Poirier Paul, Sharma Sanjay, Pipe Andrew
Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec City, Québec, Canada; Faculty of Pharmacy, Université Laval, Québec City, Québec, Canada.
St George's University of London, London, United Kingdom.
Can J Cardiol. 2016 Apr;32(4):400-6. doi: 10.1016/j.cjca.2016.02.055.
Sudden cardiac death (SCD) in a young seemingly healthy athlete is a tragic and often highly publicized event. Preparticipation screening aims to identify those affected by cardiovascular diseases who may be at higher risk of SCD during sports participation. There are conflicting recommendations from the American Heart Association and the European Society of Cardiology regarding screening electrocardiograms (ECGs) before participation in sports. The use of an ECG as a screening strategy has been questioned, with a large number of abnormal test results observed in athletes resulting from the electrocardiographic changes that occur in a highly trained individual overlapping with findings suggestive of a pathologic condition. An abnormal 12-lead ECG triggers further examinations, which are expensive given the low diagnostic yield of most abnormal electrocardiographic patterns. Universal screening of young athletes poses logistic and financial challenges. There are currently no Canadian guidelines regarding preparticipation screening of athletes. Screening of athletes ignores the much larger group of young nonathletes who participate in vigorous recreational activity and who collectively represent a population in which a much larger number of SCDs can be predicted to occur. While waiting for the best screening approach in Canada, increased awareness of and access to automated external defibrillators, along with training in cardiopulmonary resuscitation, can help reduce the number of SCDs. In some jurisdictions, electrocardiographic screening has been eschewed in favour of such an approach. Specific physician training in the field of sports cardiology with availability of experts throughout Canada may be a useful start. We provide suggestions and call for the development of Canadian guidelines by appropriate organizations.
年轻看似健康的运动员突然发生心源性猝死（SCD）是一个悲剧性事件，且常常受到高度关注。赛前筛查旨在识别那些患有心血管疾病、在运动参与过程中可能有更高SCD风险的人。美国心脏协会和欧洲心脏病学会在运动前筛查心电图（ECG）方面存在相互矛盾的建议。将ECG用作筛查策略受到了质疑，因为在运动员中观察到大量异常检测结果，这是由于训练有素的个体发生的心电图变化与提示病理状况的发现重叠所致。异常的12导联ECG会引发进一步检查，鉴于大多数异常心电图模式的诊断率较低，这些检查成本高昂。对年轻运动员进行普遍筛查带来了后勤和财务方面的挑战。目前加拿大没有关于运动员赛前筛查的指南。对运动员的筛查忽略了参与剧烈休闲活动的规模大得多的年轻非运动员群体，而在这个群体中预计会发生更多数量的SCD。在等待加拿大最佳筛查方法的同时，提高对自动体外除颤器的认识并增加其可及性，以及进行心肺复苏培训，有助于减少SCD的数量。在一些司法管辖区，已放弃心电图筛查而倾向于采用这种方法。在运动心脏病学领域进行特定的医生培训，并在加拿大各地配备专家，可能是一个有益的开端。我们提供了建议，并呼吁相关组织制定加拿大指南。
