Medical Classification Centre, Central Manpower Base, Singapore Armed Forces, 3 Depot Road, Singapore 109680, Singapore.
Europace. 2011 Jun;13(6):883-8. doi: 10.1093/europace/eur051. Epub 2011 Apr 12.
Hypertrophic cardiomyopathy is a leading cause of sudden cardiac death (SCD) in young people in the USA. Pre-participation screening for athletes might reduce the incidence of SCD. In Singapore, military service is compulsory for all young able-bodied male citizens. The Singapore Armed Forces Electrocardiogram and Echocardiogram (SAFE) pre-participation screening protocol based on the Italian programme was introduced. This study evaluates the prevalence of hypertrophic cardiomyopathy (HCM) in a young male South-East Asian population.
From October 2008 to May 2009, all male military conscripts underwent pre-participation screening. For all conscripts whose electrocardiogram (ECG) findings fulfilled any of these pre-specified criteria (Group A), direct referral for a transthoracic echocardiogram was mandatory. Conscripts with ECG findings other than pre-specified criteria (e.g. T-wave inversions, repolarization abnormalities) were referred for secondary screening by cardiologists (Group B), which could include echocardiography. Out of 18 476 subjects screened during the study period, 988 (5.3%) subjects were fast tracked for echocardiogram (Group A). Of them, there were three (0.3%) cases with severe abnormalities; there was one case each of HCM, bicuspid aortic valve with significant aortic valve regurgitation, and atrial septal defect with right ventricular systolic dysfunction. The patient with HCM had left axis deviation on ECG. None of the 215 patients who underwent echocardiography following cardiology consult (Group B) had HCM.
The prevalence of HCM in our young male population (mean age 19.5, range 16-27) using an ECG-based screening protocol was 0.005%; this appeared lower than published data from other geographical cohorts. Possible explanations include a later age of phenotypic manifestation in our population, limitations of the ECG criteria for screening, or a truly lower prevalence of HCM. More population-based longitudinal studies would be needed to ascertain the true prevalence of HCM in our South-East Asian population.
肥厚型心肌病是美国年轻人心源性猝死（SCD）的主要原因。运动员赛前筛查可能会降低 SCD 的发生率。在新加坡，所有身体健全的年轻男性公民都必须服兵役。引入了基于意大利项目的新加坡武装部队心电图和超声心动图（SAFE）参赛前筛查方案。本研究评估了东南亚年轻男性人群中肥厚型心肌病（HCM）的患病率。
从 2008 年 10 月至 2009 年 5 月，所有男性新兵都接受了参赛前筛查。对于心电图（ECG）结果符合任何这些预先规定标准的所有新兵（A 组），必须直接转诊进行经胸超声心动图检查。心电图结果不符合预先规定标准的新兵（例如 T 波倒置、复极异常）则由心脏病专家进行二次筛查（B 组），其中可能包括超声心动图。在研究期间，共有 18476 名新兵接受了筛查，其中 988 名（5.3%）新兵被快速转诊进行超声心动图检查（A 组）。其中，有 3 例（0.3%）严重异常；每例分别为肥厚型心肌病、二叶主动脉瓣伴明显主动脉瓣反流和房间隔缺损伴右心室收缩功能障碍。心电图显示肥厚型心肌病患者存在左轴偏。在接受心脏病专家咨询后进行超声心动图检查的 215 名患者（B 组）中，无一例患有肥厚型心肌病。
使用基于心电图的筛查方案，我们年轻男性人群（平均年龄 19.5 岁，范围 16-27 岁）中肥厚型心肌病的患病率为 0.005%；这似乎低于其他地理队列的已发表数据。可能的解释包括我们人群中表型表现的年龄较晚、心电图筛查标准的局限性或肥厚型心肌病的真实患病率较低。需要进行更多基于人群的纵向研究，以确定我们东南亚人群中肥厚型心肌病的真实患病率。
