ASE: Brief Echo During Physical May Spot Athletes at Sudden Death Risk

SEATTLE, June 22 -- A five-minute echocardiography exam as part of a pre-competition physical might spot athletes with a potentially life-threatening heart abnormality, researchers said here.

This conclusion emerged from a prospective evaluation of a limited two-dimensional echo exam in 395 University of Wisconsin athlete undergoing annual athletics-related physicals. The athletes' mean age was 19 years, and 49% were female.

Echocardiography revealed no abnormalities in 84% of the athletes but picked up minor abnormalities in 14% and five major abnormalities that required a full cardiovascular work-up, reported Rachael Wyman, M.D., of the University of Wisconsin in Madison at the American Society of Echocardiography meeting.

The echo exam consisted of the parasternal long axis, the parasternal short axis at the level of the aortic valve and the mid-left ventricle, an apical four-chamber view, and an apical five-chamber view. All four heart valves were evaluated by pulsed and color Doppler, and both ventricles were examined, as well as the ascending aorta and coronary arteries. No images were recorded.

The origin of the left coronary artery was identified in 99% of cases and the origin of the right coronary artery in 96%. None of the athletes had identifiable coronary abnormalities.

Dr. Wyman reported that 55 athletes had minor echo-detected abnormalities, such as mild tricuspid regurgitation, an upper-normal size right ventricle, or mild mitral regurgitation, which did not require specific follow-up. Other minor abnormalities detected by echo included mitral valve prolapse without significant regurgitation, a small atrial-septal defect, and two small atrial-septal aneurysms.

The five major abnormalities identified consisted of two patients with bicuspid valves associated with moderate or mild aortic insufficiency; and one case each of pulmonic stenosis, thickened mitral valve with mild regurgitation, and mild cardiomyopathy. Each of these athletes underwent comprehensive echo evaluations.

The limited 2D echo evaluation added about five minutes to the routine physical, demonstrating the feasibility of incorporating it into athletes' physical exams, Dr. Wyman concluded.

Another report here focused on echo findings in 144 asymptomatic high school and college athletes. The limited echo exam was designed to identify major cardiac abnormalities, reported Monique Scally, D.O., of Temple University in Philadelphia. The exam comprised measurement of left-ventricular dimensions, aortic diameter, wall thickness, and presence of valvular or myocardial abnormalities.

The athletes played football, basketball, soccer, track, or tennis. Football players weighed more and had greater body mass index compared with athletes in other sports. Football players appeared to have larger heart chambers, but after indexing to body size, they had smaller a left ventricular end diastolic diameter.

Tricuspid regurgitation was detected in 54.9% of the athletes but was mild or trivial in all but 4.9% of cases. Mitral regurgitation was identified in 19.5% of the athletes and was mild or trivial in all but 0.7% of cases. There was aortic regurgitation in 2.8% of the athletes and was mild or trivial in all cases.

The limited 2D echo exam detected no cardiac abnormalities that are known to predispose to sudden cardiac death, Dr. Scully concluded.