Abstract 15345: Prevalence of Abnormal Preparticipation Screening H&Ps in Collegiate Athletes as Compared to Focused Screening Echocardiography
Introduction: For all competitive athletes, the American Heart Association preparticipation screening (AHA PPS) guidelines recommend a 12 element focused history and physical. Evaluation of an abnormal PPS finding is left to the clinician’s discretion. The correlation between an abnormal PPS finding and structural heart disease is not well documented. A murmur on physical exam is classically used as a tool to identify a multitude of structural heart abnormalities. We propose that the current AHA PPS and specifically, a murmur detected on exam, correlate poorly with true echocardiographic abnormalities in the collegiate athlete population.
Methods: A PPS modeled after the AHA guidelines was conducted on all incoming athletes at a single university from 2007 to 2013. All athletes independently underwent a focused screening echo the same day of the exam. PPS examiners were blinded to results of the screening echoes. Data from both screening exams were compared. We report the prevalence of abnormal H&P findings and its relation to structural abnormalities found on focused echo screening.
Results: There were 2472 athletes screened. At least one positive PPS element was noted in 655 (26.5%) athletes. Of this group, 24 (3.7%) had an abnormal focused echo. The PPS was normal in 1817 (73.5%) athletes but an abnormal echo was found in 19 of these athletes, indicating 44.2% of all abnormal echoes (N=43) had a negative PPS. Of the athletes with abnormal echo findings, 23 had structural abnormalities classically associated with a murmur. Only four of these athletes had an actual murmur on exam. In total, a murmur was detected in 36 athletes. By echocardiography, 25 (69.4%) had no structural abnormalities, thereby rendering the murmur benign. A murmur consistent with a minor structural abnormality was found in 7 (19.4%) athletes, and a murmur consistent with a significant structural abnormality was found in 4 (11.1%) athletes.
Conclusions: The AHA PPS and specifically, a murmur on exam, do not reliably detect the presence of structural heart disease. An abnormal PPS is rarely associated with structural heart disease and an immediate focused echo can rapidly determine this and eliminate the need for further cardiac evaluation.
Author Disclosures: D. Modaff: None. S. Hegde: None. D. Helwig: None. N. Bell: None. P. Rahko: None.
- © 2014 by American Heart Association, Inc.