Abstract 18159: Feasibility and Utility of Pre-participation Cardiovascular Screening in a State Funded Program
The Texas State legislature allocated 1 million dollars for a pilot study to evaluate pre-participation cardiovascular screening for student athletes who may be at risk for sudden cardiac death (SCD), in particular those with hypertrophic cardiomyopathy (HCM). The evaluation included a questionnaire/ physical examination, electrocardiogram (ECG) and a limited echo.
Objectives: Determine 1) the feasibility of a state-wide screening program 2) the ability to identify at-risk individuals and 3) the incremental utility of each element of the screening process.
Methods: Data were analyzed with standard pediatric ECG and echo (adjusted for BSA) guidelines. Positive results were confirmed independently by a second blinded reader.
Results: There were 31 venues enrolling 2506 student athletes, mean age of 14.4y (10-19y), 52% (n=1301) were male, and mean BSA was 1.66 (1.04-2.71). Ethnic diversification (consistent with Texas state demographics) was 65.6% Caucasian, 18% Hispanic and 9.8% Black. Screening ECGs were concerning for potential risk of SCD in 49 (2%): 26 HCM, 14 long QT measurements (LQT), 6 Wolff-Parkinson-White (WPW) syndrome, 3 potential coronary artery abnormality. Screening echos were normal in 17/26 where the ECG had concern for HCM; 11 had concern for HCM (2 had normal ECGs), 1 with sub-aortic stenosis (sAS), and 1 with LV non-compaction cardiomyopathy (LVNC). Of the 36 found to be at risk for SCD by ECG and/ or echo, 24 (67%) pursued the recommended follow up with the following confirmed abnormalities: 2 HCM, 4LQT, 6 WPW, 1 LVNC and 1 mild sAS. LV dilation was found in 3, all with preserved systolic function consistent with findings of an athletic heart. Three had borderline aortic root dilation (z-score < 2.3) and were not restricted from athletics.
Conclusions: CV screening is technically feasible and can identify individuals at risk for SCD. Although not powered to address the ability to identify true disease given the low prevalence of HCM in this population, there does not appear to be substantial incremental benefit from the addition of the limited echo to the screening process. Despite identifying individuals at risk for SCD, many decline follow up evaluation.
- © 2010 by American Heart Association, Inc.