Screening of young athletes for heart disease needs improving

2 Sept 2010

The screening process for young footballers to detect those at risk of heart disease does not take into account the type and intensity of the exercise performed, according to a Spanish study presented at the European Society of Cardiology Congress.

The single most common cause of sudden death in competitive footballers is hypertrophic cardiomyopathy (HCM) — a disease that thickens the heart muscle without any obvious cause.

The recommended screening process to identify risk of HCM, which is particularly common in young athletes, involves physical examination, an assessment of medical history and conducting a 12-lead electrocardiogram (ECG). However, this ECG screening process does not take into account the type and intensity of the exercise performed, so there is a question over its validity.

A joint team from the Hospital Quiron at the Universidad Europa de Madrid; the Institute of Molecular Pathology and Immunology of the University of Porto; DADISA in Cadiz; and the University of Extramadura in Badajoz undertook a study into the correlation of all aspects of the screening process.

Dr José Angel Cabrera, Head of Cardiology at Hospital Quiron and co-author of the study report explains: “The aim of the study was to assess the capacity of different cardiovascular tests to identify the risk from sudden death due to hypertrophic cardiomyopathy, arrhythmogenic right ventricle dysplasia and dilated cardiomyopathy. In particular, we wanted to understand the relationship between ECG results and actual cardiovascular risk to assess the accuracy and efficiency of the screening process for HCM.”

Two professional football teams were selected for the study, with a total of 30 males participating. They had an average age of 31, and all were healthy with a high dynamic (isotonic) component training history. They underwent a complete cardiovascular examination and HCM screening procedures that included a physical examination, a study of their personal and family history, a 12-lead ECG, an MRI study and a genetic analysis.

The results showed ECG abnormalities in just over half of the subjects (56%), which — according to the current criteria — should have required them to undergo further evaluation for the diagnosis of cardiovascular disease.

Based on their MRI results alone, not one of the subjects showed clinical evidence of HCM. They all displayed normal left ventricular wall thickness, no systolic anterior motion of the mitral valve and no left ventricular outflow obstruction. Furthermore, genetic analysis showed no evidence of mutations in the genes that could lead to heart disease. So while over half of the subjects would have required further evaluation based on their ECG test results, the MRI and genetic tests showed a complete absence of heart disease.

These finding would suggest that ECG-based screening needs to be reviewed, and the criteria for further evaluation should be recalculated according to the type and intensity of the exercise performed.