Η σημασία του ΗΚΓ ηρεμίας στη διαστρωμάτωση κινδύνου για αιφνίδιο θάνατο σε Νέους Αθλητές

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1 Η σημασία του ΗΚΓ ηρεμίας στη διαστρωμάτωση κινδύνου για αιφνίδιο θάνατο σε Νέους Αθλητές Ευστάθιος Δ. Παγκουρέλιας, MD, MSc, PhD Ακαδημαϊκός Υπότροφος, Ιατρείο Μυοκαρδιοπαθειών & Νευρομυικών Νοσημάτων, Γ Καρδιολογική Κλινική, ΓΝΘ Ιπποκράτειο, Ιατρική Σχολή, Αριστοτέλειο Πανεπιστήμιο Θεσσαλονίκης

2 Conflicts of interest: Nothing to declare.

3 Diagnostic accuracy Risk stratification of a clinical laboratory index Dependent on: 1) Incidence of the disease examined and the population investigated 2) The special characteristics of the disease which need to be revealed by the marker

4 SCD incidence in young athletes

5 SCD incidence in young athletes (2) From 1996 through 2016, 11,168 adolescent athletes were screened with a mean (±SD) age of 16.4±1.2 years (95% of whom were male) in the English Football Association (FA) cardiac screening program. Preparticipation screening consisted of a health questionnaire, physical examination, electrocardiography, and echocardiography. Incidence of sudden cardiac death was 1 per 14,794 person-years, or 6.8 per 100,000 athletes.

6 Young athletes are at increased risk of SCD compared with their sedentary counterpart: as shown by the prospective clinicopathologic study of the Veneto region of Italy, the incidence of fatal events among young competitive athletes is 2.8-fold higher compared with agematched non-athletes Corrado D JACC 2003

7 Epidemiology Based on Autopsy Series Age-- 9% in middle school 62% in high school 22% in college 7% in professional Sex 90% male, 10% female Caucasians at highest risk Maron BJ et al, JAMA 1996 ; 276 :

8 Basketball Football Track Soccer Baseball Swimming Sports engaged in at the time of sudden death No of athletes 0 Maron BJ et al, JAMA 1996 ; 276 :

9 SCD incidence in Young Athletes (Summary) Incidence is approximately 1/50,000 Epidemiology highly dependable on sport discipline, race, gender, AGE and country-methodology of study. Mean age at death in athletes 23 years-old 40% deaths in athletes aged < 18 years old More common in males than females (9:1) 90% deaths during or immediately after exertion

10 Causes of Sudden Cardiac Deaths in Young Athletes Maron BJ et al, JAMA 1996 ; 276 :

11 Causes of Sudden Cardiac Deaths in Young Athletes (2) Sharma S. The Physician and sportsmedicine 2011;39(4):22-36 Malohtra A et al. N Engl J Med 2018

12 Causes of Sudden Cardiac Deaths in Young Athletes (3) Maron BJ et al, JAMA 1996 ; 276 : Sharma S. The Physician and sportsmedicine 2011;39(4):22-36

13 Preparticipation screening and the value of ECG vs

14 Preparticipation screening and the value of ECG

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18 NORMAL VS ABNORMAL?

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21 Concerns about ECG and SCD risk stratification in athletes Low incidence of sudden cardiac death High number of false positives Concerns relating to false negatives Cost Other issues

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27 SCD risk stratification and ECG in Young Athletes (1) SCD in athletes ranges from 1 to 3/50,000 depending on demographic characteristics. ECG a useful, complimentary tool to diagnose or increase suspicion over cardiomyopathies, channelopathies and life threatening rhythm disorders. However, things are not always crystal clear

28 SCD risk stratification and ECG in Young Athletes (2) What seems normal is not always normal!! Be careful with teenagers!! Mood is not the only thing to change in that age!! Careful and continuous follow up of young athletes- early signs of cardiomyopathy or channelopathy. What seems pathologic is not always pathologic!! Focus not only on HOW but also on WHAT to search for. Change in Policy: ECG and preparticipation screening are good but an EAD and a bystander knowing CPR are better!!

29 Thank you for your attention!!