Systematic echocardiography is not efficacious when screening an ethnically diverse cohort of athletes in West Asia.
BACKGROUND
The clinical and economic value of including systematic echocardiography (ECHO) alongside the 12-lead electrocardiograpm (ECG) when undertaking pre-participation screening in athletes has not been examined, yet several sporting organistations recommend its inclusion.


METHODS
To examine the efficacy of systematic ECHO alongside the ECG, to identify sudden cardiac death (SCD) disease and to provide a cost-analysis of a government-funded pre-participation screening programme.


METHODS
A total 1628 athletes presented for cardiological consultation, ECG, and ECHO as standard, with further cardiac examinations performed if necessary to confirm or exclude pathology. The efficacy of systematic ECHO was compared to an ECG-led programme, with ECHO reserved as a follow-up examination.


RESULTS
To screen 1628 athletes with ECG and ECHO cost US$743,996. There were 54 24-h-blood pressure/ECG Holter recordings, 62 exercise tests, 25 CMRs, two electrophysiological studies, and two genetic tests, which cost US$67,734: total US$811,730. Eight athletes (0.5%) were identified with hypertrophic cardiomyopathy (HCM) and two (0.1%) with Wolff-Parkinson-White syndrome. The cost per identifed athlete was US$81,173. All 10 athletes presented an abnormal ECG. No athlete diagnosed with HCM was identified by ECHO in isolation. When adopting a ECG-led screening protocol, 15% of athletes required ECHO as a follow-up examination, resulting in a US$380,600 cost reduction (47% saving), with the cost per diagnosis reduced to US$43,113.


CONCLUSIONS
Athletes diagnosed with a disease associated with SCD were identified via an abnormal ECG and/or physical examination, personal symptoms, or family history. Screening athletes with systematic ECHO is not economically or clinically effective.
Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Research Institute for Sport and Exercise Science, Liverpool John Moores University, UK.
Nathan R
NR
Riding
Department of Cardiovascular Sciences, St Georges University of London, UK.
Sanjay
S
Sharma
Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
Othman
O
Salah
Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
Nelly
N
Khalil
Rennes 1 University, Pontchaillou Hospital, INSERM U 642, France.
François
F
Carré
Research Institute for Sport and Exercise Science, Liverpool John Moores University, UK.
Keith P
KP
George
Sports Medicine Department, HPSNZ, Millennium Centre, Mairangi Bay, Auckland, New Zealand.
Bruce
B
Hamilton
CMOs Office, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
Hakim
H
Chalabi
Research Institute for Sport and Exercise Science, Liverpool John Moores University, UK.
Gregory P
GP
Whyte
Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar mathew.wilson@aspetar.com.
Mathew G
MG
Wilson
D001208:Asia / Q000208:ethnology; D056352:Athletes; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000379:methods; D016757:Death, Sudden, Cardiac / Q000208:ethnology / Q000517:prevention & control*; D004452:Echocardiography / Q000191:economics*; D004562:Electrocardiography / Q000191:economics; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000191:economics* / Q000208:ethnology; D006801:Humans; D013178:Sports Medicine
Cost-effectiveness; echocardiography; pre-participation screening; sudden cardiac death