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Counterpoint: lack of evidence for echocardiography screening in athletes
  1. Elizabeth Dineen1,
  2. Jordan Prutkin2
  1. 1 Medicine/Cardiology, University of California Irvine, Irvine, California, USA
  2. 2 Medicine/Cardiology, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Jordan Prutkin, Medicine/Cardiology, University of Washington, Seattle, WA 98103, USA; jprutkin{at}

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Prevention of sudden cardiac death (SCD) in athletes continues to be a major focus for sports medicine health professionals. While the incidence is low, the consequences can be devastating. Over the years, our understanding of SCD aetiologies and the ability to identify those at higher risk for SCD continues to improve. The preparticipation examination (PPE) is critical to this mission. While the necessity of a PPE is not questioned, the key elements of the PPE continue to fuel an ever-evolving debate.

The history and physical (H&P) are a cornerstone of the PPE at all levels. There is debate whether to incorporate the 12-lead ECG as part of this screening process. This is based on the idea that the H&P alone may not be enough to fully ascertain diseases associated with SCD. It is supported by many studies, including one of 3620 high school athletes in which the American Heart Association 14-element PPE H&P was found to have decreased sensitivity, specificity and positive predictive value for conditions associated with SCD compared with an ECG (18.8% vs 87.5%, 68% vs 97.5% and 0.3% vs 13.6%, respectively).1 There is concern, however, regarding variability in ECG interpretation and available follow-up resources, so this may not be the best choice for all communities. Thus, American guidelines endorse inclusion of the ECG at the discretion of individual medical entities based on regional athlete risk and resources.2 Importantly, some cardiovascular disease phenotypes do not manifest until later in life and therefore may have a normal initial PPE. Additionally, some conditions, …

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  • Contributors Both authors contributed to this work and met the criteria for authorship.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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