Hypertrophic Cardiomyopathy Screening - Successful Models of Intervention Using ECG

Successful Models of Intervention Using ECG

As previously discussed, ECG screening appears to be the most feasible and effective method for screening for HCM. There are contrasting policies with regards to national standards on screening young athletes for cardiovascular abnormalities. Below are a few successful interventions, followed by the United States’ approach.

Italy
By law, all competitive athletes are required to undergo physiological testing prior to competing. This consists of a history, physical examination, urinalysis, resting and exercise ECG, and pulmonary functioning test. All of these are conducted by a sports physician. If there are abnormalities, further screening of ECHO (echocardiography) is required.

• A study of 4050 Italian national team athletes revealed high levels of efficiency of their 12-lead ECG in detecting HCM in young athletes. This led to the disqualification of athletes with HCM from their respective sports.
• Over a period of 25 years, there have been monitored trends in cases of sudden death in screened and unscreened athletes. Sudden cardiovascular death accounted for 55 deaths in screened athletes and 265 in unscreened athletes. Overall, there has been an 89% decrease in incidence of athlete death due to cardiovascular abnormalities.

European Association for Cardiovascular Prevention in Sports Cardiology

This is supported by the International Olympic Committee, and follows the Italian strategy consisting of personal and family history, physical exam, and 12-lead resting ECG. FIFA also performed preparticipation screening in all soccer players in the world championships in Germany in 2006.

United States

To date, there is no national policy for the screening of CVD or sudden cardiac death in young athletes. Though many screening programs are currently being run by private entities as well as various non profit organizations. Most state laws require competitive athletes to undergo a physician-mediated physical examination and history. ECG or echocardiograms are rarely used. A medical history and physical exam have shown to have little sensitivity or power to detect HCM or other risk conditions. The theory behind this lack of national standard is that screening is viewed as an aspiration to identify a rare cardiovascular disease with low incidence in a large population (approximately 2 in 1000 individuals).