Echocardiography as a screen to prevent SCD in athletes — 5 Questions with CJSM

 

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Dr. Gian Corrado performing screening cardiac ultrasound

For our first “5 Questions with CJSM” of 2017, we have a special guest:  Dr. Gianmichel Corrado, of Boston Children’s Hospital and Northeastern University.

Dr. Gian Corrado  is a doubly special guest for me: he is the lead author of a ‘published-ahead-of-print’ CJSM study and is someone who trained me in sports medicine at Boston Children’s Hospital.

I have fond memories of working alongside him, the head team physician for Northeastern University in Boston, as we cared for hockey and football athletes.  And I remember the work he was just beginning to do in his now-blossoming area of research.

The new study reports the findings of a novel ‘take’ on a controversial aspect of sports medicine: how might we screen for underlying disorders that predispose our athletes to sudden cardiac death (SCD)?

By the way, don’t let Dr. Gian Corrado’s name fool you — this is not that Dr. Corrado, (Domenico Corrado), who also has published on screening for SCD; but both Drs. Corrado share a similar concern: the primary prevention of this catastrophic event.

Dr. Gian Corrado’s approach is to use ‘screening echocardiography in front-line providers,’ and his findings can be found here:  ‘Early Screening for Cardiovascular Abnormalities with Pre-Participation Echocardiography:  Feasibility Study.’

Dr. Corrado has this to say about his important work:

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1. CJSM: What was the principal outcome measure you were looking at in this study? What were the secondary outcome measures?

GC: Central in the debate as to how to best identify athletes at risk for sudden death (SD) is cost-effectiveness.  The American Heart Association continues to recommend a history and physical (H&P) as the sole method for screening young athletes for the cardiac conditions that can cause SD.  The H&P has been shown to be a poor test to apply to the above dilemma as it misses athletes whom have potentially deadly cardiac conditions and falsely identifies those that do not.  Many feel that, given this reality, an electrocardiogram (ECG) screening program should be implemented.  This approach has been shown to have significant limitations as it too yields high false positive rates.  The Northeastern Group has suggested and demonstrated that with advances in portable ultrasound frontline providers (FLP) can obtain limited echocardiographic images pertinent to the structural conditions that dominate in culpability with SD. Read more of this post

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ECG for the PPE? A conversation with Dr. Jonathan Drezner

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Dr. Jonathan Drezner in South Africa. Photo courtesy Alison Brooks.

Highlighting the just-published issue of CJSM is the new American Medical Society for Sports Medicine (AMSSM) position statement on cardiovascular preparticipation screening in young athletes.  The position statement is an invaluable contribution to the ongoing discussion over the pros and cons of adding the ECG to the preparticipation evaluation/examination (PPE) to prevent sudden cardiac death/arrest (SCD/SCA).

Those familiar with this debate will be familiar as well with the lead author of the statement, Dr. Jonathan Drezner. Dr. Drezner is a Professor in the Department of Family Medicine at the University of Washington and a team physician for the Seattle Seahawks of the NFL.  Dr. Drezner has published frequently in our pages, most often on the subjects of the PPE and screening for SCD/SCA.

The debate over the role of ECG in the PPE is one of the more contentious in sports medicine.  We look forward to seeing how the AMSSM statement will contribute to the direction that debate will take.  jsm-podcast-bg-1

You can gain added perspective on the statement and the controversy by listening to our newest podcast — a conversation with Dr. Drezner himself.  You can access the podcast both on iTunes and you can find it on our CJSM website as well.

Enjoy the discussion, and be sure to check out the statement itself, freely available in the 2016 September CJSM.

 

November…….already

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Transitions: November in the USA.

Really?  Can it be that November is here?

I just covered my last high school football game of the fall, a loss in the playoffs. A season which began in the heat and humidity of August [with its attendant muscle cramps and concerns of exertional heat illness & exercise-associated hyponatremia] is now over, and injuries sustained on wrestling mats and in basketball gymnasia are beginning to show up in my clinic.  Before you know it, the skiiers and snowboarders will be filling out the waiting room.

November also brings with it the publication of our last CJSM of 2015, and it is a good one.  We have profiled two offerings in particular, both of which currently are freely available on line:  original research looking at potential limitations of American Heart Association recommendations for pre-participation cardiac screening in youth athletes; and a provocative editorial [and just right for the change of seasons] arguing for adult autonomy in deciding whether or not to wear helmets when skiing.

Both subjects are among the more controversial in sports medicine.  Whether or not to consider pre-participation screening with ECG when taking care of our younger athletes–well, that’s a question whose answer can vary depending on what side of the Atlantic one is on, or what part of the United States you may live in.  It’s a question whose answers may lie in much of the research we publish in our journal, with luminaries such as Jonathan Drezner and William Roberts weighing in.

Whenever we publish research or commentary on the question of mandatory personal protective equipment, I sometimes feel as if we have entered the ‘blood sport’ arena of sports medicine.  This issue’s editorial  on the ‘Ethics of Head Protection While Skiing’ has already generated some buzz on our twitter feed. Two years ago, we published the Canadian Academy of Sport and Exercise Medicine (CASEM) Position Statement on the Mandatory Use of Bicycle Helmets, and our social media feeds erupted.  I have never seen so much discussion on the blog site.

There is much more to be read carefully in this November 2015 issue.  A very interesting piece of original research, from one of our more prolific authors (Dr. Irfan Asif), looks at the potential psychological stressors of undergoing pre-participation cardiovascular screening.  As a pediatric sports medicine specialist, I’ll be reading with great interest a study on the potential prognostic implications of post-injury amnesia in pediatric and adolescent concussed athletes–lead author Johna Register-Mihalik continues to make major contributions to our understanding of that injury in that population.

So, enjoy this issue.  And brace yourself–2016 is on its way.  It will be here before you know it!

CJSM Podcast 11: The Wilderness Medicine Issue

JSM-Podcast-BG (1)We’ve been working on the September 2015 CJSM issue for a long time–and by ‘we’ I mean a team of individuals, ranging from the CJSM editors to authors and thematic issue editors from the American Medical Society for Sports Medicine (AMSSM) and the Wilderness Medical Society.

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Dr. Chris Madden in his ‘office.’

Our guest for this, our 11th podcast, is Dr. Christopher Madden, a past president of the AMSSM and one of this issue’s editors (and an author too).  Dr. Madden is a hard-working clinician at Longs Peak Family Medicine, and practices the full range of family and sports medicine.

In between circumcisions, vasectomies, concussions, and mountain bike rides, he was able to find that ‘sweet spot’ to sit and talk with us for a little bit about the newly published Wilderness Medicine thematic issue.

We covered an array of topics–from diagnosing acute mountain sickness in pre-verbal children to the top 3 most memorable parts of his year as AMSSM president.

We enjoyed the chat, and we hope you do too.  Check it out here.

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