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Lessons learned from preparticipation cardiovascular screening in a state funded program.

Ilana Zeltser1, Bryan Cannon, Lawrence Silvana

  • 1University of Texas Southwestern Medical Center and Children's Medical Center, Dallas, TX, USA. Ilana.zeltser@childrens.com

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Summary

Statewide cardiovascular screening of student athletes using electrocardiography and echocardiography identified few at-risk individuals. Questionnaires proved unreliable, and follow-up rates were low, highlighting challenges in mass screening for sudden cardiac death risk.

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Area of Science:

  • Cardiology
  • Sports Medicine
  • Public Health

Background:

  • Sudden cardiac death (SCD) in young athletes is a critical concern.
  • Previous screening methods have limitations in identifying at-risk individuals.
  • A Texas pilot study aimed to evaluate a comprehensive screening program.

Purpose of the Study:

  • To assess the feasibility of a statewide cardiovascular screening program for student athletes.
  • To determine the reliability of identifying athletes at risk of sudden death.
  • To identify implementation challenges of a large-scale screening initiative.

Main Methods:

  • Utilized questionnaires, physical examinations, electrocardiography (ECG), and limited echocardiography.
  • Screened 2,506 students across 31 venues.
  • Analyzed data using established pediatric ECG and echocardiography criteria; positive results confirmed by blinded reviewers.

Main Results:

  • ECG identified cardiovascular disease in 2.3% of students (57/2,506), including hypertrophic cardiomyopathy, long QT syndrome, Wolff-Parkinson-White syndrome, and coronary anomalies.
  • Echocardiography revealed concerning findings in 11 athletes (0.53%), primarily hypertrophic and dilated cardiomyopathy.
  • Only 11 athletes (0.44% of total) were confirmed to have cardiovascular disease after follow-up; questionnaires had high false-positive rates.

Conclusions:

  • ECG and echocardiography screening identified a small number of athletes at risk for cardiovascular disease.
  • Questionnaires demonstrated limited value with numerous false positives.
  • Significant interobserver variability in echocardiography and low follow-up rates pose challenges for statewide implementation.