Cardiovascular Screening before Sports Participation: Results of 11487 Children

Abstract

Aim In this study, it is aimed to analyze the data of children who were referred to our clinic for pre-participation sports screening.

Methods Data, between September 2017 and December 2021, had been analyzed. All these subjects had been questioned for their personal and family medical stories and examined for cardiovascular system findings. Electrocardiography (ECG) and echocardiography were applied to all of them.

Results 11487 children were consulted to the cardiology clinic for pre-sports participation screening. The mean age was 12.7±4,57 (7–18 years). 34/11487(0,29%) subjects weren’t allowed to participate in sports activities at first. In 23 of 34 subjects, cardiac arrhythmias were established. 15 had Wolff-Parkinson-White (WPW) syndrome, 3 subjects had ventricular extrasystole, and also ventricular tachycardia in one of them. Four subjects had long QT syndrome and one had ST elevation with the pre-diagnosis of coronary artery disease. ECG screening alone aided in identifying asymptomatic (0.05%) that could have been potentially at risk for sudden cardiac death.

Conclusion Positive ECG and echocardiography findings involve a very little ratio.But ECG involves an important tool for screening lethal cardiac arrhythmias in asymptomatic patients.If ECG or echocardiography couldn’t be taken, further evaluation should be necessary with symptoms and/or family history. Keywords: Echocardiography, electrocardiography, pediatric, screening, sports

Zusammenfassung

Ziel Ziel der vorliegenden Studie war es, die Daten von Kinder auszuwerten, die an unsere kardiologische Ambulanz zum Screening vor Teilnahme an sportlichen Aktivitäten überwiesen wurden.

Methoden Zwischen September 2017 und Dezember 2021 erhobene Daten gingen in die Analyse ein. Bei allen Studienteilnehmern erfolgten die Erhebung der Eigen- und Familienanamnese sowie eine Untersuchung des Herz-Kreislauf-Systems. Elektrokardiographie (EKG) und Echokardiographie waren in allen Fällen Bestandteil der Untersuchung.

Ergebnisse Insgesamt wurden 11 487 Kinder an die kardiologische Ambulanz zum Screening vor Teilnahme an sportlichen Aktivitäten überwiesen. Das Durchschnittsalter betrug 12,7 ± 4,57 (7–18) Jahre. Zunächst erhielten 34/11 487(0,29 %) der Untersuchten keine Erlaubnis zur Teilnahmen an sportlichen Aktivitäten. Bei 23 dieser 34 Kinder wurden Herzrhythmusstörungen nachgewiesen. In 15 Fällen fand sich ein Wolff- Parkinson-White (WPW)-Syndrom, in 3 Fällen eine ventrikuläre Extrasystolie und in einem Fall eine ventrikuläre Tachykardie. In 4 Fällen bestand ein Long-QT-Syndrom und in einem Fall eine ST-Hebung bei Vordiagnose einer koronaren Herzkrankheit. EKG-Screening als alleinige Untersuchung trug zur Erkennung von asymptomatischen Fällen mit potenziellem Risiko für plötzlichen Herztod bei.

Schlussfolgerung Der Anteil auffälliger EKG- und Echokardiographie- Befunde ist äußerst gering. Dennoch stellt das EKG ein wichtiges Instrument für das Screening auf tödliche Herzrhythmusstörungen bei asymptomatischen Patienten dar. Falls ein EKG oder eine Echokardiographie nicht durchgeführt werden konnten, sollte stets bei Vorliegen von Symptomen und/oder einer entsprechenden Familienanamnese eine weitere Abklärung erfolgen.

Key words

echocardiography - electrocardiography - pediatric - screening - sports

Schlüsselwörter

Echokardiographie - Elektrokardiographie - Pädiatrie - Screening - Sport

• References

• 1 Corrado D. et al. Sudden cardiac death in athletes: can it be prevented by screening?. Herz 2009; 34: 259-266
• 2 Landry CH. et al. Sudden Cardiac Arrest during Participation in Competitive Sports. N Engl J Med 2017; 377: 1943-1953
• 3 Bagnall RD. et al. A prospective study of sudden cardiac death among children and young adults. New England Journal of Medicine 2016; 374: 2441-2452
• 4 Corrado D. et al. Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J 2005; 26: 516-524
• 5 Winkel BG. et al. Sudden cardiac death in children (1–18 years): symptoms and causes of death in a nationwide setting. European heart journal 2014; 35: 868-875
• 6 Malhotra A. et al. Outcomes of cardiac screening in adolescent soccer players. New England Journal of Medicine 2018; 379: 524-534
• 7 Miller SM, Peterson AR. The Sports Preparticipation Evaluation. Pediatr Rev 2019; 40: 108-128
• 8 Williams EA. et al. Performance of the American Heart Association (AHA) 14-Point Evaluation Versus Electrocardiography for the Cardiovascular Screening of High School Athletes: A Prospective Study. J Am Heart Assoc 2019; 8: e012235
• 9 Kasamaki Y. et al. Automated versus manual measurement of the QT interval and corrected QT interval. Ann Noninvasive Electrocardiol 2011; 16: 156-164
• 10 Sharma S. et al. International Recommendations for Electrocardiographic Interpretation in Athletes. J Am Coll Cardiol 2017; 69: 1057-1075
• 11 Mont L. et al. Pre-participation cardiovascular evaluation for athletic participants to prevent sudden death: Position paper from the EHRA and the EACPR, branches of the ESC. Endorsed by APHRS, HRS, and SOLAECE. Eur J Prev Cardiol 2017; 24: 41-69
• 12 Cohen MI. Frequent premature ventricular beats in healthy children: when to ignore and when to treat?. Curr Opin Cardiol 2019; 34: 65-72
• 13 Biasco L. et al. Clinical, electrocardiographic, echocardiographic characteristics and long-term follow-up of elite soccer players with J-point elevation. Circ Arrhythm Electrophysiol 2013; 6: 1178-1184
• 14 Pettersen MD. et al. Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: an echocardiographic study. J Am Soc Echocardiogr 2008; 21: 922-934
• 15 Fuse S. et al. Standard method for ultrasound imaging of coronary artery in children. Pediatr Int 2010; 52: 876-882
• 16 Elliott PM. et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 2014; 35: 2733-2779
• 17 Marcus FI. et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the task force criteria. Circulation 2010; 121: 1533-1541
• 18 Bozkurt B. et al. Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association. Circulation 2016; 134: e579-e646
• 19 Lovic D. et al. Left ventricular hypertrophy in athletes and hypertensive patients. The Journal of Clinical Hypertension 2017; 19: 413-417
• 20 Harmon KG. et al. Incidence of sudden cardiac death in athletes: a state-of-the-art review. Br J Sports Med 2014; 48: 1185-1192
• 21 Maron BJ. et al. Assessment of the 12-lead ECG as a screening test for detection of cardiovascular disease in healthy general populations of young people (12–25 Years of Age): a scientific statement from the American Heart Association and the American College of Cardiology. Circulation 2014; 130: 1303-1334
• 22 Tasaki H, Hamasaki Y, Ichimaru T. Mass screening for heart disease of school children in Saga city: 7-year follow up study. Jpn Circ J 1987; 51: 1415-1420
• 23 Cain N. et al. Natural history of Wolff-Parkinson-White syndrome diagnosed in childhood. Am J Cardiol 2013; 112: 961-965
• 24 Obeyesekere MN. et al. Risk of arrhythmia and sudden death in patients with asymptomatic preexcitation: a meta-analysis. Circulation 2012; 125: 2308-2315
• 25 Gerling S. et al. Echocardiographic diagnosis of congenital coronary artery abnormalities in a continuous series of adolescent football players. Eur J Prev Cardiol 2019; 26: 988-994
• 26 Calò L. et al. Electrocardiographic and echocardiographic evaluation of a large cohort of peri-pubertal soccer players during pre-participation screening. Eur J Prev Cardiol 2019; 26: 1444-1455