A Spanish study presented at the European Society of Cardiology Congress revealed that the screening process for young footballers to identify those at risk of heart disease does not take into account the type and intensity of the exercise performed.
Hypertrophic cardiomyopathy (HCM) is the single most common cause of sudden death in competitive footballers. HCM is an idiopathic condition in which cardiac muscles undergo pathological thickening. The recommended screening tests to detect athletes who are at risk of HCM, specially young athletes because they are more vulnerable to the disease, include physical examination, an assessment of medical history and conducting a 12-lead electrocardiogram (ECG). However, this ECG screening process does not take into consideration the type and intensity of the exercise performed, so its reliability is still questionable.
A collaborative team from the Hospital Quiron at the Universidad Europa de Madrid; the Institute of Molecular Pathology and Immunology of the University of Porto; DADISA in Cadiz; and the University of Extramadura in Badajoz conducted a study into the correlation of all aspects of the screening process. Dr José Angel Cabrera, Head of Cardiology at Hospital Quiron and co-author of the study report explains, “The aim of the study was to assess the capacity of different cardiovascular tests to identify the risk from sudden death due to hypertrophic cardiomyopathy, arrhythmogenic right ventricle dysplasia and dilated cardiomyopathy. In particular, we wanted to understand the relationship between ECG results and actual cardiovascular risk to assess the accuracy and efficiency of the screening process for HCM.”
ECG and MRI for detection of cardiac diseases.
Two professional football teams were selected for the study, with a total of 30 males participating. They had an average age of 31, and all were healthy with a high dynamic (isotonic) component training history. They underwent a complete cardiovascular examination and HCM screening procedures that included a physical examination, a study of their personal and family history, a 12-lead ECG, an MRI study and a genetic analysis. The results showed ECG abnormalities in just over half of the subjects (56%), which, according to the current criteria, should undergo further investigations for the diagnosis of cardiovascular disease. According to their MRI results only, no one of the subjects displayed clinical evidence of HCM. They all showed normal left ventricular wall thickness, no systolic anterior motion of the mitral valve and no left ventricular outflow obstruction. Furthermore, genetic analysis showed no evidence of mutations in the genes that could lead to heart disease. So while over half of the subjects would have required further evaluation based on their ECG test results, the MRI and genetic tests demonstrated completely healthy cardiac muscles for all participants. These finding would suggest that ECG-based screening needs to be reviewed, and the criteria for further evaluation should be recalculated according to the type and intensity of the exercise performed.