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