Sports Medicine Unit regional referral center for exercise prescription in young patients with heart diseases, AULSS 2, Via Castellana, 2, 31100 Treviso, Italy.
Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via n. Giustiniani 2, 35121 Padova, Italy.
Eur Heart J. 2023 Mar 21;44(12):1084-1092. doi: 10.1093/eurheartj/ehad017.
This study aimed to report the long-term findings of the Italian programme of cardiovascular preparticipation screening (PPS) in young, competitive athletes.
The study assessed the diagnostic yield for diseases at risk of sudden cardiac death (SCD), the costs of serial evaluations, and the long-term outcomes of PPS in a large population of Italian children (age range, 7-18 years). The PPS was repeated annually and included medical history, physical examination, resting electrocardiogram, and stress testing; additional tests were reserved for athletes with abnormal findings. Over an 11-year study period, 22 324 consecutive children [62% males; mean age, 12 (interquartile range, 10-14) years at first screening] underwent a total of 65 397 annual evaluations (median 2.9/child). Cardiovascular diseases at risk of SCD were identified in 69 children (0.3%) and included congenital heart diseases (n = 17), channelopathies (n = 14), cardiomyopathies (n = 15), non-ischaemic left ventricular scar with ventricular arrhythmias (n = 18), and others (n = 5). At-risk cardiovascular diseases were identified over the entire age range and more frequently in children ≥12 years old (n = 63, 91%) and on repeat evaluation (n = 44, 64%). The estimated cost per diagnosis was 73 312€. During a follow-up of 7.5 ± 3.7 years, one child with normal PPS findings experienced an episode of resuscitated cardiac arrest during sports activity (event rate of 0.6/100.000 athletes/year).
The PPS programme led to the identification of cardiovascular diseases at risk of SCD over the whole study age range of children and more often on repeat evaluations. Among screened children, the incidence of sport-related cardiac arrest during long-term follow-up was low.
本研究旨在报告意大利心血管预参赛筛查（PPS）计划在年轻竞技运动员中的长期发现。
本研究评估了意大利儿童（年龄范围 7-18 岁）中风险猝死（SCD）的疾病诊断率、连续评估的成本以及 PPS 的长期结果。PPS 每年重复进行，包括病史、体格检查、静息心电图和应激试验；对有异常发现的运动员保留额外的检查。在 11 年的研究期间，22324 名连续儿童[62%为男性；首次筛查时的平均年龄为 12 岁（四分位间距 10-14 岁）]共进行了 65397 次年度评估（中位数 2.9/儿童）。发现 69 名儿童（0.3%）患有 SCD 风险的心血管疾病，包括先天性心脏病（n=17）、通道病（n=14）、心肌病（n=15）、非缺血性左心室瘢痕伴室性心律失常（n=18）和其他疾病（n=5）。在整个年龄范围内都发现了心血管疾病，在≥12 岁的儿童（n=63，91%）和重复评估的儿童（n=44，64%）中更为常见。每例诊断的估计费用为 73312 欧元。在 7.5±3.7 年的随访期间，一名 PPS 检查结果正常的儿童在运动中经历了一次复苏性心脏骤停（发生率为 0.6/100000 名运动员/年）。
在儿童整个研究年龄范围内，PPS 计划导致了 SCD 风险的心血管疾病的发现，并且在重复评估中更为常见。在筛查儿童中，长期随访期间运动相关心脏骤停的发生率较低。
