Advertisement

Comparison of U.S. and Italian Experiences With Sudden Cardiac Deaths in Young Competitive Athletes and Implications for Preparticipation Screening Strategies

      Controversy has evolved over the most practical and effective strategy for preparticipation cardiovascular screening of competitive athletes to detect unsuspected cardiovascular disease and prevent sudden death on the athletic field. Athlete screening in the Veneto region of Italy is part of a national program (with 12-lead electrocardiography) that has reported the detection of previously undiagnosed hypertrophic cardiomyopathy and a decrease in the cardiovascular death rate in young athletes. In this study, over time periods of similar length, cardiovascular-related mortality rates in Veneto athletes were compared with those of a demographically similar region of the United States (Minnesota) in which screening is limited to history and physical examination. There were 55 sudden cardiovascular deaths reported in Veneto over 26 years (2.1/year), compared with 22 deaths in 23 years (0.96/year) in Minnesota. Over the recent and comparable 11-year period, 1993 to 2004, 12 deaths were reported in Veneto and 11 in Minnesota. When analyzed as deaths per 100,000 person-years, Veneto exceeded Minnesota for all years combined (1.87 for 1979 to 2004 vs 1.06 for 1985 to 2007, respectively, p = 0.006), although the 2 regions did not differ significantly for 1993 to 2004 (0.87 vs 0.93, respectively, p = 0.88) or most recently for 2001 to 2004 (0.43 vs 0.90, respectively, p = 0.38). In conclusion, sudden cardiovascular deaths in young competitive athletes occurred at a low rate in both Veneto and Minnesota. Despite different preparticipation screening strategies, athlete sudden death rates in these demographically similar regions of the United States and Italy have not differed significantly in recent years. These data do not support a lower mortality rate associated with preparticipation screening programs involving routine electrocardiography and examinations by specially trained personnel.
      To read this article in full you will need to make a payment

      References

        • Maron B.J.
        Sudden death in young athletes: lessons from the Hank gathers affair.
        N Engl J Med. 1993; 329: 55-57
        • Maron B.J.
        Sudden death in young athletes.
        N Engl J Med. 2003; 349: 1064-1075
        • Maron B.J.
        • Shirani J.
        • Poliac L.C.
        • Mathenge R.
        • Roberts W.C.
        • Mueller F.O.
        Sudden death in young competitive athletes: clinical, demographic and pathological profiles.
        JAMA. 1996; 276: 199-204
        • Van Camp S.P.
        • Bloor C.M.
        • Mueller F.O.
        • Cantu R.C.
        • Olson H.G.
        Non-traumatic sports death in high school and college athletes.
        Med Sci Sports Exerc. 2003; 42: 1959-1963
        • Maron B.J.
        • Thompson P.D.
        • Ackerman M.J.
        • Balady G.
        • Berger S.
        • Cohen D.
        • Dimeff R.
        • Douglas P.S.
        • Glover D.W.
        • Hutter Jr, A.M.
        • Krauss M.D.
        • Maron M.S.
        • Mitten M.J.
        • Roberts W.O.
        • Puffer J.C.
        • American Heart Association Council on Nutrition, Physical Activity, and Metabolism
        Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: update 2007.
        Circulation. 2007; 115: 1643-1645
        • Myerburg R.J.
        • Vetter V.L.
        Electrocardiograms should be included in preparticipation screening of athletes.
        Circulation. 2007; 116: 2616-2626
        • Chaitman B.R.
        Should an electrocardiogram be included in routine preparticipation screening of young athletes?.
        Circulation. 2007; 116: 2610-2615
        • Corrado D.
        • Basso C.
        • Schiavon M.
        • Thiene G.
        Screening for hypertrophic cardiomyopathy in young athletes.
        N Engl J Med. 1998; 339: 364-369
        • Corrado D.
        • Pelliccia A.
        • Bjørnstad H.H.
        • Vanhees L.
        • Biffi A.
        • Borjesson M.
        • Panhuyzen-Goedkoop N.
        • Deligiannis A.
        • Solberg E.
        • Dugmore D.
        • et al.
        Cardiovascular preparticipation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol.
        Eur Heart J. 2005; 26: 510-524
        • Corrado D.
        • Basso C.
        • Pavei A.
        • Michieli P.
        • Schiavon M.
        • Thiene G.
        Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program.
        JAMA. 2006; 296: 1593-1601
        • Maron B.J.
        • Zipes D.P.
        36th Bethesda Conference.
        J Am Coll Cardiol. 2005; 45: 1312-1375
        • International Olympic Committee, Medical Commission
        Sudden cardiovascular death in sport: Lausanne recommendations: preparticipation cardiovascular screening.
        (Accessed November 13, 2008)
        • Glover D.W.
        • Maron B.J.
        Profile of preparticipation cardiovascular screening for high school athletes.
        JAMA. 1998; 279: 1817-1819
        • Glover D.W.
        • Glover D.W.
        • Maron B.J.
        Evolution in the process of screening United States high school student-athletes for cardiovascular disease.
        Am J Cardiol. 2007; 100: 1709-1712
        • Pfister G.C.
        • Puffer J.C.
        • Maron B.J.
        Preparticipation cardiovascular screening for US collegiate student-athletes.
        JAMA. 2000; 283: 1597-1599
        • Maron B.J.
        • Gohman T.E.
        • Aeppli D.
        Prevalence of sudden cardiac death during competitive sports activities in Minnesota high school athletes.
        J Am Coll Cardiol. 1998; 32: 1881-1884
        • Maron B.J.
        • Douglas P.S.
        • Graham T.P.
        • Nishimura R.A.
        • Thompson P.D.
        Task Force 1: preparticipation screening and diagnosis of cardiovascular disease in athletes.
        J Am Coll Cardiol. 2005; 45: 1322-1326
        • Vetter V.L.
        • Elia J.
        • Erickson C.
        • Berger S.
        • Blum N.
        • Uzark K.
        • Webb C.L.
        Cardiovascular monitoring of children and adolescents with heart disease receiving stimulant drugs.
        Circulation. 2008; 117: 2407-2423
        • Maron B.J.
        • Carney K.P.
        • Lever H.M.
        • Lewis J.F.
        • Barac I.
        • Casey S.A.
        • Sherrid M.V.
        Relation of race to sudden cardiac death in competitive athletes with hypertrophic cardiomyopathy.
        J Am Coll Cardiol. 2003; 41: 974-980
        • Maron B.J.
        • Doerer J.J.
        • Haas T.S.
        • Tierney D.M.
        • Mueller F.O.
        Sudden deaths in young competitive athletes: analysis of 1,866 deaths in the U.S., 1980–2006.
        Circulation. 2009; 119: 1085-1092
        • Pelliccia A.
        • Maron B.J.
        Preparticipation cardiovascular evaluation of the competitive athlete: perspectives from the 30-year Italian experience.
        Am J Cardiol. 2005; 75: 827-829
        • Maron B.J.
        • Thompson P.D.
        • Puffer J.C.
        • McGrew C.A.
        • Strong W.B.
        • Douglas P.S.
        • Clark L.T.
        • Mitten M.J.
        • Crawford M.H.
        • Atkins D.L.
        • Driscoll D.J.
        • Epstein A.E.
        Cardiovascular preparticipation screening of competitive athletes: a statement for health professionals from the Sudden Death Committee (Clinical Cardiology) and Congenital Cardiac Defects Committee (Cardiovascular Diseases in the Young) American Heart Association.
        Circulation. 1996; 94: 850-856
        • Maron B.J.
        • Poliac L.C.
        • Roberts W.O.
        Risk for sudden cardiac death associated with Marathon running.
        J Am Coll Cardiol. 1996; 28: 428-431
        • Roberts W.O.
        • Maron B.J.
        Evidence for decreasing occurrence of sudden cardiac death associated with the Marathon.
        J Am Coll Cardiol. 2005; 46: 1373-1374
        • Thompson P.D.
        • Levine B.D.
        Protecting athletes from sudden cardiac death.
        JAMA. 2006; 296: 1648-1650
        • Thiene G.
        • Nava A.
        • Corrado D.
        • Rossi L.
        • Pennelli N.
        Right ventricular cardiomyopathy and sudden death in young people.
        N Engl J Med. 1988; 318: 129-133

      Linked Article