Cardiovascular Sciences Research Centre, St Georges University of London, London, UK.
Department of Family Medicine and the Center for Sports Cardiology, University of Washington, Seattle, Washington, USA.
Clin Cardiol. 2020 Aug;43(8):906-914. doi: 10.1002/clc.23364. Epub 2020 Apr 3.
Pre-participation cardiovascular screening (PPCS) is recommended by several scientific and sporting organizations on the premise that early detection of cardiac disease provides a platform for individualized risk assessment and management; which has been proven to lower mortality rates for certain conditions associated with sudden cardiac arrest (SCA) and sudden cardiac death (SCD). What constitutes the most effective strategy for PPCS of young athletes remains a topic of considerable debate. The addition of the electrocardiogram (ECG) to the medical history and physical examination undoubtedly enhances early detection of disease, which meets the primary objective of PPCS. The benefit of enhanced sensitivity must be carefully balanced against the risk of potential harm through increased false-positive findings, costly downstream investigations, and unnecessary restriction/disqualification from competitive sports. To mitigate this risk, it is essential that ECG-based PPCS programs are implemented by institutions with a strong infrastructure and by physicians appropriately trained in modern ECG standards with adequate cardiology resources to guide downstream investigations. While PPCS is compulsory for most competitive athletes, the current debate surrounding ECG-based programs exists in a binary form; whereby ECG screening is mandated for all competitive athletes or none at all. This polarized approach fails to consider individualized patient risk and the available sports cardiology resources. The limitations of a uniform approach are highlighted by evolving data, which suggest that athletes display a differential risk profile for SCA/SCD, which is influenced by age, sex, ethnicity, sporting discipline, and standard of play. Evaluation of the etiology of SCA/SCD within high-risk populations reveals a disproportionately higher prevalence of ECG-detectable conditions. Selective ECG screening using a risk-based approach may, therefore, offer a more cost-effective and feasible approach to PPCS in the setting of limited sports cardiology resources, although this approach is not without important ethical considerations.
赛前心血管筛查 (PPCS) 得到了多个科学和体育组织的推荐，其前提是早期发现心脏疾病为个体化风险评估和管理提供了平台；这已被证明可以降低与心脏骤停 (SCA) 和心源性猝死 (SCD) 相关的某些疾病的死亡率。最有效的年轻运动员 PPCS 策略是什么仍然是一个颇具争议的话题。心电图 (ECG) 的加入无疑增强了对疾病的早期检测，这符合 PPCS 的主要目标。必须仔细权衡增加的敏感性益处与通过增加假阳性发现、昂贵的下游调查和不必要的限制/取消竞技体育资格而带来的潜在伤害风险。为了降低这种风险，至关重要的是，具有强大基础设施的机构和经过适当培训的精通现代 ECG 标准并具有足够心脏病学资源来指导下游调查的医生实施基于 ECG 的 PPCS 计划。虽然 PPCS 是大多数竞技运动员的强制性要求，但目前围绕基于 ECG 的计划的争论是以二元形式存在的；即所有竞技运动员都必须进行 ECG 筛查，或者根本不进行筛查。这种两极化的方法没有考虑到个体化患者的风险和现有的运动心脏病学资源。统一方法的局限性通过不断发展的数据得到了强调，这些数据表明，运动员的 SCA/SCD 风险具有不同的特征，受年龄、性别、种族、运动项目和比赛水平的影响。对高危人群中 SCA/SCD 的病因学进行评估，揭示了心电图可检测条件的比例过高。因此，在运动心脏病学资源有限的情况下，采用基于风险的选择性 ECG 筛查可能是一种更具成本效益和可行的 PPCS 方法，尽管这种方法并非没有重要的伦理考虑。
