Publication Date
8-1-2018
Journal
The Texas Heart Journal
DOI
10.14503/THIJ-18-6645
PMID
30374227
Publication Date(s)
August 2018
Language
English
PMCID
PMC6183627
PubMedCentral® Posted Date
8-1-2018
PubMedCentral® Full Text Version
Post-Print
Published Open-Access
yes
Keywords
Adolescent, death, sudden, cardiac/epidemiology/etiology/prevention & control, diagnostic imaging/methods, eligibility determination/standards, exercise/adverse effects, heart defects, congenital/diagnosis/diagnostic imaging/epidemiology/statistics & numerical data, magnetic resonance imaging/utilization, mass screening/economics/methods/statistics & numerical data, predictive value of tests, sports medicine/standards
Copyright
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Abstract
Improving preparticipation screening of candidates for sports necessitates establishing the prevalence of high-risk cardiovascular conditions (hr-CVC) that predispose young people to sudden cardiac death (SCD). Our accurate, novel protocol chiefly involved the use of cardiac magnetic resonance (CMR) to estimate this prevalence.
Middle and high school students from a general United States population were screened by means of questionnaires, resting electrocardiograms, and CMR to determine the prevalence of 3 types of hr-CVC: electrocardiographic abnormalities, cardiomyopathies, and anomalous coronary artery origin from the opposite sinus with intramural coronary course (ACAOS-IM). We examined the range of normal left ventricular size and function in the main study cohort (schoolchildren 11–14 yr old). We defined diagnostic criteria for hr-CVC and compared the cardiac measurements of these younger participants with those of older children whom we examined (age, 15–18 yr).
From 5,169 completed diagnostic studies (mean participant age, 13.06 ± 1.78 yr), CMR results revealed 76 previously undiagnosed cases of hr-CVC (1.47% of the total cohort): 11 of dilated cardiomyopathy (14.5%), 3 of nonobstructive hypertrophic cardiomyopathy (3.9%), 23 ACAOS-IM cases (30.3%; 6 left-ACAOS and 17 right-ACAOS), 4 Wolff-Parkinson-White patterns (5.3%), 34 prolonged QT intervals (44.7%), and 1 Brugada pattern (1.3%). Cardiomyopathies were significantly more prevalent in the older children. Of note, we identified 959 cases (18.5%) of left ventricular noncompaction.
If our estimate is accurate, only 1.47% of school-age sports participants will need focused secondary evaluations; the rest can probably be reassured about their cardiac health after one 30-minute screening study.