An Italian group researchers evaluated a consecutive cohort of 10,985 young athletes with history, physical examination, resting ECG and ECG stress testing. Athletes with ventricular arrhythmias induced by ECG stress testing underwent 24-hour 12-lead Holter monitoring and echocardiography. Cardiac magnetic resonance was reserved for those with frequent, repetitive or exercise-worsened ventricular arrhythmias, and for athletes with echocardiographic abnormalities,
Of 10,985 athletes , 451 had an abnormal history, physical examination or resting ECG and 31 were diagnosed with a cardiac disease and were at risk of sudden cardiac death. Among the remaining 10,534 athletes, ventricular arrhythmias at ECG stress testing occurred in 524 and a previously missed at-risk condition was identified in 23; the most common was an echocardiographically silent non-ischaemic left-ventricular fibrosis evidenced by cardiac magnetic resonance. The addition of ECG stress testing increased the diagnostic yield of preparticipation evaluation by 75% and decreased the positive predictive value by 20%. During a 32?±?21 months follow-up, no cardiac arrests occurred among either eligible athletes or non-eligible athletes with cardiovascular disease.
Eur J Prev Cardiol. 2019 Dec 2:2047487319890973. doi: 10.1177/2047487319890973