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Sudden deaths (SD) in young competitive athletes due to cardiovascular disease is an important community issue with relevance to designing effective screening initiatives. However, the frequency with which these tragic events occur importantly impact considerations for selecting the most appropriate screening strategy. Therefore, the objective of this study was to add to the body of knowledge and determine the incidence and causes of cardiovascular SDs in Minnesota high school athletes.
The forensic case records of the U.S. National Registry of Sudden Death in Athletes were interrogated to identify those events judged to be cardiovascular in origin, occurring in organized competitive interscholastic sports participants.
Over the 26 year period, 1986–2011, 13 SDs occurred in high school student–athletes related to physical exertion during competition (n = 7) or at practice (n = 6). Ages were 12 to18 (median 16); each was a white male. Most common sports involved were: basketball, wrestling, or cross–country running. Forensic examination found cardiac causes in 7: hypertrophic cardiomyopathy ; anomalous coronary artery ; myocarditis ; aortic stenosis ; arrhythmogenic right ventricular cardiomyopathy ; 4had structurally normal hearts (with negative toxicology). There were 4,440,161 sports participations, including 1,930,504 individual participants among 24 sports. SD risk was 1:341,551 participations and 1:137,893 participants/academic year. In only 4 athletes (31%) could the responsible cardiovascular diseases be reliably detected by history, physical examination or 12–lead ECG, equivalent to 1:1,000,000 participations.
In this high school athlete population, risk of cardiovascular SD was small, in the range of 1:100,000 participants. Based on autopsy data, only about 30% of the SDs were due to diseases that could be reliably detected by screening, even with 12–lead ECGs. These data argue against the prudence of national mandatory 12–lead ECG screening for competitive athletes in the U.S.
South, Room 102
Sunday, March 10, 2013, 11:00 a.m.–11:15 a.m.
Session Title: Evaluating the Athlete's Heart: Emerging Science
Abstract Category: 29. Sports and Exercise Cardiology: Diagnostic Testing: ECG Exercise or “The Older Athlete”
Presentation Number: 930–4
- 2013 American College of Cardiology Foundation