Cardiovascular Sciences Research Centre

The charitable organisation Cardiac Risk in the Young (CRY) have conducted pre-participation cardiovascular screening in a large number of highly trained British athletes, a majority of whom were potential members of the British squad preparing for the Olympic and Paralympic games in 2012.

The CRY research fellows based at the department of cardiovascular sciences, St George’s University London have been heavily involved in these screening programs under the supervision of Professor Sanjay Sharma. The funding for this project was provided by Philips®.

Between October 2007 and March 2012, 1100 elite British athletes underwent cardiac screening. A vast majority of these athletes participated in sports that feature in Olympic and Paralympic events.

The screening program incorporated a health questionnaire, 12-lead electrocardiogram and transthoracic echocardiogram. Those with an abnormality were referred for further diagnostic evaluation or follow-up; the CRY Specialist Centre for Sports Cardiology and Inherited Cardiac Diseases at St George’s Hospital served as one of the referral centres.

The athletes diagnosed with ECG abnormality included 1 with Wolff-Parkinson-White syndrome (WPW) and 2 with prolonged QT interval. One athlete (participating in a sport not featuring in Olympics) was identified with dilated aortic root with bicuspid aortic valve and aortic regurgitation; he required cardiac surgery following which he has returned to competitive sports.

Echocardiogram identified 12 more athletes with valve abnormalities who will require follow-up; these included 6 with bicuspid aortic valve, 5 with mitral valve prolapse, and 2 with pulmonary stenosis. None of the athletes were diagnosed with a cardiomyopathy, however some require long-term regular follow-up.

The study shows that cardiovascular abnormalities in highly trained British athletes are rare; however cardiovascular screening can lead to early identification of important conditions which may potentially predispose an athlete to sudden cardiac death. Most athletes with minor cardiac abnormalities can be allowed to compete with close monitoring.

Dr Saqib Ghani MBBS, MRCP

CRY Research Fellow

Cardiovascular Sciences, St George’s University London

Recent scenes of the collapse of Bolton midfielder Fabrice Muamba during the Spurs vs Bolton FA Cup quarter final highlighted the risk of Sudden Arrythmic Death syndrome (SADS) in atheletes.

Professor Sanjay Sharma, from St George’s University of London appears on Sports Tonight Live to provide expert analysis of this event.

Black and white athletes should receive separate screening guidelines to detect heart defects, in order to reduce false positives, according to Dr Nabeel Sheikh at St George’s University of London.

Current European Society of Cardiology (ESC) guidelines that are used by sports organisations are based on data obtained from white athletes.

For this study, Dr. Sheikh and colleagues analysed ECGs from 923 black athletes, 1,711 white athletes and 209 patients with hypertrophic cardiomyopathy and compared them to current and previous guidelines. The results showed 43% of the participating black athletes would have been highlighted for further investigation, despite being healthy. However, this is still a reduction from 60% false positive results using the 2005 ESC guidelines.

“It shows that we do need to take ethnicity into account during pre-participation screening if we want to avoid over-investigation of black athletes,” says Dr Sheikh. “The implications for practice are potentially huge, given that in both the United States and the United Kingdom an ever increasing proportion of elite athletes are of African/Afro-Caribbean ethnicity.”

As the official cardiologist for the London 2012 Olympics, Professor Sanjay Sharma talks about his role during this event, and what it means for his research at the Cardiovascular Sciences Research Centre.