European Heart Journal Advance Access originally published online on March 28, 2007
European Heart Journal 2007 28(9):1170; doi:10.1093/eurheartj/ehm044
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ECG-based screening: not only for athletes
Cardiology Service
CMSR Veneto Medica
Altavilla Vicentina
Italy
Referral Center for Cardiomyopathies
Azienda Ospedaliera-Universitaria Careggi
Firenze
Italy
Referral Center for Cardiomyopathies
Azienda Ospedaliera-Universitaria Careggi
Firenze
Italy
Department of Pathology
University of Padua
Italy
Department of Pathology
University of Padua
Italy
E-mail address: snistr{at}tin.it
We appreciated the paper by Pelliccia et al.1 emphasizing the efficacy of the Italian preparticipation screening program for identifying hypertrophic cardiomyopathy (HCM) in athletes. Their findings may indeed explain the lower rate of athletic field deaths due to HCM reported in Italy compared to the USA, where standard 12-lead electrocardiography (ECG) is not routinely performed. Indeed, comparable findings have been obtained by other screening programs. In Italy,2 we specifically addressed the efficacy of military pre-enrolment medical evaluation in detecting HCM in 34 910 male conscripts. The diagnostic sensitivity for HCM and the clinical yield of such screening, based on standard ECG, together with family history and physical examination, proved comparable to that reported by Corrado et al.3in athletes. Furthermore, our follow-up data were consistent with the hypothesis that withdrawal of affected individuals from strenuous physical activities might effectively prevent sudden cardiac death. Conversely, Eckart et al.4 demonstrated that sudden death in US military recruits (not screened by routinary 12-lead ECG) was mainly due to cardiac abnormalities including HCM, and was mostly related to exercise (86%). Altogether these data1–3 prompt the need to add standard ECG to family history and physical examination in each screening protocol of large populations, with the aim of diagnosing heart disease and prevent sudden cardiac death.
Moreover, the relevant findings of Pelliccia et al., raise further important questions for every-day office clinical practice: should the indication for standard ECG be extended also to candidates for non-competitive sport activities? If so, at what age should we consider its large-scale implementation? Should community pediatricians consider ECG screening in adolescents before they are handed over to general practitioners. As military duty is no longer mandatory in Italy, as well as in most Western countries, we believe that these issues deserve appropriate debate beyond their application to competitive sports: the potential implications of cost-effective screening strategies seem too important to be confined to the limited population of voluntary competitive athletes only.
References
- Pelliccia A, Di Paolo FM, Corrado D, Buccolieri C, Quattrini FM, Pisicchio C, Spataro A, Biffi A, Granata M, Maron BJ. Evidence for efficacy of the Italian national pre-participation screening programme for identification of hypertrophic cardiomyopathy in competitive athletes. Eur Heart J (2006) 27:2196–2200.
[Abstract/Free Full Text] - Nistri S, Thiene G, Basso C, Corrado D, Vitolo A, Maron BJ. Screening for hypertrophic cardiomyopathy in a young male military population. Am J Cardiol (2003) 91:1021–1023.[CrossRef][ISI][Medline]
- Corrado C, Basso C, Schiavon M, Thiene G. Screening for hypertrophic cardiomyopathy in young athletes. N Engl J Med (1998) 339:364–369.
[Abstract/Free Full Text] - Eckart RE, Scoville SL, Campbell CL, Shry EA, Stajduhar KC, Potter RN, Pearse LA, Virmani R. Sudden death in young adults: a 25-year review of autopsies in military recruits. Ann Intern Med (2004) 141:829–834.
[Abstract/Free Full Text]
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