This post was authored by Dermot M. Phelan, MD, PhD, member of the ACC’s Sports and Exercise Cardiology Section and director of the Sports Cardiology Center at the Cleveland Clinic.

After a calamitous opener at Ohio Stadium, the Buckeye Nation (including this adopted son of Ohio) rejoiced last Monday night after Ohio State secured the National Championship through the calculations of Urban Meyer, the powerful arm of Cardale Jones and the dancing feet of Ezekiel Elliott. Throughout the country, college athletes went to bed overjoyed, devastated or indifferent but with one eye firmly fixed on Lucas Oil Stadium in Indianapolis. Here, the National Football League (NFL) Scouting Combine will take place within a short few weeks. By invite only, college athletes will have the opportunity to showcase their skills, strength and pace in the hopes of improving their draft status, salary and career prospects. Over the years, this has become a media extravaganza. Who can resist the spectacle of the 40-yard dash and the 225-lbs bench press (14 players have done more than 40 reps!)?

Less celebrated, but of no less import, is the medical evaluation of the athletes. Annually, the medical teams of each NFL franchise descend upon Indianapolis with the mandate to ensure the health of potential draftees; these can be described as pre-employment physicals. Each joint is tested and re-tested, every past injury and concussion discussed, MRI scanners are on hand and in constant use.

Among the many medical professionals is Lon Castle, MD, FACC, who has been attending the Combine since its inception. Dr. Castle is a cardiologist out of the Cleveland Clinic who has lent his knowledge and expertise to the NFL and the team doctors for many years. Recently I have had the privilege of assisting him in his endeavors. Last February, as we reviewed the athletes’ electrocardiograms (ECGs), one of the team doctors drolly observed that having a “normal” ECG was so rare that it is an independent predictor of not making it to the NFL! Perhaps for this reason, a number of years ago, the NFL Cardiovascular Health Subcommittee, adeptly led by Andy Tucker, MD, from Baltimore, recommended echocardiographic screening, in addition to ECG testing, for all attendees. This presented a monumental challenge: echo over 300 men (often very large) with accurate and instant reads over a few days.  Many felt it could not be done. I believe that there are few places that could have managed it but Richard Kovacs, MD, FACC, and his team from Indiana University stepped in and not only met, but exceeded, expectations.

Screening with echocardiography remains a controversial topic. What are the false positive and false negative rates in any particular cohort and what about the cost to players for these errors? I believe that image quality and the experience of the reader are the primary predictors of these errors; these are of the highest quality at the Combine. Echocardiographic stress tests, cardiac CT and cardiac MRI’s are on hand to clarify instances of diagnostic dilemmas. Every possible effort is made to ensure the accuracy of the information for the safety of the players. The vast majority of the time there are no issues. Rarely are players disqualified from training for their safety and, occasionally, information comes to light on conditions that can be treated or simply need to be monitored.

Whatever the outcome, the NFL Combine is a critical event in the calendar for players with dreams of excelling in the NFL and the franchises which depend on accurate and fair assessments of the medical health of their potential draftees.

This post is part of a series of posts from the ACC’s Sports and Exercise Cardiology Section. Follow the sports and exercise cardiology conversation on Twitter with the hashtag #SportsCardio.

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