MRI-Based Screening May Help Detect Pre-Existing Heart Defects and Prevent SCD in Young Athletes
A single-center study has shown that a protocol consisting of a questionnaire, resting electrocardiogram (ECG), and a screening MRI (s-MRI) could be a cost-effective approach to prevent sudden cardiac death (SCD) in young athletes, according to results presented from the S2P Study by Paolo E. Angelini, MD, on March 17 at ACC.17 in Washington, DC.
Pre-existing defects, usually congenital, predispose patients to SCD under strenuous exertion such as sports. However, in the United States, a basic history and physical remains the predominant screening approach for student athletes. Thus, the "exact incidence of SCD in population-based studies is not available," said Angelini. He stated that a list of high-risk cardiovascular conditions (hr-CVC) has not been well defined.
In the Screen to Prevent (S2P) study, Angelini and colleagues employed their screening protocol in 5,255 youth ages 11-14 (average age 13 years; 32 percent white, 23 percent black and 19 percent Hispanic) between 2010 and 2017 at the Texas Heart Institute in Houston. They found that symptoms identified in the history and physical and on ECG did not correlate with any hr-CVC and alone were insufficient to identify structural hr-CVCs and their severity.
On s-MRI screening, the most frequent abnormality was an ECG defect, found in 40 individuals, followed by anomalous origin of the right coronary artery in 23 individuals, and cardiomyopathy in 15 (12 of whom had dilated cardiomyopathy). The investigators also performed quantitative MRI in 1,159 of the participants to help establish parameters for left ventricular mass and left ventricular end-diastolic volume.
Angelini stated these data support the use of this protocol to derive prevalence data in the general population, rather than in the SCD population, that can then be used to screen youth for sports or other strenuous activities. "It is safe, accurate, comfortable and likely cost-effective" in high-risk populations to identifying those at risk for SCD, he said. The S2P study provides a first step in defining "high risk" by using prevalence data. Further research is needed to explore its potential to prevent SCD in young athletes.
"Cost effectiveness of such an approach to prevent sudden cardiac death has not been demonstrated," said Kim A. Eagle, MD, MACC, editor-in-chief of ACC.org. "It is important to determine how many student athletes may be excluded from sports participation for conditions or findings that may or may not really represent a major threat." He added that this study is "hypothesis-generating, not conclusive."
Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Sports and Exercise Cardiology, SCD/Ventricular Arrhythmias, Congenital Heart Disease, CHD & Pediatrics and Arrhythmias, CHD & Pediatrics and Quality Improvement, Sports & Exercise and Congenital Heart Disease & Pediatric Cardiology
Keywords: ACC17, ACC Annual Scientific Session, Athletes, Cardiomyopathies, Cardiomyopathy, Dilated, Confidence Intervals, Death, Sudden, Cardiac, Electrocardiography, Heart Defects, Congenital, Prevalence, Sports
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