Young athletes: Preventing sudden death by adopting a modern screening approach? A critical review and the opening of a debate

• Main Authors: Paolo Angelini, Raja Muthupillai, Alberto Lopez, Benjamin Cheong, Carlo Uribe, Eduardo Hernandez, Stephanie Coulter, Emerson Perin, Silvana Molossi, Federico Gentile, Scott Flamm, Giovanni Lorenz, Flavio D'Ascenzi, Jonathan Tobis, Roberto Sarnari, Antonio Corno, James Furgerson, Amedeo Chiribiri, Adriana D.M. Villa, Fulvio Orzan, Pedro Brugada, John Jefferies, Pierre Aubry, Jeffrey Towbin, Gaetano Thiene, Robert Tomanek
• Format: Article
• Language: English
• Published: Elsevier 2021-06-01
• Series: International Journal of Cardiology: Heart & Vasculature
• Subjects: Death, sudden, cardiac; Heart defects, congenital; Sports medicine; Adolescent medicine; Autopsy; Diagnostic screening programs
• Online Access: http://www.sciencedirect.com/science/article/pii/S2352906721000786

Preventing sudden cardiac death (SCD) in athletes is a primary duty of sports cardiologists. Current recommendations for detecting high-risk cardiovascular conditions (hr-CVCs) are history and physical examination (H&P)-based. We discuss the effectiveness of H&P-based screening versus more-modern and accurate methods. In this position paper, we review current authoritative statements and suggest a novel alternative: screening MRI (s-MRI), supported by evidence from a preliminary population-based study (completed in 2018), and a prospective, controlled study in military recruits (in development).We present: 1. Literature-Based Comparisons (for diagnosing hr-CVCs): Two recent studies using traditional methods to identify hr-CVCs in >3,000 young athletes are compared with our s-MRI-based study of 5,169 adolescents. 2. Critical Review of Previous Results: The reported incidence of SCD in athletes is presently based on retrospective, observational, and incomplete studies. H&P’s screening value seems minimal for structural heart disease, versus echocardiography (which improves diagnosis for high-risk cardiomyopathies) and s-MRI (which also identifies high-risk coronary artery anomalies). Electrocardiography is valuable in screening for potentially high-risk electrophysiological anomalies. 3. Proposed Project: We propose a prospective, controlled study (2 comparable large cohorts: one historical, one prospective) to compare: (1) diagnostic accuracy and resulting mortality-prevention performance of traditional screening methods versus questionnaire/electrocardiography/s-MRI, during 2-month periods of intense, structured exercise (in military recruits, in advanced state of preparation); (2) global costs and cost/efficiency between these two methods. This study should contribute significantly toward a comprehensive understanding of the incidence and causes of exercise-related mortality (including establishing a definition of hr-CVCs) while aiming to reduce mortality.