ABSTRACT
BACKGROUND: Competitive sport can serve as a trigger for sudden cardiac death (SCD). The majority of athletes who die suddenly have previously unsuspected structural heart disease. Medical evaluation before competition offers the potential to identify cardiovascular abnormalities in asymptomatic athletes. Consensus on the ideal screening programme has not been reached. So, a cardiovascular pre-competition screening of elite football players was developed and implemented prior to the 2006 FIFA World Cup Germany to detect SCD risk factors. METHODS: Medical history, physical examination, 12-lead resting- and exercise electrocardiogram (ECG) and echocardiography results of the players were recorded on a standardised form by the team physicians and submitted after the final match for retrospective evaluation by two blinded independent cardiologic reviewers. RESULTS: Response rate was 82% (605 of 736 players). Completeness and quality of the recordings and examination methods differed amongst teams. In 25 players (4.8%), the examining physicians evaluated the resting ECG as pathological. Suspicious echocardiographic findings demanding further investigations to rule out serious cardiovascular disease existed in 1% of the players. CONCLUSION: Cardiovascular pre-competition screening proved feasible in international elite football teams, but turned out to be vital to ensure high quality of data, particularly with regard to stress testing and echocardiography. The screening concept was revised mainly to improve completeness and quality of data acquisition. Resting ECG and echocardiography were retained, but it is questionable if exercise testing should be included in this context.
Subject(s)
Cardiovascular Diseases/diagnosis , Death, Sudden, Cardiac/prevention & control , Soccer , Adult , Death, Sudden, Cardiac/etiology , Echocardiography , Electrocardiography , Exercise Test , Germany , Humans , Male , Physical Examination , Risk Factors , Young AdultABSTRACT
OBJECTIVES: To develop a precompetition medical assessment (PCMA) of elite football players aimed at identifying risk factors for sudden cardiac death. DESIGN: Retrospective analysis of the PCMA forms. PARTICIPANTS: Of the 32 national teams (with 23 players), PCMA forms from 605 players were submitted after the final match (82%). Data of 582 players were analyzed (79%). MAIN OUTCOME MEASURES: Recorded results of a standardized PCMA in all players before the 2006 FIFA World Cup including medical history, physical examination, resting/exercise electrocardiogram, and echocardiography were analyzed by 2 independent cardiologic reviewers. RESULTS: Apart from general deficits in data quality, at least 6 players (1.0%) could be identified as demanding further investigations to rule out a serious cardiovascular disease. CONCLUSIONS: Comprehensive cardiac testing is feasible in international elite football. To improve future results, the PCMA was revised. It is questionable if exercise stress testing should be included in future PCMA. To ensure correct results, sports cardiologic expertise is essential. In the face of organizational challenges and variable medical standards, alternative approaches to the practical implementation of the PCMA need to be investigated.
