Sudden cardiac death in athletes: Researchers focus on prevention

Every few years there’s news coverage on a young, assumed-healthy athlete, who suddenly dies on the field or court. Sometimes the tragedy even happens right in front of the players’ teammates, coaches and parents. Later, the autopsy often reveals a previously undetected heart condition like hypertrophic cardiomyopathy, leaving many to wonder, “Why didn’t we know about this problem sooner?”

To help, Boston Children’s Hospital researchers are working on revamping current methods to screen for potential heart problems in young athletes—without adding huge expenses or time burdens to existing techniques.

Unfortunately current screening tests for cardiovascular risks in young athletes aren’t always a great indicator that there’s a real problem. Electrocardiography (ECG) is the most common way to detect a heart problem in a young athlete, but the test has a high rate of reporting false positives, or false alarms. That’s problematic for several reasons.

Is there a way to find undetected heart problems?

For starters, the athletes who would likely get a false positive from an ECG, about 10 percent of the entire population, would need to be benched immediately to see a cardiologist for more tests. This would lead to a lot of worry for thousands of families and result in weeks or months spent away from sports.

There is also the issue of costs. If all these athletes required additional heart tests it would lead to hundreds of thousands of dollars in added medical costs. That’s a lot of emotional and financial strain to put on families and healthcare budgets, especially considering how few of these kids are likely to have a legitimate issue. (Sudden cardiac death among athletes is extremely rare, estimated to happen to only one per 23,000 to one per 300,000 student athletes worldwide.)

Given its high false-positive rate and how rare the conditions they screen for are, the American Heart Association doesn’t recommend ECGs as standard screenings for young athletes. Still, even though the number of cases of children dying of heart conditions on the field is rare, it remains a big concern for the medical community. Many believe that limiting athlete screening to just a review of their medical history and a physical exam isn’t always enough.

 Gianmichel Corrado, MD

“The sports medicine physical lacks an effective way of ferretting out these ‘hidden’ heart problems, which is a real concern,” says Gianmichel Corrado, MD, from Boston Children’s Hospital’s Division of Sports Medicine. “But by adding a simple, inexpensive ultrasound exam to the sports medicine physical, we think we can change that.”

A better way to ECG screening?

That change could be found in the Early Screening for Cardiovascular Abnormalities With Preparticipation Echocardiography (ESCAPE) protocol, recently developed by Corrado and his colleagues. It takes traditional screening methods, but adds an additional two-minute, inexpensive focused ultrasound to the process. (Their research was recently published in the Journal of Ultrasound in Medicine.)

As part of the ESCAPE protocol study, the researchers examined 65 male athletes, 18 to 25, by reviewing their medical history and giving them a physical exam. They also gave each participant an ECG and a focused echocardiography. ECGs showed potential heart issues in three of the athletes, but after receiving a focused ultrasound, these were proven to be false-positives. Another three athletes were red flagged as having potential problems during the medical history review and the physical, but showed no problems during the ECG and focused ultrasound.

Because of the ESCAPE protocol six out of the 65 young men studied, almost 10 percent, were spared false-positives that could have unnecessarily forced them from the locker room to the cardiologist’s office.

“The ESCAPE protocol provides peace of mind, without burdening existing screening methods in terms of time or money,” says Corrado. “More research is needed to see if this can work for larger populations. But based on what we’ve seen thus far, it very well could become the sports medicine physical of the future.”