Undergraduate Student The University of British Columbia Vancouver, British Columbia, Canada
Background: Sudden cardiac death is commonly the first manifestation of underlying cardiovascular disease in young athletes. Preparticipation screening can be utilized to try to identify athletes at an increased risk.
METHODS AND RESULTS: Competitive and recreational athletes (aged 12-34 years) were voluntarily screened with the SportsCardiologyBC questionnaire and an ECG in British Columbia from August 1, 2019 to October 1, 2024. ECGs were interpreted by sports cardiologists using the 2017 International Criteria for ECG Interpretation of the Athlete. Follow-up with a cardiologist was recommended by both verbal and written communication if concerning symptoms and/or an ECG abnormality were detected. Further evaluation and investigations were at the discretion of the cardiologist. Data are presented as median [quartile 1-quartile 3] or percentages. A total of 1057 athletes were included (mean±SD, 19.0±2.7) years; 43% female. One-hundred and twelve participants had abnormal screenings, 86 (77%) from questionnaires and 24 (21%) from ECGs, and two (2%) had abnormalities on both. ECG abnormalities requiring follow-up are presented in Figure 1. Sixty-four athletes underwent evaluation by a sports cardiologist resulting in three cardiac diagnoses. After further investigation, no athlete was restricted from sport. Two athletes were diagnosed with Wolff-Parkinson-White (one underwent accessory pathway ablation), and one athlete was diagnosed with Long QT syndrome. Five athletes were diagnosed with non-cardiac diagnoses (anemia (3), exercise-induced asthma, and costochondritis). The remaining 56 athletes were not deemed to have any concerning symptoms and/or underlying cardiac pathology. An abnormal questionnaire did not result in any cardiac diagnoses.
Serial annual screening was conducted for 13% (n=134) of the cohort. During the study, only one athlete went on to develop an abnormal ECG after serial screenings. The mean age of the athletes at time of the first ECG was 19.0+1.6 years. The average time between the initial and final ECG was 1.9+1.0 years.
Conclusion: Cardiovascular screening of young Canadian athletes resulted in a low incidence (0.3%) of cardiac diagnoses identified. Consistent with prior research, the questionnaire has poor predictive value in identifying athletes with underlying cardiac disease. Further refinement of cardiovascular screening questionnaires should be sought to reduce unwarranted follow-ups. Only one athlete during a 3-year period went onto to develop an abnormal ECG requiring evaluation. The utility of serial ECG-based screening requires further study.
