Η ΣΗΜΑΣΙΑΤΟΥ ΗΚΓ ΗΡΕΜΙΑΣΣΤΗ … · SCD incidence in Young Athletes...

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Η ΣΗΜΑΣΙΑ ΤΟΥ ΗΚΓ ΗΡΕΜΙΑΣ ΣΤΗ ΔΙΑΣΤΡΩΜΑΤΩΣΗ ΚΙΝΔΥΝΟΥ ΓΙΑ ΑΙΦΝΙΔΙΟ ΘΑΝΑΤΟ ΣΕ ΝΕΟΥΣ ΑΘΛΗΤΈΣ Ευστάθιος Δ. Παγκουρέλιας , MD, MSc, PhD Ακαδημαϊκός Υπότροφος, Ιατρείο Μυοκαρδιοπαθειών & Νευρομυικών Νοσημάτων, Γ’ Καρδιολογική Κλινική, ΓΝΘ Ιπποκράτειο, Ιατρική Σχολή, Αριστοτέλειο Πανεπιστήμιο Θεσσαλονίκης

Transcript of Η ΣΗΜΑΣΙΑΤΟΥ ΗΚΓ ΗΡΕΜΙΑΣΣΤΗ … · SCD incidence in Young Athletes...

Page 1: Η ΣΗΜΑΣΙΑΤΟΥ ΗΚΓ ΗΡΕΜΙΑΣΣΤΗ … · SCD incidence in Young Athletes (Summary) •Incidence is approximately 1/50,000 •Epidemiology highly dependable on sport

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

Page 2: Η ΣΗΜΑΣΙΑΤΟΥ ΗΚΓ ΗΡΕΜΙΑΣΣΤΗ … · SCD incidence in Young Athletes (Summary) •Incidence is approximately 1/50,000 •Epidemiology highly dependable on sport

Conflicts of interest:

Nothing to declare.

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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

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GREEK DATA??

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

ΣΗΜΕΡΑ

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SCD INCIDENCE IN YOUNG ATHLETES

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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.

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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

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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

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

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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

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CAUSES OF SUDDEN CARDIAC DEATHS IN YOUNG ATHLETES

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

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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

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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

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PREPARTICIPATION SCREENINGAND THE VALUE OF ECG

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PREPARTICIPATION SCREENINGAND THE VALUE OF ECG

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NORMAL

VS

ABNORMAL?

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• 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

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NEW TRENDS IN SCD RISK STRATIFICATION IN ATHLETES

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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”

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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!!

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Thank you for your attention!!