SUMMATION OF A REPORT ON ECHOCARDIOGRAPHY IN THE EVALUATION OF ATHLETES Article published by Dr. Gonzalo Grazioli, an article published in F1000 research. The following is a summation of the article which is applicable to high school athletes and athletes in general who participate in athletics. The application of preparticipation screening remains controversial. Echocardiography has shown higher sensitivity and specificity, in comparison to the EKG, ruling out the causes of sudden death. It is a subject of controversy due to the actual cost of adding it to a battery of diagnostic tests but depending on the type of sport, echocardiography may be cost effective if added in the first line of examination. Regarding the evaluation of cardiac adaptation to training in athletes, echocardiography is proved to be useful in the differential diagnosis of diseases that can cause sudden death analyzing both the left ventricle (hypertrophy, cardiomyopathy, dilated cardiomyopathy and left ventricle noncompaction) and the right ventricle (arrhythmogenic right ventricular cardiomyopathy). The number of people who are practicing a sport has increased five-fold over the past 30 years. An increase in cardiovascular events has also been demonstrated during its practice. As a consequence, the absolute number of people at risk at sudden cardiac death (SCD) during exercises is also increasing. Sports activity is not a cause of the increase in mortality per se rather it might act as a trigger of cardiac arrest in athletes with structural or electrical heart abnormalities that can generate malignant arrhythmias. Therefore, a preparticipation screening (PPS) protocol seems to be of interest. (The European Society of Cardiology) has proposed an exam which emphasizes 3 points or steps: A. family and personal history; B. physical examination; C. 12-lead electrocardiogram (ECG). The ECG has demonstrated at 70% sensitivity to detect the most frequent causes of SCD in young athletes. However, about a third of these athletes with an anomalous origin of coronary arteries, aortic diseases and incipient forms of cardiomyopathies will present with a normal ECG. The echocardiogram might be a useful noninvasive and accessible tool to increase sensitivity of screening. In the particular group quoted by the author of this article, echocardiographic findings among 2,688 competitive athletes; most of the echocardiographic examinations were normal and only 203 (7.5%) showed abnormalities. Cessation of athletic activity was indicated in four athletes, two for hypertrophic cardiomyopathy, one pectus excavatum with compression of the right ventricle and one significant pulmonary valve stenosis. The other minor alterations in echocardiography is 7.5% of the total population did not entail cessation of athletic activity and only indicated periodic monitoring. Although rare, some cardiac structural changes can be missed on physical exam and electro- cardiography. In contrast, they are easily recognized with echocardiography. These findings would suggest the use of echocardiography in at least the first PPS of competitive athletes to improve the effectiveness of programs aimed at preventing SCD in athletes.
