Background For more than 20 years in Italy, young athletes havebeen screened before participating in competitive sports. Weassessed whether this strategy results in the prevention ofsudden death from hypertrophic cardiomyopathy, a common cardiovascularcause of death in young athletes.
Methods We prospectively studied sudden deaths among athletesand nonathletes (35 years of age or less) in the Veneto regionof Italy from 1979 to 1996. The causes of sudden death in bothpopulations were compared, and the pathological findings inthe athletes were related to their clinical histories and electrocardiograms.Cardiovascular reasons for disqualification from participationin sports were investigated and follow-up was performed in aconsecutive series of 33,735 young athletes who underwent preparticipationscreening in Padua, Italy, during the same period.
Results Of 269 sudden deaths in young people, 49 occurred incompetitive athletes (44 male and 5 female athletes; mean [±SD]age, 23±7 years). The most common causes of sudden deathin athletes were arrhythmogenic right ventricular cardiomyopathy(22.4 percent), coronary atherosclerosis (18.4 percent), andanomalous origin of a coronary artery (12.2 percent). Hypertrophiccardiomyopathy caused only 1 sudden death among the athletes(2.0 percent) but caused 16 sudden deaths in the nonathletes(7.3 percent). Hypertrophic cardiomyopathy was detected in 22athletes (0.07 percent) at preparticipation screening and accountedfor 3.5 percent of the cardiovascular reasons for disqualification.None of the disqualified athletes with hypertrophic cardiomyopathydied during a mean follow-up period of 8.2±5 years.
Conclusions The results show that hypertrophic cardiomyopathywas an uncommon cause of death in these young competitive athletesand suggest that the identification and disqualification ofaffected athletes at screening before participation in competitivesports may have prevented sudden death.
Source Information
From the Department of Cardiology (D.C.) and the Institute of Pathological Anatomy (C.B., G.T.), University of Padua, and the Center for Sports Medicine, National Health Service (M.S.) — both in Padua, Italy.
Address reprint requests to Dr. Thiene at the Istituto di Anatomia Patologica, Via A. Gabelli 61, 35121 Padua, Italy.
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