
26. Corrado D, Basso C, Pavei A, et al. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA 2006; 296: 1593-601 (Pubitemid 44515020)
27. Baggish AL, Hutter AM, Wang F, et al. Cardiovascular screening in college athletes with and without electrocardiography: a cross-sectional study. Ann Int Med 2010; 152: 269-75
28. Wheeler MT, Heidenreich PA, Froelicher VF, et al. Costeffectiveness of preparticipation screening for prevention of sudden cardiac death in young athletes. Ann Int Med 2010; 152: 276-86
29. Borjesson M, Dellborg M. Is there evidence for mandating electrocardiogram as part of the pre-participation examination? Clin J Sports Med 2011; 21: 13-7
30. Drezner J, Corrado D. Is there evidence for recommending electrocardiogram as part of the pre-participation examination? Clin J Sports Med 2011; 21: 18-24
31. Fuller C, McNulty CM, Spring DA, et al. Prospective screening of 5,615 high school athletes for risk of sudden cardiac death. Med Sci Sports Exerc 1997; 29: 1131-8 (Pubitemid 27407133)
32. Fuller CM. Cost effectiveness analysis of screening of high school athletes for risk of sudden cardiac death. Med Sci Sports Exerc 2000; 32: 887-90 (Pubitemid 30230667)
33. Decree of the Italian Ministry of Health. Norme per la tutela sanitaria dell attività sportiva agnostica. Rules for the protection of athletic activity. Gazzetta Ufficale 1982 Mar 5; 63
34. Pellicia A, Maron BJ. Preparticipation cardiovascular evaluation of the competitive athlete: perspectives from the 30-year Italian experience. Am J Cardiol 1995; 75: 827-9
35. Pelliccia A, Culasso F, Di Paolo FM, et al. Prevalence of abnormal electrocardiograms in a large, unselected population undergoing pre-participation cardiovascular screening. Eur Heart J 2007; 28: 2006-10 (Pubitemid 47579542)
36. Corrado D, Biffi A, Basso C, et al. 12-Lead ECG in the athlete: physiological versus pathological abnormalities. Br J Sports Med 2009; 43: 669-76
37. Corrado D, Pelliccia A, Heidbuchel H, et al. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J 2010; 31: 243-59
38. Drezner JA. Contemporary approaches to the identification of athletes at risk for sudden cardiac death. Curr Opin Cardiol 2008; 23: 494-501
39. Thompson PD, Levine BD. Protecting athletes from sudden cardiac death. JAMA 2006; 296: 1648-50 (Pubitemid 44515021)
40. van Walraven C, Davis D, Forster AJ, et al. Timedependent bias was common in survival analyses published in leading clinical journals. J Clin Epidemiol 2004; 57: 672-82 (Pubitemid 39195217)
41. Drezner JA, Chun JS, Harmon KG, et al.Survival trends in the United States following exercise-related sudden cardiac arrest in the youth: 2000-2006. Heart Rhythm 2008; 5: 794-9
42. Maron BJ.Hypertrophic cardiomyopathy and other causes of sudden cardiac death in young competitive athletes, with considerations for preparticipation screening and criteria for disqualification. Cardiol Clin 2007; 25: 399-414 (Pubitemid 47603215)
43. Holst AG, Winkel BG, Theilade J, et al. Incidence and etiology of sports related sudden cardiac death in Denmark: implications for preparticipation. Heart Rhythm 2010; 7: 1365-71
44. Steinvil A, Chundadze T, Zeltser D, et al. Mandatory electrocardiographic screening of athletes to reduce their risk for sudden death proven fact or wishful thinking. J Am Coll Cardiol 2011; 57: 1291-6
45. Corrado D, Basso C, Schiavon M, et al. Screening for hypertrophic cardiomyopathy in young athletes. N Engl J Med 1998; 339: 364-9 (Pubitemid 28363798)
46. Basso C, Thiene G, Corrado D, et al. Hypertrophic cardiomyopathy and sudden deaths in the young: pathological evidence of myocardial ischemia. Hum Pathol 2000; 31: 988-98
47. Maron BJ, Wolfson JK, Ciró A, et al. Relation of electrocardiographic abnormalities and patterns of left ventricular hypertrophy identified by two-dimensional echocardiography in patients with hypertrophic cardiomyopathy. Am J Cardiol 1983; 51: 189-94 (Pubitemid 13220701)
48. Maron BJ. Preparticipation screening in athletes. In: Shephard RJ, A ́ strand P-O, editors. Endurance in Sport. 2nd ed. Oxford: Blackwell Scientific, 2000: 667-81
49. Pelliccia A, Di Paolo FM, Corrado DA. Evidence for efficacy of the Italian national pre-participation screening programme for identification of hypertrophic cardiomyopathy in competitive athletes. Eur Heart J 2006; 27: 2196-200 (Pubitemid 44418944)
50. Pelliccia A, Fagard R, Bjornstad H, et al. Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the Study Group of Sports Cardiology of theWorking Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J 2005; 26: 1422-45
51. Haneda N,Mori C,Nishio T, et al.Heart diseases discovered by mass screening in the schools of Shimane Prefecture over a period of 5 years. Jap Circ J 1986; 50: 1325-9 (Pubitemid 17018408)
52. Tasaki H, Hamasaki Y, Ichimaru T. Mass screening for heart disease of school children in Saga city: 7-year follow up study. Jap Circ J 1987; 51: 1415-20 (Pubitemid 18072832)
53. Melacini P, Cianfrocca C, Calore C, et al. Marginal overlap between electrocardiographic abnormalities in patients with hypertrophic cardiomyopathy and trained athletes: implications for preparticipation screening [abstract]. Circulation 2007; 116: 765
54. Sathanandam S, Zimmerman F, Davis J, et al. ECG screening criteria for LVH does not correlate with diagnosis of hypertrophic cardiomyopathy [abstract]. Circulation 2009; 120: S647
55. Cheng TO. Hypertrophic cardiomyopathy. Int J Cardiol 2009; 131: 151-5
56. Colan SD, Lipshultz SE, Lowe AM, et al. Epidemiology and cause-specific outcomes of hypertrophic cardiomyopathy in children. Circulation 2007; 115: 773-81
57. Decker JA, Rossano JW, Smith EO, et al. Risk factors and mode of death in isolated hypertrophic cardiomyopathy in children. J Am Coll Cardiol 2009; 54: 250-4
58. Yetman AT, Hamilton RM, Benson LN, et al. Long-term outcome and prognostic determinants in children with hypertrophic cardiomyopathy. J Am Coll Cardiol 1998; 32: 1943-50 (Pubitemid 29010459)
59. Basavarajaiah S, Boraita A, Whyte G, et al. Ethnic differences in left ventricular remodeling in highly-trained athletes relevance to differentiating physiologic left ventricular hypertrophy from hypertrophic cardiomyopathy. J Am Coll Cardiol 2008; 51: 2256-62 (Pubitemid 351754996)
60. Perez M, Fonda H, Le V-V, et al. Adding an electrocardiogram to the pre-participation examination in competitive athletes: a systematic review. Curr Probl Cardiol 2009; 34: 586-662
61. Pelliccia A, Di Paolo FM, Quattrini FM, et al. Outcomes in athletes with marked ECG repolarization abnormalities. N Engl J Med 2008; 358: 152-61
62. National Center for Health Statistics. Health, United States, 2007: with chartbook on trends in the health of Americans. Hyattsville (MD): National Center for Health Statistics, 2007
63. Shephard RJ. The economic benefits of enhanced fitness. Champaign (IL): Human Kinetics, 1986
64. Wisten A, Andersson S, Forsberg H, et al. Sudden cardiac death in the young in Sweden: electrocardiogram in relation to forensic diagnosis. J Int Med 2004; 255: 213-20 (Pubitemid 38241365)
65. Borjesson M, Pelliccia A. Incidence and aetiology of sudden cardiac death in young athletes: an international perspective. Br J Sports Med 2009; 43: 644-8
66. Van Camp SP, Bloor CM, Mueller FO, et al. Nontraumatic sports death in high school and college athletes. Med Sci Sports Exerc 1995; 27: 641-7
67. Drezner JA, Rao AL, Heistand J, et al. Effectiveness of emergency response planning for sudden cardiac arrest in United States high schools with automated external defibrillators. Circulation 2009; 120: 518-25
68. Asif IM, Harmon KC, Drezner JA, et al. Incidence and etiology of sudden death in National Collegiate Athletic Association (NCAA) athletes [abstract]. Clin J Sports Med 2010; 20: 136
69. Chugh SS, Reiner K, Balaji S, et al. Population based analysis of sudden death in children: Oregon unexpected death study. Heart Rhythm 2009; 6: 1618-22
70. Atkins DL, Stewart SE, Sears GK, et al. Epidemiology and outcomes from out-of-hospital cardiac arrest in children: the Resuscitation Outcomes Consortium Epistry cardiac arrest. Circulation 2009; 119: 1484-91
71. Maron BJ, Gohman TE, Aeppli D. Prevalence of sudden cardiac death during competitive sports in Minnesota high school athletes. J Am Coll Cardiol 1998; 32: 1881-4 (Pubitemid 29010450)
72. Maron BJ, Doerer JJ, Haas TS, et al. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006. Circulation 2009; 119: 1085-92
73. Solberg EE, Gjertsen F, Haugstad E, et al. Sudden death in sports among young adults in Norway. Eur J Cardiovasc Prev Rehabil 2010; 17: 337-41
74. Pelliccia A, Kinoshita N, Pisichio C, et al. Intense, uninterrupted endurance training in Olympic athletes. J Am Coll Cardiol 2010; 55: 1619-25
75. Corrado D, Basso C, Rizzoli G, et al. Does sports activity enhance the risk of sudden death in adolescents and young adults? J Am Coll Cardiol 2003; 42: 1959-63 (Pubitemid 37485572)
76. Harmon KG, Asif IM, Klossner D, et al. Incidence of sudden cardiac death in national collegiate athletic association athletes. Circulation 2011; 123: 1594-600
77. Drezner JA, Rogers KJ, Zimmer RR, et al. Use of automated external defibrillators at NCAA Division I universities. Med Sci Sports Exerc 2005; 37: 1487-92 (Pubitemid 41368491)
78. Shephard RJ, Kavanagh T. Predicting the exercise catastrophe in the "post-coronary" patient. Can Fam Physician 1978; 24: 614-8
79. Shephard RJ. Sudden death: a significant hazard of exercise? Br J Sports Med 1974; 8: 101-10
80. Maron BJ, Shirani J, Poliac LC, et al. Sudden death in young competitive athletes: clinical, demographic and pathological profiles. JAMA 1996; 276: 199-204 (Pubitemid 26235063)
81. de Noronha SV, Sharma S, Papadakis M, et al. Aetiology of sudden cardiac death in athletes in the United Kingdom: a pathological study. Heart 2009; 95: 1409-14
82. Basso C, Maron BJ, Corrado D, et al. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol 2000; 35: 1493-501 (Pubitemid 30307492)
83. Corrado D, Thiene G, Nava A, et al. Sudden death in young competitive athletes: clinicopathologic correlations in 22 cases. Am J Med 1990; 89: 588-96 (Pubitemid 20384315)
84. Glover DW, Maron BJ. Profile of preparticipation cardiovascular screening for high school athletes. JAMA 1998; 279: 1817-9 (Pubitemid 28280255)
85. Lawless CE, Best TM. Electrocardiograms in athletes: interpretation and diagnostic accuracy. Med Sci Sports Exerc 2008; 40: 787-98
86. Maron BJ, Bodison SA, Wesley YE, et al. Results of screening a large group of intercollegiate competitive athletes for cardiovascular disease. J Am Coll Cardiol 1987; 10: 1214-21 (Pubitemid 18004671)
87. Hevia AC, Fernandez M, Palacio JMA, et al. ECG as a part of the preparticipation screening programme: an old and still present international dilemma. Br J Sports Med 2011; 135 (6): 272-3
88. Wilson MG, Basavarajaiah S, Whyte GP, et al.Efficacy of personal symptom and family history questionnaires when screening for inherited pathologies: the role of electrocardiography. Br J Sports Med 2008; 42: 207-11 (Pubitemid 351449144)
89. Restier-Miron L, Fayn J, Millat G, et al. Spatio-temporal electrocardiographic characterization of ventricular depolarization and repolarization abnormalities in long QT syndrome. J Electrocardiol 2007; 40: 369-74
90. Pelliccia A, Maron BJ, Culasso F, et al. Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation 2000; 102: 278-84 (Pubitemid 30457576)
91. Le V-V, Wheeler MT, Mandic S, et al. Addition of the electrocardiogram to the preparticipation examination of college athletes. Clin J Sports Med 2010; 20: 98-105
92. Nora M, Zimmerman F, Ow P, et al. Preliminary findings of ECG screening in 9,125 young adults [abstract 3718]. Circulation 2007; 116: 845
93. Levine BD, Stray-Gundersen J. The medical care of competitive athletes: the role of the physician and individual assumption of risk. Med Sci Sports Exerc 1994; 26: 1190-2 (Pubitemid 24319175)
94. Elliott PM, Sharma S, Varnava A, et al. Sudden death in hypertrophic cardiomyopathy: identification of high risk patients. J Am Coll Cardiol 2000; 36: 2212-8
95. Corrado D, Basso C, Schiavon M, et al. Screening for hypertrophic cardiomyopathy in young athletes. N Engl J Med 2007; 339: 364-9
96. Elston J, Stein K. Public health implications of establishing a national programme to screen young athletes in the UK. Br J Sports Med 2011; 45 (7): 576-82
97. Bouchard C, Shephard RJ, Stephens T. Physical activity, fitness and health. Champaign, (IL): Human Kinetics, 1994
98. McDonald IG, Daly J, Jelinek VM, et al. Opening Pandora's box: the unpredictability of reassurance by a normal test result. BMJ 1996; 313: 329-32 (Pubitemid 26334816)
99. Daw EW, Chen SN, Czernuszewicz G, et al. Genome-wide mapping of modifier chromosomal loci for human hypertrophic cardiomyopathy. HumanMol Genet 2007; 16: 2463-71 (Pubitemid 47500632)
100. Geisterfer-Lowrance AAT, Kass S, Tanigawa G, et al. A molecular basis for familial hypertrophic cardiomyopathy: a b-myosin heavy chain gene mutation. Cell 1990; 62: 999-1006
101. Marian AJ, Roberts R. Recent advances in the molecular genetics of hypertrophic cardiomyopathy. Circulation 1995; 92: 1336-47
102. Schwarz K, Carrier L, Guicheney P, et al. Molecular basis of familial cardiomyopathies. Circulation 1995; 91: 532-40
103. Spirito P, Seidman CE, McKenna WJ, et al. The management of hypertrophic cardiomyopathy. N Engl J Med 1997; 336: 775-85 (Pubitemid 27113973)
104. Thierfelder L, Watkins H, MacRae C, et al. α-Tropomyosin and cardiac troponin T mutations cause familial hypertrophic cardiomyopathy: a disease of the sarcomere. Cell 1994; 77: 701-12
105. Watkins H, Conner D, Thierfelder L, et al. Mutations in the cardiac myosin binding protein-C gene on chromosome 11 cause familial hypertrophic cardiomyopathy. Nature Genetics 1995; 11: 434-7