About 4 percent of the Italian athletes studied over a 10-year
period with MRI and CT scans as well as electrocardiograms (ECG) had
cardiovascular disorders – a higher proportion than researchers
expected to find.
“Even though it’s a small percentage with abnormalities, the
implications can be huge,” said lead author Dr. Antonio Pelliccia,
scientific director of the Institute of Sports Medicine of the
Italian National Olympic Committee in Rome. “Athletes may be
healthy, but they may not be safe from certain risks such as sudden
Pelliccia and colleagues looked at screening results for more than
2,300 athletes during the period between the 2004 Olympic Games in
Athens and the 2014 games in Sochi, Russia. As part of the heart
screening process, the Italian medical team incorporates medical
history, a physical exam, an ECG and an echocardiogram.
They found that 92 athletes had abnormal results, including
inherited heart problems, coronary artery disease, hypertension,
electrical diseases such as atrial fibrillation and tachycardias.
The research team didn’t see a major difference based on the type of
Overall, nine of 92 athletes with cardiac abnormalities were
disqualified from competitive sport and 17 had temporary
restrictions until the abnormalities were resolved. For many of the
athletes, however, these abnormalities don’t show any symptoms and
may not affect performance either, the study authors write in the
British Journal of Sports Medicine.
About 60 percent had valvular problems, which didn’t prompt
conversations about disqualification for future sport participation,
“Not all abnormalities are diseases, and not all are concerning,”
Pelliccia said. “Valvular abnormalities in young people, for
instance, are treatable and don’t represent a real limitation.”
Since 2009, the Italian National Olympic Committee has required
periodic evaluation of elite athletes. Few international groups -
only the Federation Internationale de Football Association (FIFA)
and Union Cycliste Internationale (UCI) - require screenings, the
authors note. In fact, no medical evaluation was universally
required for athletes until the 2016 Rio de Janeiro Summer Olympic
Games, they write.
Italy’s screening process, particularly with mandated
electrocardiograms, has been among the most vigorous in recent
years, said Dr. Douglas Zipes, a professor of cardiology at Indiana
University School of Medicine in Indianapolis, who wasn’t involved
with the study.
“Their required ECGs have reduced sudden deaths and encouraged the
rest of the world to follow suit,” Zipes told Reuters Health. “But
the rest of the world still asks questions about the benefits, costs
and effectiveness of requiring it.”
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The study also points out false negatives from the screenings during
the decade, said Dr. Kimberly Harmon, head football physician at the
University of Washington in Seattle, who wasn’t involved with the
study. Many of the abnormalities may have been present at previous
screenings but didn’t lead to a diagnosis because of inconclusive
results or incorrect interpretation of the results.
“Screening for these conditions is important to prevent sudden
cardiac death,” she told Reuters Health by email. “The currently
recommended history and physical is unlikely to discover many of
these conditions, so advanced screening may be required to detect
Despite concerns, sudden death in athletes is still quite rare,
Zipes noted, with fewer than 100 sudden deaths occurring in U.S.
athletes annually. That compares to more than 300,000 annual sudden
deaths in the general U.S. population, according to a 2014 American
Heart Association report.
“We make a big deal out of these deaths because of the emotional
impact, especially among professional and Olympic athletes who
represent the epitome of health,” he said.
The study makes a statement about the potential for cardiovascular
abnormalities in everyday athletes as well - but shouldn’t cause
alarm, he said.
“Exercise is beneficial, whether you achieve Olympic status or are a
weekend warrior,” Zipes said. “Ultimately, whatever you like to do,
exercise is helpful for the heart.”
SOURCE: http://bit.ly/2iY0c3K British Journal of Sports Medicine,
online December 30, 2016
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