Pediatric Cardiology

Biography

Biography: Silvana Molossi

Abstract

Cardiovascular screening of adolescent athletes is a controversial topic. Questions of sensitivity, specificity, practicality, and costs as well as appropriate protocols remain unanswered. Moreover, little is known about the natural history of factors that predispose young athletes to sudden cardiac death (SCD). History and physical exam remain the recommended approach in the US, whereas the addition of an ECG is widely used in Italy and other countries, at times also echocardiography and stress exercise test. Feasibility of large screening in the young population is debatable, especially related to its predictive value and the rare event of SCD. Beginning in 2010, the Texas Adolescent Athlete Heart Screening Registry (TAAHSR) project has conducted community-based cardiovascular screenings for adolescent athletes aged 14-18 years and of multiple ethnicities.
Medical and family cardiovascular history, a 12 lead ECG and a limited 2-D echocardiogram (ECHO) are obtained. All athletes with positive findings due to concern for a possible cardiovascular condition at screening are referred for complete cardiology evaluation and follow up results tracked subsequently. About 8% of athletes are referred due to either ECG or ECHO abnormalities. The prevalence of SCD-related conditions is 0.22% of the population screened. History data does not correlate with likelihood of referral nor positive cardiac diagnosis. Quality of data and trained personnel are of paramount importance to decrease false positives and increase yield of detection of true cardiovascular conditions in the young athlete population. Large-scale community screening in high school athletes using both ECG and ECHO identifies previously unknown SCD-related conditions.