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Limited echo - useful in athletic screening?

Comment by Nicole M. Panhuyzen-Goedkoop and Erik Ekker Solberg, EACPR Sports Cardiology Section

An Echo Screening Tool for Sudden Cardiac Death in Young Athletes
M.A. Grenier et al.
Presentation Abstract, 23rd Annual American Society of Echocardiography Meeting; Cincinnati, Ohio, USA: 30 June–3 July


85 athletes, 14-19 years old, underwent pre-participation cardiovascular screening (PPS) including a limited echocardiography (nine minutes recording, off-line interpretation done separately) with real-time qualitative interpretation of a 15 image protocol. Those with an abnormal outcome were referred for a standard echocardiography. Although their standard PPS was normal, 10 athletes (12%) had an abnormal outcome of the real-time 15 image echocardiography study:  dilated aortic root in 4, PDA in 1, ASD in 1, LV dysfunction (EF 48%) in 1, LV noncompaction in 2, and LVH in 1 athlete. The authors revealed a high rate of clinically silent cardiovascular disease, with an unknown impact of early identification, intervention strategies and the risk of undetecting the disease.  

This is an interesting study testing simplification of the screening process. Rapid interpretation of limited echocardiography, however, may lead to misinterpretation of the data. It was remarkable that in those athletes with an abnormal echocardiography study (12%), none had an abnormal ECG, while several of the abnormalities described are usually associated with abnormal ECG findings. The identified diseases in this study are not always silent diseases at high risk for SCD. And left ventricular dysfunction based on ejection fraction of 48% alone does not imply pathology in an athlete in a position to succumb to bradycardia. Therefore not all athletes in this study with identified pathology have to be excluded from participation in sports.

It is valuable that the worth of limited echo in PPS is tested. However it is not time to change the existent practice.