title: Preventing sudden cardiac death in athletes: in search of evidence-based, cost-effective screening.
abstract: Sudden cardiac death in athletes is a recurrent phenomenon at sporting events and during training. Recent studies have associated sudden cardiac death with such cardiovascular conditions as coronary artery anomalies, cardiomyopathies, and electrocardiographic abnormalities, most of which are screenable with modern imaging techniques. We recently inaugurated the Center for Coronary Artery Anomalies at the Texas Heart Institute, which is dedicated to preventing sudden cardiac death in the young and investigating coronary artery anomalies. There, we are conducting 2 cross-sectional studies intended to firmly establish and quantify, in a large group of individuals from a general population, risk factors for sudden cardiac death that arise from specific cardiovascular conditions. In a pilot screening study, we are using a brief, focused clinical questionnaire, electrocardiography, and a simplified novel cardiovascular magnetic resonance screening protocol in approximately 10,000 unselected 11- to 15-year-old children. Concurrently, we are prospectively studying the prevalence of these same conditions, their severity, and their relation to exercise and mode of death in approximately 6,500 consecutive necropsy cases referred to a large forensic center. Eventually, we hope to use our findings to develop a more efficient method of preventing sudden cardiac death in athletes. We believe that these studies will help quantify sudden cardiac death risk factors and the relevance of associated physical activities--crucial information in evaluating the feasibility and affordability of cardiovascular magnetic resonance-based screening. We discuss the rationale for and methods of this long-term endeavor, in advance of reporting the results.
authors.affiliation: Department of Cardiology, Texas Heart Institute, Texas Luke's Episcopal Hospital, Houston, Texas 77030, USA. PAngelini@leachmancardiology.com
authors.forename: Paolo
authors.initials: P
authors.lastname: Angelini
authors.forename: Mladen I
authors.initials: MI
authors.lastname: Vidovich
authors.forename: Christine E
authors.initials: CE
authors.lastname: Lawless
authors.forename: Macarthur A
authors.initials: MA
authors.lastname: Elayda
authors.forename: J Alberto
authors.initials: JA
authors.lastname: Lopez
authors.forename: Dwayne
authors.initials: D
authors.lastname: Wolf
authors.forename: James T
authors.initials: JT
authors.lastname: Willerson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D056352:Athletes; D001344:Autopsy; D002648:Child; D003430:Cross-Sectional Studies; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D004562:Electrocardiography; D019317:Evidence-Based Medicine; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis* / Q000191:economics / Q000401:mortality / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013781:Texas; D055815:Young Adult
keywords: Adolescent; adult; arrhythmias, cardiac/complications; coronary vessel anomalies/complications; death, sudden, cardiac/etiology/prevention & control; guidelines as topic; heart defects, congenital/diagnosis; magnetic resonance angiography; mass screening/standards; practice guidelines as topic; preventive medicine; sports medicine