Int J Sports Med 2004; 25(8): 641-642
DOI: 10.1055/s-2004-821302
Letter to the Editors

© Georg Thieme Verlag KG Stuttgart · New York

A Crucial Point: The Early Diagnosis of Increased Risk Subjects Before Sudden Cardiac Death

E. Kasikcioglu1
  • 1Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
Further Information

Publication History

Publication Date:
10 September 2004 (online)

Dear Editors,

I read with great interest the recently published study by Hipp et al. [[2]] in the January, 2004 issue of the Int J Sports Med. Diagnosis of hypertrophic cardiomyopathy and pathologic ventricular hypertrophy is an important problem due to fact that they are major risk factors for sudden death in young athletes [[6]]. Although exercise related sudden death with a small proportion of unexpected deaths is a tragic event, detection of increased risk group remains a major medical-social-ethical-financial-legal problem. Based on long-standing Italian experience, any effort of such magnitude involving several million athletes each year requires enormous financial support and raises innumerable challenges in terms of organization, manpower, and implementation. However, it would clearly be in the best interests of physicians charged with responsibility for making eligibility decisions concerning athletes to have existing and systemic recommendations on which to rely [[9]].

In addition, the fact of the matter is that differentiating pathologic hypertrophy from conditioning hypertrophy (athlete's heart) remains a challenge [[1], [3]]. The proposed primary mechanism of sudden death in athletes involves the development of a fatal arrhythmia, presumably ventricular fibrillation, or asystole [[10]]. There is a lack of knowledge about myocardial repolarization changes during exercise in athletes; however, we found that QT dispersion values during exercise (QTdex) were significantly lower in athletes than in controls [[4]]. The reduced QTdex reflects homogeneous myocardial repolarization and may help to explain the reduced mortality rate in regularly exercising subjects. I have claimed that measurement of QTdex could provide a simple and inexpensive screening method for athletes.

Recently, tissue Doppler echocardiography has been frequently used for differentiating physiologic and pathologic hypertrophy. On the other hand, myocardial performance index measured by tissue Doppler imaging had the best sensitivity and specificity for the differentiation of the two kinds of left ventricular hypertrophy [[5]]. The establishment of a myocardial performance index in athletes may be used in clinical practice since it is a useful method for differentiation of pathologic and physiologic hypertrophy.

Up to now, there is no gold standard method for screening, subject's history and physical examination are still primary methods as they are easy, cheap, and non-invasive, even though they fail to identify high risk pathologies [[7]]. The American Heart Association recommends a standard cardiovascular history and physical examination every 2 years by a certified health care professional during high school and college years [[8]].

References

  • 1 Dickhuth H H, Röcker K, Hipp A, Heitkamp H C, Keul J. Echocardiographic findings in endurance athletes with hypertrophic non-obstructive cardiomyopathy (HNCM) compared to non-athletes with HNCM and to physiological hypertrophy (athlete's heart).  Int J Sports Med. 1994;  15 273-277
  • 2 Hipp A A, Heitkamp H C, Röcker K, Dickhuth H H. Hypertrophic cardiomyopathy - sports-related aspects of diagnosis, theraphy, and sports eligibility.  Int J Sports Med. 2004;  25 20-26
  • 3 Kasikcioglu E, Akhan H. Echocardiographic limits of left ventricular remodeling in athletes.  J Am Coll Cardiol. 2004;  44 469-470
  • 4 Kasikcioglu E, Kayserilioglu A, Yildiz S, Akhan H, Cuhadaroglu C. QT dispersion in soccer players during exercise testing.  Int J Sports Med. 2004;  25 177-181
  • 5 Kasikcioglu E, Akhan H, Oflaz H, Kayserilioglu A. . Differentiate two different cardiac hypertrophy by pulse tissue Doppler imaging; hypertensive and athletic. Proceedings of Asian-Pacific Hypertension Congress 2004
  • 6 Maron B J, Mitchell J H. 26th Bethesda conference: recommendations for determining eligibility for competition in athletes with cardiovascular abnormalities.  J Am Coll Cardiol. 1994;  24 845-899
  • 7 Maron B J, Shirani J, Poliac L C, Mathenge R, Roberts W C, Mueller F O. Sudden death in young competitive athletes: clinical, demographic, and pathologic profiles.  JAMA. 1996;  276 199-204
  • 8 Maron B J, Thompson P D, Puffer J C, McGrew C A, Strong W B, Douglas P S, Clark L T, Mitten M J, Crawford M H, Atkins D L, Driscoll D J, Epstein A E. Cardiovascular preparticipation screening of competitive athletes.  Circulation. 1996;  94 850-856
  • 9 Pellicia A, Maron B J. Preparticipation cardiovascular evaluation of the competitive athlete:perspectives from the 30 year Italian experience.  Am J Cardiol. 1995;  75 827-829
  • 10 Van Camp S P. Sudden death.  Clin Sport Med. 1992;  11 273-289

Consultant Cardiologist in Sports Medicine MD, PhD Erdem Kasikcioglu

Istanbul University, Istanbul Faculty of Medicine

PK 9, Avcilar

34840 Istanbul

Turkey

Phone: + 902163405316

Fax: + 90 21 63 30 74 73

Email: ekasikcioglu@yahoo.com

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