title: Prevalence of hypertrophic cardiomyopathy on an electrocardiogram-based pre-participation screening programme in a young male South-East Asian population: results from the Singapore Armed Forces Electrocardiogram and Echocardiogram screening protocol.
abstract: OBJECTIVE
  Hypertrophic cardiomyopathy is a leading cause of sudden cardiac death (SCD) in young people in the USA. Pre-participation screening for athletes might reduce the incidence of SCD. In Singapore, military service is compulsory for all young able-bodied male citizens. The Singapore Armed Forces Electrocardiogram and Echocardiogram (SAFE) pre-participation screening protocol based on the Italian programme was introduced. This study evaluates the prevalence of hypertrophic cardiomyopathy (HCM) in a young male South-East Asian population.
  
  
  RESULTS
  From October 2008 to May 2009, all male military conscripts underwent pre-participation screening. For all conscripts whose electrocardiogram (ECG) findings fulfilled any of these pre-specified criteria (Group A), direct referral for a transthoracic echocardiogram was mandatory. Conscripts with ECG findings other than pre-specified criteria (e.g. T-wave inversions, repolarization abnormalities) were referred for secondary screening by cardiologists (Group B), which could include echocardiography. Out of 18 476 subjects screened during the study period, 988 (5.3%) subjects were fast tracked for echocardiogram (Group A). Of them, there were three (0.3%) cases with severe abnormalities; there was one case each of HCM, bicuspid aortic valve with significant aortic valve regurgitation, and atrial septal defect with right ventricular systolic dysfunction. The patient with HCM had left axis deviation on ECG. None of the 215 patients who underwent echocardiography following cardiology consult (Group B) had HCM.
  
  
  CONCLUSIONS
  The prevalence of HCM in our young male population (mean age 19.5, range 16-27) using an ECG-based screening protocol was 0.005%; this appeared lower than published data from other geographical cohorts. Possible explanations include a later age of phenotypic manifestation in our population, limitations of the ECG criteria for screening, or a truly lower prevalence of HCM. More population-based longitudinal studies would be needed to ascertain the true prevalence of HCM in our South-East Asian population.
authors.affiliation: Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, 3 Depot Road, Singapore 109680, Singapore.
authors.forename: Choon Ta
authors.initials: CT
authors.lastname: Ng
authors.forename: Tek Siong
authors.initials: TS
authors.lastname: Chee
authors.forename: Lee Fong
authors.initials: LF
authors.lastname: Ling
authors.forename: Yian Ping
authors.initials: YP
authors.lastname: Lee
authors.forename: Chi Keong
authors.initials: CK
authors.lastname: Ching
authors.forename: Terrance S J
authors.initials: TS
authors.lastname: Chua
authors.forename: Christopher
authors.initials: C
authors.lastname: Cheok
authors.forename: Hean Yee
authors.initials: HY
authors.lastname: Ong
mesh_terms: D000293:Adolescent; D000328:Adult; D001210:Asia, Southeastern / Q000453:epidemiology; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis* / Q000453:epidemiology* / Q000208:ethnology; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D004562:Electrocardiography; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008889:Military Personnel; D015995:Prevalence; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology; D055815:Young Adult