Early screening for cardiovascular abnormalities with preparticipation echocardiography: utility of focused physician-operated echocardiography in preparticipation screening of athletes.
OBJECTIVE
We have developed the Early Screening for Cardiovascular Abnormalities With Preparticipation Echocardiography protocol to improve false-positive rates, reduce referrals, and broaden the spectrum of disease that can be captured through preparticipation screening of athletes. This study documents the first application of this protocol and uses case analysis to discuss the potential utility of portable sonography in screening.


METHODS
Sixty-five male collegiate athletes, aged 18 to 25 years, were prospectively enrolled. Each athlete was screened with a history and physical examination, electrocardiography (ECG), and focused echocardiography performed by a noncardiologist sports medicine physician. The history and physical examination were based on the 12-element American Heart Association recommendations; 2010 European Society of Cardiology criteria were used to screen ECGs. Focused physician-operated echocardiography was performed to assess for hypertrophic cardiomyopathy and aortic root dilatation. Athletes screening positive were referred to a cardiologist.


RESULTS
Most of the athletes (n = 59) did not screen positive by any screening modality. Three athletes screened positive on ECG but had normal focused echocardiographic findings. Three athletes screened positive by history and physical examination but had normal ECG and focused echocardiographic findings. All athletes screening positive were referred to a cardiologist and eventually cleared for sports participation. No athlete screened positive by focused echocardiography alone. Focused echocardiography was able to reduce the referral rate for hypertrophic cardiomyopathy by 33% and obtained measurements statistically similar to those of formal echocardiography.


CONCLUSIONS
This study provides evidence that focused physician-operated echocardiography can improve false-positive rates and broaden the spectrum of disease that is detectable through preparticipation screening of athletes.
Division of Sports Medicine, Boston Children's Hospital, 319 Longwood Ave, Boston, MA 02115 USA. g.corrado@neu.edu.
Eugene S
ES
Yim
Frederick
F
Basilico
Gianmichel
G
Corrado
D000293:Adolescent; D000328:Adult; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging*; D042241:Early Diagnosis; D004452:Echocardiography / Q000379:methods*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D010358:Patient Participation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013178:Sports Medicine / Q000379:methods*; D055815:Young Adult
aortic root dilatation; athletes; echocardiography; point-of-care ultrasound; preparticipation screening; sonography; sudden cardiac death