Detecting Underlying Cardiovascular Disease in Young Competitive Athletes.
Sudden cardiac death (SCD) is frequently the first manifestation of underlying cardiovascular disease in young competitive athletes (YCAs), yet there are no Canadian guidelines for preparticipation screening in this population. The goal of this study was to determine the prevalence of potentially lethal cardiovascular disease in a sample of Canadian YCAs by comparing 2 screening strategies.



We prospectively screened 1419 YCAs in British Columbia, Canada (age 12-35 years). We initially screened 714 YCAs using the American Heart Association 12-element recommendations, physical examination, and electrocardiogram (ECG) examination (phase 1). This strategy yielded a high number of false positive results; 705 YCAs were subsequently screened using a novel SportsCardiologyBC (SCBC) questionnaire and ECG examination in the absence of a physical examination (phase 2).



Overall, 7 YCAs (0.52%) were found to have clinically significant diagnoses associated with SCD (4 pre-excitation, 1 long QT syndrome, 1 mitral valve prolapse, 1 hypertrophic cardiomyopathy). Six of the 7 athletes (85.7%) with disease possessed an abnormal ECG. Conversely, only 2 had a positive personal or family history (1 athlete had an abnormal ECG and family history). The SCBC questionnaire and protocol (phase 2) was associated with fewer false positive screens; 3.7% (25 of 679) compared with 8.1% (55 of 680) in phase 1 (P = 0.0012).



The prevalence of conditions associated with SCD in a cohort of Canadian YCAs was comparable with American and European populations. The SCBC questionnaire and protocol were associated with fewer false positive screens. The ECG identified most of the positive cases irrespective of screening strategy used.
Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: mckinney.jimmy@gmail.com.
James
J
McKinney
Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
Daniel J
DJ
Lithwick
Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
Barbara N
BN
Morrison
Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
Hamed
H
Nazzari
Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
Michael
M
Luong
Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada; Duke Clinical Research Institute, Durham, North Carolina, USA.
Christopher B
CB
Fordyce
Division of Sports Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Jack
J
Taunton
Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
Andrew D
AD
Krahn
Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
Brett
B
Heilbron
Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
Saul
S
Isserow
D000293:Adolescent; D000328:Adult; D056352:Athletes / Q000706:statistics & numerical data*; D001955:British Columbia / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology; D002648:Child; D004562:Electrocardiography / Q000379:methods; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000379:methods*; D010808:Physical Examination; D011446:Prospective Studies; D055815:Young Adult