Table 2.
Prevalence of high-risk cardiovascular conditions in athletic candidates: comparison of results from 3 recent large prospective studies that used different protocols.
| Malhotra et al. [2] (H&P, ECG, routine echo) |
Williams et al. [6] (H&P, ECG, rare echo) |
Angelini et al. [3] (H&P, ECG, s-MRI) |
|
|---|---|---|---|
| n (%) | n (%) | n (%) | |
| Sample size | 11,168 | 3,620 | 5,169 |
| hr-CVC | 42 (0.38) | 15 (0.41) | 76 (1.47) |
| hr-CMP | 6 (0.05) | 2 (0.06) | 14 (0.27) |
| DCM | 1 (0.01) | 0 (0.00) | 11 (0.21) |
| HCM | 5 (0.04) | 2 (0.06) | 3 (0.06) |
| hr-ACAOS-IM | 2 (0.02) | 1 (0.03) | 23 (0.44) |
| R-ACAOS-IM | 1 (0.01) | 1 (0.03) | 17 (0.33) |
| L-ACAOS-IM | 1 (0.01) | 0 (0.00) | 6 (0.12) |
| ARVC | 0 (0.00) | 0 (0.00) | 0 (0.00) |
| WPW | 26 (0.23) | 9 (0.25) | 4 (0.08) |
ARVC, arrhythmogenic right ventricular cardiomyopathy; DCM, dilated cardiomyopathy; H&P, history and physical examination; ECG, electrocardiogram; Echo, echocardiogram; HCM, hypertrophic cardiomyopathy; hr-ACAOS-IM, high-risk anomalous origin of coronary artery from the opposite sinus of Valsalva with intramural course; hr-CVC, high-risk cardiovascular condition; hr-CMP, high-risk cardiomyopathy; L- ACAOS-IM, left ACAOS from the right sinus with intramural course; R-ACAOS-IM, right ACAOS from the left sinus with intermural course; s-MRI, screening cardiac magnetic resonance imaging; WPW, Wolff-Parkinson-White syndrome.
Notice the differences in favor of the diagnostic accuracy of an s-MRI-based protocol, especially regarding CAAs and DCM (p value <0.01 for MRI-based versus the other screening methods). Prolonged QTc in the THI study (Bazett criteria, see Angelini et al. [3] in Table 3) was identified by using a Philips automatic ECG device (with an electrophysiologist’s confirmation), but we do not know the criteria or methods used by the other investigators, who report some 3-times-higher prevalence.