Skip to main content
Top
Published in: Clinical Research in Cardiology 1/2010

01-01-2010 | Original Paper

Benefits and limitations of cardiovascular pre-competition screening in international football

Authors: Thomas Thünenkötter, Christian Schmied, Jiri Dvorak, Wilfried Kindermann

Published in: Clinical Research in Cardiology | Issue 1/2010

Login to get access

Abstract

Background

Competitive sport can serve as a trigger for sudden cardiac death (SCD). The majority of athletes who die suddenly have previously unsuspected structural heart disease. Medical evaluation before competition offers the potential to identify cardiovascular abnormalities in asymptomatic athletes. Consensus on the ideal screening programme has not been reached. So, a cardiovascular pre-competition screening of elite football players was developed and implemented prior to the 2006 FIFA World Cup Germany™ to detect SCD risk factors.

Methods

Medical history, physical examination, 12-lead resting- and exercise electrocardiogram (ECG) and echocardiography results of the players were recorded on a standardised form by the team physicians and submitted after the final match for retrospective evaluation by two blinded independent cardiologic reviewers.

Results

Response rate was 82% (605 of 736 players). Completeness and quality of the recordings and examination methods differed amongst teams. In 25 players (4.8%), the examining physicians evaluated the resting ECG as pathological. Suspicious echocardiographic findings demanding further investigations to rule out serious cardiovascular disease existed in 1% of the players.

Conclusion

Cardiovascular pre-competition screening proved feasible in international elite football teams, but turned out to be vital to ensure high quality of data, particularly with regard to stress testing and echocardiography. The screening concept was revised mainly to improve completeness and quality of data acquisition. Resting ECG and echocardiography were retained, but it is questionable if exercise testing should be included in this context.
Literature
1.
go back to reference Basso C, Maron BJ, Corrado D et al (2000) Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol 35:1493–1501CrossRefPubMed Basso C, Maron BJ, Corrado D et al (2000) Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol 35:1493–1501CrossRefPubMed
2.
go back to reference Corrado D, Thiene G, Cocco P et al (1992) Non-atherosclerotic coronary artery disease and sudden death in the young. Br Heart J 68:601–607CrossRefPubMed Corrado D, Thiene G, Cocco P et al (1992) Non-atherosclerotic coronary artery disease and sudden death in the young. Br Heart J 68:601–607CrossRefPubMed
3.
go back to reference Corrado D, Basso C, Schiavon M et al (1998) Screening for hypertrophic cardiomyopathy in young athletes. N Engl J Med 339:364–369CrossRefPubMed Corrado D, Basso C, Schiavon M et al (1998) Screening for hypertrophic cardiomyopathy in young athletes. N Engl J Med 339:364–369CrossRefPubMed
4.
go back to reference Corrado D, Basso C, Rizzoli G et al (2003) Does sports activity enhance the risk of sudden death in adolescents and young adults? J Am Coll Cardiol 42:1959–1963CrossRefPubMed Corrado D, Basso C, Rizzoli G et al (2003) Does sports activity enhance the risk of sudden death in adolescents and young adults? J Am Coll Cardiol 42:1959–1963CrossRefPubMed
5.
go back to reference Corrado D, Pelliccia A, Bjornstad HH et al (2005) Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol: consensus statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J 26:516–524CrossRefPubMed Corrado D, Pelliccia A, Bjornstad HH et al (2005) Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol: consensus statement of the Study Group of Sport Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J 26:516–524CrossRefPubMed
6.
go back to reference Corrado D, Basso C, Pavei A et al (2006) Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA 296:1593–1601CrossRefPubMed Corrado D, Basso C, Pavei A et al (2006) Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA 296:1593–1601CrossRefPubMed
7.
go back to reference Dvorak J, Grimm K, Schmied C et al (2009) Development and implementation of a standardized Precompetition Medical Assessment of International Elite Football Players: 2006 FIFA World Cup Germany. Clin J Sport Med 19(4):316–321CrossRefPubMed Dvorak J, Grimm K, Schmied C et al (2009) Development and implementation of a standardized Precompetition Medical Assessment of International Elite Football Players: 2006 FIFA World Cup Germany. Clin J Sport Med 19(4):316–321CrossRefPubMed
8.
go back to reference Etchells E, Bell C, Robb K (1997) Does this patient have an abnormal systolic murmur? JAMA 277(7):564–571CrossRefPubMed Etchells E, Bell C, Robb K (1997) Does this patient have an abnormal systolic murmur? JAMA 277(7):564–571CrossRefPubMed
9.
go back to reference Furlanello F, Bertoldi A, Dallago M et al (1998) Cardiac arrest and sudden death in competitive athletes with arrhythmogenic right ventricular dysplasia. Pacing Clin Electrophysiol 21:331–335CrossRefPubMed Furlanello F, Bertoldi A, Dallago M et al (1998) Cardiac arrest and sudden death in competitive athletes with arrhythmogenic right ventricular dysplasia. Pacing Clin Electrophysiol 21:331–335CrossRefPubMed
10.
go back to reference Gibbons RJ, Balady GJ, Bricker JT et al (2002) ACC/AHA 2002 guideline update for exercise testing, summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to update the 1997 Exercise Testing Guidelines). Circulation 106:1883–1892CrossRefPubMed Gibbons RJ, Balady GJ, Bricker JT et al (2002) ACC/AHA 2002 guideline update for exercise testing, summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to update the 1997 Exercise Testing Guidelines). Circulation 106:1883–1892CrossRefPubMed
11.
go back to reference Herren T, Gerber PA, Duru F (2009) Arrhythmogenic right ventricular cardiomyopathy/dysplasia: a not so rare “disease of the desmosome” with multiple clinical presentations. Clin Res Cardiol 98(3):141–158CrossRefPubMed Herren T, Gerber PA, Duru F (2009) Arrhythmogenic right ventricular cardiomyopathy/dysplasia: a not so rare “disease of the desmosome” with multiple clinical presentations. Clin Res Cardiol 98(3):141–158CrossRefPubMed
13.
go back to reference Junge A, Grimm K, Feddermann N, Dvorak J (2009) Precompetition orthopaedic assessment of international elite football players. Clin J Sport Med 19(4):326–328CrossRefPubMed Junge A, Grimm K, Feddermann N, Dvorak J (2009) Precompetition orthopaedic assessment of international elite football players. Clin J Sport Med 19(4):326–328CrossRefPubMed
14.
go back to reference Kindermann W (2000) Das Sportherz. Dtsch Z Sportmed 9:307–308 Kindermann W (2000) Das Sportherz. Dtsch Z Sportmed 9:307–308
15.
go back to reference Kindermann W (2007) Physiologische Anpassungen des Herz-Kreislaufsystems an körperliche Belastung. In: Kindermann W, Dickhuth H, Niess A et al (eds) Sportkardiologie, 2. Auflage. Steinkopf Verlag, Darmstadt, 1–20) Kindermann W (2007) Physiologische Anpassungen des Herz-Kreislaufsystems an körperliche Belastung. In: Kindermann W, Dickhuth H, Niess A et al (eds) Sportkardiologie, 2. Auflage. Steinkopf Verlag, Darmstadt, 1–20)
16.
go back to reference Lang RM, Bierig M, Devereux RB et al (2006) Recommendations for chamber quantification. Eur J Echocardiogr 7:79–108CrossRefPubMed Lang RM, Bierig M, Devereux RB et al (2006) Recommendations for chamber quantification. Eur J Echocardiogr 7:79–108CrossRefPubMed
17.
go back to reference Lauschke J, Maisch B (2009) Athlete’s heart or hypertrophic cardiomyopathy? Clin Res Cardiol 98(2):80–88CrossRefPubMed Lauschke J, Maisch B (2009) Athlete’s heart or hypertrophic cardiomyopathy? Clin Res Cardiol 98(2):80–88CrossRefPubMed
18.
go back to reference Maron BJ, Gohman TE, Aeppli D (1998) Prevalence of sudden cardiac death during competitive sports activities in Minnesota high school athletes. J Am Coll Cardiol 32:1881–1884CrossRefPubMed Maron BJ, Gohman TE, Aeppli D (1998) Prevalence of sudden cardiac death during competitive sports activities in Minnesota high school athletes. J Am Coll Cardiol 32:1881–1884CrossRefPubMed
19.
go back to reference Maron BJ, Gohman TE, Kyle SB et al (2002) Clinical profile and spectrum of commotio cordis. JAMA 287:1142–1146CrossRefPubMed Maron BJ, Gohman TE, Kyle SB et al (2002) Clinical profile and spectrum of commotio cordis. JAMA 287:1142–1146CrossRefPubMed
21.
go back to reference Maron BJ, Thompson PD, Ackerman MJ et al (2007) Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update. Circulation 115:1643–1655CrossRefPubMed Maron BJ, Thompson PD, Ackerman MJ et al (2007) Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update. Circulation 115:1643–1655CrossRefPubMed
22.
go back to reference McKenna WJ, Thiene G et al (1994) Diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy: Task Force of the Working Group Myocardial and Pericardial Disease of the European Society of Cardiology and of the Scientific Council on Cardiomyopathies of the International Society and Federation of Cardiology. Br Heart J 71:215–218CrossRefPubMed McKenna WJ, Thiene G et al (1994) Diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy: Task Force of the Working Group Myocardial and Pericardial Disease of the European Society of Cardiology and of the Scientific Council on Cardiomyopathies of the International Society and Federation of Cardiology. Br Heart J 71:215–218CrossRefPubMed
23.
go back to reference Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE (2002) Exercise capacity and mortality among men referred for exercise testing. N Engl J Med 346(11):793–801CrossRefPubMed Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE (2002) Exercise capacity and mortality among men referred for exercise testing. N Engl J Med 346(11):793–801CrossRefPubMed
24.
go back to reference Pelliccia A, Maron BJ, Culasso F et al (2000) Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation 102:278–284PubMed Pelliccia A, Maron BJ, Culasso F et al (2000) Clinical significance of abnormal electrocardiographic patterns in trained athletes. Circulation 102:278–284PubMed
25.
go back to reference Pelliccia A, Di Paolo F, Quattrini FM et al (2008) Outcomes in athletes with marked ECG repolarization abnormalities. N Engl J Med 358:152–161CrossRefPubMed Pelliccia A, Di Paolo F, Quattrini FM et al (2008) Outcomes in athletes with marked ECG repolarization abnormalities. N Engl J Med 358:152–161CrossRefPubMed
26.
go back to reference Sahn D, DeMaria A, Kisslo J et al (1978) Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 58:1072–1082PubMed Sahn D, DeMaria A, Kisslo J et al (1978) Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 58:1072–1082PubMed
27.
go back to reference Scharhag J (2007) Das Sportler EKG. Dtsch Z Sportmed 6:184–185 Scharhag J (2007) Das Sportler EKG. Dtsch Z Sportmed 6:184–185
28.
go back to reference Sharma S, Whyte G, Elliot P et al (1999) Electrocardiographic changes in 1000 highly trained junior elite athletes. Br J Sports Med 33:319–324CrossRefPubMed Sharma S, Whyte G, Elliot P et al (1999) Electrocardiographic changes in 1000 highly trained junior elite athletes. Br J Sports Med 33:319–324CrossRefPubMed
29.
go back to reference Thompson PD, Funk EJ, Carleton RA et al (1982) Incidence of death during jogging in Rhode Island from 1975 through 1980. JAMA 247:2535–2538CrossRefPubMed Thompson PD, Funk EJ, Carleton RA et al (1982) Incidence of death during jogging in Rhode Island from 1975 through 1980. JAMA 247:2535–2538CrossRefPubMed
30.
go back to reference Thünenkötter T, Schmied C, Grimm K, Dvorak J, Kindermann W (2009) Precompetition cardiac assessment of football players participating in the 2006 FIFA World Cup Germany™. Clin J Sport Med 19(4):322–325CrossRefPubMed Thünenkötter T, Schmied C, Grimm K, Dvorak J, Kindermann W (2009) Precompetition cardiac assessment of football players participating in the 2006 FIFA World Cup Germany™. Clin J Sport Med 19(4):322–325CrossRefPubMed
31.
go back to reference Urhausen A, Kindermann W (1999) Sports-specific adaptations and differentiation of the athlete’s heart. Sports Med 28(4):237–244CrossRefPubMed Urhausen A, Kindermann W (1999) Sports-specific adaptations and differentiation of the athlete’s heart. Sports Med 28(4):237–244CrossRefPubMed
32.
go back to reference Virmani R, Robinowitz M, McAllister HA Jr (1982) Nontraumatic death in joggers: a series of 30 patients at autopsy. Am J Med 72:874–882CrossRefPubMed Virmani R, Robinowitz M, McAllister HA Jr (1982) Nontraumatic death in joggers: a series of 30 patients at autopsy. Am J Med 72:874–882CrossRefPubMed
33.
go back to reference Zehender M, Meinertz T, Keul J et al (1990) ECG variants and cardiac arrhythmias in athletes: clinical relevance and prognostic importance. Am Heart J 119:1378–1391CrossRefPubMed Zehender M, Meinertz T, Keul J et al (1990) ECG variants and cardiac arrhythmias in athletes: clinical relevance and prognostic importance. Am Heart J 119:1378–1391CrossRefPubMed
Metadata
Title
Benefits and limitations of cardiovascular pre-competition screening in international football
Authors
Thomas Thünenkötter
Christian Schmied
Jiri Dvorak
Wilfried Kindermann
Publication date
01-01-2010
Publisher
D. Steinkopff-Verlag
Published in
Clinical Research in Cardiology / Issue 1/2010
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-009-0072-7

Other articles of this Issue 1/2010

Clinical Research in Cardiology 1/2010 Go to the issue