Should Cardiac Imaging be Recommended as a First-Line Tool in Screening Athletes?

There is insufficient evidence to justify the use of all cardiac imaging modalities as a first-line screening tool in athletes given their current limitations in predicting sudden cardiac death (SCD) in low-risk populations, according to a paper published Sept. 9 in the Journal of the American College of Cardiology: Cardiovascular Imaging . However, the authors note that cardiac imaging as a second-line screening tool becomes of “prime relevance in the evaluation of athletes in whom an abnormality is identified on ECG” or clinical suspicion is raised by symptoms, family history and/or a clinical exam.

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"The causes of SCD are relatively diverse and are not accurately identified by any one imaging test, especially in the middle-aged athlete who represents a substantial proportion of competitive sports participation," the authors said.

The paper highlights the incomplete understanding of what constitutes the normal range of morphology and function across the broad spectrum of athletes in terms of age, ethnicity and other factors. In particular, the paper provides examples of cases where use of newer techniques or imaging modalities has resulted in atypical results that then trigger further tests, psychological stress, and unnecessary exclusions from competition in asymptomatic athletes with very low risk of SCD.

“Patient specific investigations should be focused on evaluating those athletes in whom clinical suspicion is raised by symptoms, family history, clinical exam and/or abnormalities on ECG,” the authors said. “While it is imperative that we continue our efforts to safeguard athletes, we must also recognize the current limitations of our tools in predicting SCD in low-risk populations.”

“The authors provide an excellent state-of-the-art paper on current issues in athlete cardiovascular imaging, while at the same time providing a unique, practical, and valuable reference tool,” said Christine E. Lawless, MD, FACC, co-chair of the Sports and Exercise Cardiology Council and Section. “They astutely point out that an opportunity to answer the ECG debate was missed years ago. But, now that the ‘train has left the station,’ the information provided here will help cardiovascular care specialists successfully meet the cardiovascular needs of athletes throughout the world.”

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Clinical Topics: Arrhythmias and Clinical EP, Sports and Exercise Cardiology, SCD/Ventricular Arrhythmias

Keywords: Athletes, Specialization, Reference Values, Electrocardiography, Death, Sudden, Cardiac

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