Η ΣΗΜΑΣΙΑ ΤΟΥ ΗΚΓ ΗΡΕΜΙΑΣ ΣΤΗ ΔΙΑΣΤΡΩΜΑΤΩΣΗ ΚΙΝΔΥΝΟΥ ΓΙΑ ΑΙΦΝΙΔΙΟ ΘΑΝΑΤΟ

ΣΕ ΝΕΟΥΣ ΑΘΛΗΤΈΣ

Ευστάθιος Δ. Παγκουρέλιας, MD, MSc, PhD

Ακαδημαϊκός Υπότροφος, Ιατρείο Μυοκαρδιοπαθειών & ΝευρομυικώνΝοσημάτων, Γ’ Καρδιολογική Κλινική, ΓΝΘ Ιπποκράτειο, Ιατρική Σχολή,Αριστοτέλειο Πανεπιστήμιο Θεσσαλονίκης

Conflicts of interest:

Nothing to declare.

DIAGNOSTIC ACCURACY – RISK STRATIFICATIONOF 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

GREEK DATA??

Anastasakis A, et al. Europace. 2018;20(3):472-480.

ΣΗΜΕΡΑ

SCD INCIDENCE IN YOUNG ATHLETES

SCD INCIDENCE IN YOUNG ATHLETES (2)

• From 1996 through 2016, 11,168 adolescentathletes were screened with a mean (±SD) age of16.4±1.2 years (95% of whom were male) in theEnglish Football Association (FA) cardiacscreening program.

• Preparticipation screening consisted of a healthquestionnaire, physical examination,electrocardiography, and echocardiography.

• Incidence of sudden cardiac death was 1 per14,794 person-years, or 6.8 per 100,000athletes.

Corrado D JACC 2003

Young athletes are atincreased risk of SCDcompared with theirsedentary counterpart:as shown by theprospective clinico-pathologic study of theVeneto region of Italy, theincidence of fatal eventsamong young competitiveathletes is 2.8-fold highercompared with age-matched non-athletes

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 : 199 - 203

Maron BJ et al, JAMA 1996 ; 276 : 199 - 203

Sports engaged in at the time of sudden death

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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

CAUSES OF SUDDEN CARDIAC DEATHS IN YOUNG ATHLETES

Maron BJ et al, JAMA 1996 ; 276 : 199 - 203

CAUSES OF SUDDEN CARDIAC DEATHS IN YOUNG ATHLETES (2)

Malohtra A et al. N Engl J Med 2018Sharma S . The Physician and sportsmedicine 2011;39(4):22-36

CAUSES OF SUDDEN CARDIAC DEATHS IN YOUNG ATHLETES (3)

Maron BJ et al, JAMA 1996 ; 276 : 199 - 203 Sharma S . The Physician and sportsmedicine 2011;39(4):22-36

PREPARTICIPATION SCREENINGAND THE VALUE OF ECG

PREPARTICIPATION SCREENINGAND THE VALUE OF ECG

NORMAL

VS

ABNORMAL?

• Low incidence of sudden cardiac death

• High number of false positives

• Concerns relating to false negatives

• Cost

• Other issues

CONCERNS ABOUT ECGAND SCD RISK STRATIFICATION IN ATHLETES

NEW TRENDS IN SCD RISK STRATIFICATION IN ATHLETES

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”

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!!

Thank you for your attention!!