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.

 

The CJSM Blog: 2015 in review

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The sun sets on 2015– photo, Kit Yoon

It’s hard to believe 2015 is wrapping up–as I write, it’s already New Year’s Eve in places like Australia and New Zealand, where members of the Australasian College of Sports Physicians [the ‘ACSP,’ one of our affiliated societies] live.

This time of year is one of reflection and thanks.  As I look back on 2015, it is remarkable, I think, to reflect on the many high points this journal enjoyed in its 25th year. The year began with the highly anticipated position statement on musculoskeletal ultrasound, authored by members of the American Medical Society for Sports Medicine [‘AMSSM,’ another one of our affiliated societies].   Mid-year we published a statement that made a huge splash in the research world and the wider, lay media:  the Statement from the proceedings of the 3rd International Exercise-Associated Hyponatremia Consensus Conference.   And we wrapped things up with a controversial study looking at the limitations inherent in screening for sudden-cardiac death in young athletes.

Through it all, we’ve enjoyed our interactions with you, our readers.  Whether on our iPad app, the website, our blog posts and podcasts, or our Twitter feed, we have spent a remarkable year with you.

Thank you.  May you have a wonderful New Year’s, and may 2016 be a professionally fulfilling year for you all.  We look forward to advancing the science of clinical sports medicine with you all.  And before the clock ticks down the final seconds of 2015, we welcome you to see our annual CJSM blog report, below.

Cheers!  See you in 2016!

Here’s an excerpt:

The concert hall at the Sydney Opera House holds 2,700 people. This blog was viewed about 37,000 times in 2015. If it were a concert at Sydney Opera House, it would take about 14 sold-out performances for that many people to see it.

Click here to see the complete report.

Sudden Cardiac Death: The Israeli Experience

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Dr. Jose Garza, conducting a stress test on an athlete, Monterrey, Mexico

Screening for sudden cardiac death (SCD) remains one of the more contentious debates in the world of sports medicine.  As a matter of public policy, consensus medical opinion in the United States still argues against universal, mandatory  screening with electrocardiograms (ECGs); whereas in Europe, specifically in Italy, ECG screening is more of a routine practice.

The debate over this screening is carried on at many conferences and in many medical journals, including ours.  We’ve previously looked at the question of whether it makes sense to screen North American athletes with ECGs, for instance.  Earlier this year, we published a review of the different approaches American universities are currently using regarding the issue of athletic cardiovascular screening.  Recently, the topic came up in the podcast discussion I had with Dr. William Roberts on new directions for the pre-participation evaluation (PPE).  American and European sport medicine bodies can find a lot of common ground in where the PPE can be improved, according to Dr. Roberts, with the principal exception of this one issue.

Recently, Dr. Sami Viskin, from the Department of Cardiology, Tel Aviv Medical Center, spoke at my home institution about how athletes are screened for SCD in Israel.  He has written extensively on the issue of screening athletes for SCD, including a study arguing that it is not a cost-effective strategy in the United States.  The title of his recent talk: “Mandatory ECG screening of athletes saves lives: proven fact or wishful thinking?”

Our Division of Sports Medicine has been hosting another international guest this past month: Dr. Jose Angel Garza, a sports medicine physician from the University Hospital of the Universidad Autonoma de Nuevo Leon (UANL) in Monterrey, Mexico. He was also present at Dr. Viskin’s talk, and I asked him for his reflections on the subject of mandatory ECG screening in athletes.

Thanks Joe!

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Among the sports medical community, there is an ongoing and often heated debate on whether mandatory ECG screening should be performed on athletes. Several countries such as Italy and Israel have implemented such measures. The European Society of Cardiology has issued recommendations about mandatory screening of athletes with ECG. So this begs the question: Does ECG screening save lives in athletes? Read more of this post

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