Etiologies of Sudden Cardiac Death in National Collegiate Athletic Association Athletes

Study Questions:

What are the etiologies of sudden cardiac death (SCD) in college athletes?

Methods:

A total of 45 cases of SCD were identified in National Collegiate Athletic Association (NCAA) athletes from 2004 to 2008, based on an internal reporting system and review of media reports. Autopsy reports were reviewed and adjudicated by a multidisciplinary panel.

Results:

Cause of death could be reasonably determined in 36 cases. Three athletes had no autopsy, five autopsy reports could not be obtained, and one autopsy had insufficient information to determine cause of death. The most common finding at death was a structurally normal heart or autopsy-negative sudden unexplained death (11, 31%), followed by coronary artery abnormalities (5, 14%), dilated cardiomyopathy (3, 8%), myocarditis related (3, 8%), aortic dissection (3, 8%), and idiopathic left ventricular hypertrophy (LVH)/possible hypertrophic cardiomyopathy (HCM) (3, 8%). There was one case each (3%) of HCM, arrhythmogenic right ventricular cardiomyopathy, long QT syndrome, commotio cordis, and Kawasaki disease. There was one case of death in a sickle cell-positive athlete who also had LVH. The adjudicated diagnosis agreed with the official pathology report in only 59% of cases.

Conclusions:

The authors concluded that unexplained death with a structurally normal heart is the most common finding after suspected SCD in NCAA athletes.

Perspective:

This study reports that autopsy-negative sudden unexplained death is the most common finding on autopsy at death, while HCM is less common than previously thought in NCAA athletes. Centralized data collection with mandatory reporting of deaths and standardized protocols for cardiovascular autopsies in athletes are needed, including post-mortem genetic testing, particularly in autopsy-negative cases. The diagnoses from media descriptions are often inaccurate, and even formal autopsy diagnosis may not correctly reflect pathologic findings in the report. A meaningful discussion regarding screening and prevention cannot happen without an accurate understanding of the incidence and etiologies of SCD in athletes.

Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Sports and Exercise Cardiology, Genetic Arrhythmic Conditions, SCD/Ventricular Arrhythmias, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, Sports and Exercise and Congenital Heart Disease and Pediatric Cardiology

Keywords: Hypertrophy, Left Ventricular, Athletes, Mucocutaneous Lymph Node Syndrome, Cardiomyopathy, Hypertrophic, Long QT Syndrome, Myocarditis, Genetic Testing, Autopsy, Arrhythmogenic Right Ventricular Dysplasia, Cause of Death, Commotio Cordis, Cardiomyopathy, Dilated, Death, Sudden, Cardiac


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