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Eur J Prev Cardiol. 2015 Feb;22(2):263-70. doi: 10.1177/2047487313506549. Epub 2013 Sep 20.

Systematic echocardiography is not efficacious when screening an ethnically diverse cohort of athletes in West Asia.

Author information

1
Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Research Institute for Sport and Exercise Science, Liverpool John Moores University, UK.
2
Department of Cardiovascular Sciences, St Georges University of London, UK.
3
Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
4
Rennes 1 University, Pontchaillou Hospital, INSERM U 642, France.
5
Research Institute for Sport and Exercise Science, Liverpool John Moores University, UK.
6
Sports Medicine Department, HPSNZ, Millennium Centre, Mairangi Bay, Auckland, New Zealand.
7
CMOs Office, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
8
Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar mathew.wilson@aspetar.com.

Abstract

BACKGROUND:

The clinical and economic value of including systematic echocardiography (ECHO) alongside the 12-lead electrocardiograpm (ECG) when undertaking pre-participation screening in athletes has not been examined, yet several sporting organistations recommend its inclusion.

DESIGN:

To examine the efficacy of systematic ECHO alongside the ECG, to identify sudden cardiac death (SCD) disease and to provide a cost-analysis of a government-funded pre-participation screening programme.

METHODS:

A total 1628 athletes presented for cardiological consultation, ECG, and ECHO as standard, with further cardiac examinations performed if necessary to confirm or exclude pathology. The efficacy of systematic ECHO was compared to an ECG-led programme, with ECHO reserved as a follow-up examination.

RESULTS:

To screen 1628 athletes with ECG and ECHO cost US$743,996. There were 54 24-h-blood pressure/ECG Holter recordings, 62 exercise tests, 25 CMRs, two electrophysiological studies, and two genetic tests, which cost US$67,734: total US$811,730. Eight athletes (0.5%) were identified with hypertrophic cardiomyopathy (HCM) and two (0.1%) with Wolff-Parkinson-White syndrome. The cost per identifed athlete was US$81,173. All 10 athletes presented an abnormal ECG. No athlete diagnosed with HCM was identified by ECHO in isolation. When adopting a ECG-led screening protocol, 15% of athletes required ECHO as a follow-up examination, resulting in a US$380,600 cost reduction (47% saving), with the cost per diagnosis reduced to US$43,113.

CONCLUSIONS:

Athletes diagnosed with a disease associated with SCD were identified via an abnormal ECG and/or physical examination, personal symptoms, or family history. Screening athletes with systematic ECHO is not economically or clinically effective.

KEYWORDS:

Cost-effectiveness; echocardiography; pre-participation screening; sudden cardiac death

PMID:
24057688
DOI:
10.1177/2047487313506549
[Indexed for MEDLINE]

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