Author + information
- Navin Chandra,
- Mohamad Barakat,
- Harshil Dhutia,
- Michael Papadakis,
- Rachel Bastiaenen and
- Sanjay Sharma
Background: Sudden cardiac death (SCD) in young individuals is a public health concern given the significant number of life-years lost. Previous data from competitive athletes suggest that screening incorporating an electrocardiogram (ECG) reduces the incidence of SCD. However, the majority of SCD occurs in the general population. In the UK, screening for cardiac disorders is confined to symptomatic individuals or those with a family history of inherited cardiac conditions or premature cardiac death. We assessed the efficacy, feasibility and cost of ECG screening for cardiovascular conditions associated with SCD in young individuals from the general population.
Methods: Between 2010-2015, 10,359 young individuals (14-35 years) underwent screening comprising history, examination and ECG. ECGs were analysed for pathological patterns and individuals with features suggestive of cardiomyopathy underwent on-site echocardiography. Individuals with electrical or structural abnormalities were referred for further evaluation. ECGs were evaluated using the European Society of Cardiology recommendations for competitive athletes and compared with the recently published ‘Seattle-Criteria’ and ‘Refined-Criteria'.
Results: Cardiovascular symptoms were reported in 44.2% of individuals and an abnormal physical examination occurred in 0.3%. ECG patterns suggestive of cardiac pathology were identified in 22.4%. On-site echocardiography was performed in 13.0%. Subsequent referral for further evaluation was necessary in 7.0%. Cardiovascular diagnoses associated with SCD were confirmed in 0.3% of individuals. This strategy demonstrated a high specificity (93.2%) and low false-positive rate (6.8%) at an estimated cost of £106,141 per diagnosis made. ECG interpretation using the ‘Seattle-Criteria’ and ‘Refined-Criteria’ improved specificity and false-positive rates and reduced cost.
Conclusions: A screening strategy incorporating the ECG appears effective with a high specificity, low false-positive rate and favourable cost. However, if applied to all young individuals in the general population, the logistical and financial implications seem impractical and unjustifiable.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Imaging the Athlete's Heart
Abstract Category: 31. Non Invasive Imaging: Sports and Exercise
Presentation Number: 1119-222
- 2017 American College of Cardiology Foundation