Biography
Biography: Michelle Grenier
Abstract
Introduction: Sudden Cardiac Death (SCD) is fairly frequent in the young athletic population, most common causes being hypertrophic cardiomyopathy (HCM), coronary artery anomalies and electrical abnormalities (including WPW, Long QT syndrome). The use of screening tools looking for these conditions remains controversial. EKG is an adjunct to SCD screening, but may lead to false positive results due to conditions such as physiological hypertrophy seen in athletic hearts. This athletic hypertrophy (eccentric or concentric) constitutes a "gray area" of abnormality. Hypothesis: Elite adolescent rowers will manifest cardiac changes including hypertrophy and EKG changes normally seen in elite adult rowers.
Methods: Cardiac screening was performed at an elite high school rowing event. 77 rowers participated, of age 15-18. 65% of them were male. The Protocol consisted of a 12-point AHA questionnaire, physical examination, 12-lead EKG, and an echo done on site. The preliminary results of the studies were given to the participants prior to completion of the study. Abnormal final results were communicated. Results: All participants had normal physical examinations. None had overt abnormalities by echo. Subtle abnormalities were seen including: 2 dilated aortic roots (1 with a dilated main Pulmonary artery/ Tricuspid and Mitral regurgitation). Also 1 MR and TR. Coronary origins and proximal vessels were visualized in 53 of 77 participants. None of the subjects exhibited hypertrophy, although 20 (25%) had coarse posterior wall or apical trabeculations. LVEDd was increased in 9 of the rowers (12%). Ejection Fraction (EF) was calculated in 73/77, with 55/77 having EFs greater than 55%. The remaining EFs were less than 55% with one at 48%. Of note, septal and lateral DTI velocities fell within normal range. By EKG, 75/77 were in sinus rhythm (2 were functional). 4 had LVH criteria (2 had increased LVEDd by echo), 3 with long LQT (1 with dilated MPA and aortic root), 2 first degree AV block, 1 WPW (symptomatic). EKG abnormalities were communicated.
Conclusions: In this population of young, elite rowers, there were 4 patients identified as having risk for SCD, at a rate of 3.1%. Few false positive EKGs for hypertrophy were seen. Elite young rowers do not exhibit the eccentric hypertrophy described in adult rowers, which may be a manifestation of the duration of high level participation in the sport or the age of the rower.