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A guideline update for the practice of echocardiography in the cardiac screening of sports participants: a joint policy statement from the British Society of Echocardiography and Cardiac Risk in the Young

Echo Research & Practice volume 5, pages G1–G10 (2018)Cite this article

Abstract

Sudden cardiac death (SCD) in an athlete is a rare but tragic event. In view of this, pre-participation cardiac screening is mandatory across many sporting disciplines to identify those athletes at risk. Echocardiography is a primary investigation utilized in the pre-participation setting and in 2013 the British Society of Echocardiography and Cardiac Risk in the Young produced a joint policy document providing guidance on the role of echocardiography in this setting. Recent developments in our understanding of the athlete’s heart and the application of echocardiography have prompted this 2018 update.

References

  1. Sharma S, Drezner J, Baggish A, Papadakis M, Wilson M, Prutkin J, La Gerche A, Ackerman M, Borjesson M, Salerno J, et al. International recommendations for electrocardiographic interpretation in athletes. Journal American College Cardiology 201769 1057–1075. https://doi.org/10.1016/j.jacc.2017.01.015)

    Article  Google Scholar 

  2. Brown B, Somauroo J, Green D, Wilson M, Drezner J, George K & Oxborough D. The complex phenotype of the athlete’s heart: implications for preparticipation screening. Exercise and Sports Science Reviews 201745 96–104. https://doi.org/10.1249/JES.0000000000000102)

    Article  Google Scholar 

  3. Pellicia A, Caselli S, Sharma S, Basso C, Bax J, Corrado D, D’Andrea A, D’Ascenzi F, Di Paolo F, Edvardsen T, et al. European Association of Preventive Cardiology (EAPC) and European Association of Cardiovascular Imaging (EACVI) joint position statement: recommendations for the indication and interpretation of cardiovascular imaging in the evaluation of the athlete’s heart. European Heart Journal 2017 [epub]. https://doi.org/10.1093/eurheartj/ehx532)

    Google Scholar 

  4. Finocchiaro G, Papadakis M, Robertus J, Dhutia H, Steriotis A, Tome M, Mellor G, Merghani A, Malhotra A, Behr E, et al. Etiology of sudden death in sports: insights from a United Kingdom regional registry. Journal of the American College of Cardiology 201667 2108–2115. https://doi.org/10.1016/j.jacc.2016.02.062)

    Article  Google Scholar 

  5. Harmon K, Drezner J, Maleszewski J, Lopez-Anderson M, Owens D, Prutkin J, Asif I, Klossner D & Ackerman M. Pathogeneses of sudden cardiac death in national collegiate athletic association athletes. Circulation Arrhythmia and Electrophysiology 20147 198–204. https://doi.org/10.1161/CIRCEP.113.001376)

    Article  Google Scholar 

  6. Eckart R, Scoville S, Campbell C, Shry E, Stajduhar K, Potter R, Pearse L & Virmani R. Sudden death in young adults: a 25-year review of autopsies in military recruits. Annals of Internal Medicine 2004141 829–834. https://doi.org/10.7326/0003-4819-141-11-200412070-00005)

    Article  Google Scholar 

  7. Mont L, Pellicia A, Sharma S, Biffi A, Borjesson M, Brugada J, Carre F, Guasch E, Heidbuchel H, La Gerche A, et al. Pre-participation cardiovascular evaluation for athletic participants to prevent sudden death: position paper from the EHRA and the EACPR, branches of the ESC. Endorsed by APHRS, HRS, and SOLAECE. European Journal of Preventative Cardiology 201724 41–69. https://doi.org/10.1177/2047487316676042)

    Article  Google Scholar 

  8. Wharton G, Steeds R, Allen J, Phillips H, Jones R, Kanagala P, Lloyd G, Masani N, Mathew T, Oxborough D, et al. A minimum dataset for a standard adult transthoracic echocardiogram: a guideline protocol from the British Society of Echocardiography. Echo Research and Practice 20152 G9–G24. https://doi.org/10.1530/ERP-14-0079)

    Article  Google Scholar 

  9. Utomi V, Oxborough D, Whyte G, Somauroo J, Sharma S, Shave R, Atkinson G & George K. Systematic review and meta analysis of training mode, imaging modality and body size influences on the morphology and function of the male athlete’s heart. Heart 201399 1727–1733. https://doi.org/10.1136/heartjnl-2012-303465)

    Article  Google Scholar 

  10. Finocchiaro G, Dhutia H, D’Silva A, Malhotra A, Steriotis A, Miller L, Prakash K, Narain R, Papadakis M, Sharma R, et al. Effect of sex and sporting discipline on LV adaptation to exercise. JACC Cardiovascular Imaging 201710 965–972. https://doi.org/10.1016/j.jcmg.2016.08.011)

    Article  Google Scholar 

  11. Mitchell J, Haskell W, Snell P & Van Camp S. Task force 8: classification of sports. Journal of the American College of Cardiology 200545 1364–1367. https://doi.org/10.1016/j.jacc.2005.02.015)

    Article  Google Scholar 

  12. Ainsworth B, Haskell W, Leon A, Jacobs D, Montoye H, Sallis J & Paffenbarger R. Compendium of physical activities: classification of energy costs of human physical activities. Medicine in Science Sports and Exercise 199325 71–80. https://doi.org/10.1249/00005768-199301000-00011)

    Article  CAS  Google Scholar 

  13. Whyte G, George K, Nevil A, Shave R, Sharma S & McKenna W. Left ventricular morphology and function in female athletes: a meta-analysis. International Journal of Sports Medicine 200425 380–383. https://doi.org/10.1055/s-2004-817827)

    Article  CAS  Google Scholar 

  14. Giraldeau G, Kobayashi Y, Finocchiario G, Wheeler M, Perez M, Kuznetsova T, Lord R, George K, Oxborough D, Schnittger I, et al. Gender differences in ventricular remodeling and function in college athletes, insights from lean body mass scaling and deformation imaging. American Journal of Cardiology 2015116 1610–1616. https://doi.org/10.1016/j.amjcard.2015.08.026)

    Article  Google Scholar 

  15. Whyte G, George K, Sharma S, Firoozi S, Stephens N, Senior R & McKenna W. The upper limit of physiological cardiac hypertrophy in elite male and female athletes: the British experience. European Journal of Applied Physiology 200492 592–597.

    Article  CAS  Google Scholar 

  16. Makan J, Sharma S, Firoozi S, Whyte G, Jackson P & McKenna W. Physiological upper limits of ventricular cavity size in highly trained adolescent athletes. Heart 200591 495–499. https://doi.org/10.1136/hrt.2004.035121)

    Article  CAS  Google Scholar 

  17. Sheikh N, Papadakis M, Carre F, Kervio G, Panoulas V, Ghani S, Zaidi A, Gati S, Rawlins J, Wilson M, et al. Cardiac adaptation to exercise in adolescent athletes of African ethnicity: an emergent elite athletic population. British Journal of Sports Medicine 201347 585–592. https://doi.org/10.1136/bjsports-2012-091874)

    Article  Google Scholar 

  18. Basavarajaiah S, Boraita A, Whyte G, Wilson M, Carby L, Shah A & Sharma S. Ethnic differences in left ventricular remodeling in highly-trained athletes: relevance to differentiating physiologic left ventricular hypertrophy from hypertrophic cardiomyopathy. Journal of the American College of Cardiology 200851 2256–2262. https://doi.org/10.1016/j.jacc.2007.12.061)

    Article  Google Scholar 

  19. Zaidi A, Ghani S, Sharma R, Oxborough D, Panoulas V, Sheikh N, Gati S, Papadakis M & Sharma S. Physiologic right ventricular adaptation in elite athletes of African and Afro-Caribbean origin. Circulation 2013127 1783–1792. https://doi.org/10.1161/CIRCULATIONAHA.112.000270)

    Article  Google Scholar 

  20. Rawlins J, Carre F, Kervio G, Papadakis M, Chandra N, Edwards G, Whyte G & Sharma S. Ethnic differences in physiological cardiac adaptation to intense physical exercise in highly trained female athletes. Circulation 2010121 1078–1085. https://doi.org/10.1161/CIRCULATIONAHA.109.917211)

    Article  CAS  Google Scholar 

  21. Papadakis M, Wilson M, Ghani S, Kervio G, Carre F & Sharma S. Impact of ethnicity upon cardiovascular adaptation in competitive athletes: relevance to preparticipation screening. British Journal of Sports Medicine 201246 (Supplement 1) i22–i28. https://doi.org/10.1136/bjsports-2012-091127)

    Article  Google Scholar 

  22. Wilson MG, Chatard JC, Carre F, Hamilton B, Whyte G, Sharma S & Chalabi H. Prevalence of electrocardiographic abnormalities in West-Asian and African male athletes. British Journal of Sports Medicine 201246 341–347. https://doi.org/10.1136/bjsm.2010.082743)

    Article  CAS  Google Scholar 

  23. Oxborough D, Sharma S, Shave R, Whyte G, Birch K, Artis N, Batterham A & George K. The right ventricle of the endurance athlete: the relationship between morphology and deformation. Journal of the American Society of Echocardiography 201225 263–271. https://doi.org/10.1016/j.echo.2011.11.017)

    Article  Google Scholar 

  24. George KP, Batterham AM & Jones B. The impact of scalar variable and process on athlete-control comparisons of cardiac dimensions. Medicine and Science in Sports and Exercise 199830 824–830.

    CAS  PubMed  Google Scholar 

  25. Riding N, Salah O, Sharma S, Carre F, O’Hanlon R, George K, Hamilton B, Chalabi H, Whyte G & Wilson M. Do big athletes have big hearts? Impact of extreme anthropometry upon cardiac hypertrophy in professional male athletes. British Journal of Sports Medicine 201246 i90–i97. https://doi.org/10.1136/bjsports-2012-091258)

    Article  Google Scholar 

  26. Malhotra A, Dhutia H, Ghati S, Yeo T, Dores H, Bastiaenen R, Narain R, Merghani A, Finocchiaro G, Sheikh N, et al. Anterior T-wave inversion in young white athletes and nonathletes prevalence and significance. Journal of the American College of Cardiology 201769 1–9. https://doi.org/10.1016/j.jacc.2016.10.044)

    Article  Google Scholar 

  27. Spence A, Naylor L, Carter H, Buck C, Dembo L, Murray C, Watson P, Oxborough D, George K & Green D. A prospective randomised longitudinal MRI study of left ventricular adaptation to endurance and resistance training in humans. Journal of Physiology 2011589 5443–5452. https://doi.org/10.1113/jphysiol.2011.217125)

    Article  CAS  Google Scholar 

  28. Oxborough D, Heemels H, Somauroo J, McClean G, Mistry P, Lord R, Utomi V, Jones N, Thijssen D, Sharma S, et al. Left and right ventricular longitudinal strain-volume/area relationships in elite athletes. International Journal of Cardiovascular Imaging 201632 1199–1211. https://doi.org/10.1007/s10554-016-0910-4)

    Article  Google Scholar 

  29. McClean G, George K, Lord R, Utomi V, Jones N, Somauroo J, Fletcher S & Oxborough D. Chronic adaptation of atrial structure and function in elite male athletes. EHJ: Cardiovascular Imaging 201516 417–422. https://doi.org/10.1093/ehjci/jeu215)

    Google Scholar 

  30. D’andrea A, Riegler L, Golia E, Cocchia R, Scarafile R, Salerno G, Pezzullo E, Nunziata L, Citro R, Cuomo S, et al. Range of right heart measurements in top-level athletes: the training impact. International Journal of Cardiology 2013164 48–57. https://doi.org/10.1016/j.ijcard.2011.06.058)

    Article  Google Scholar 

  31. Spence AL, Naylor LH, Carter HH, Buck CL, Dembo L, Murray CP, Watson P, Oxborough D, George KP & Green DJ. A prospective randomised longitudinal MRI study of left ventricular adaptation to endurance and resistance exercise training in humans. Journal of Physiology 2011589 5443–5452. https://doi.org/10.1113/jphysiol.2011.217125)

    Article  CAS  Google Scholar 

  32. D’Ascenzi F, Pisicchio C, Caselli S, Di Paolo F, Spataro A & Pellicia A. RV remodeling in olympic athletes. JACC: Cardiovascular Imaging 201710 385–393. https://doi.org/10.1016/j.jcmg.2016.03.017)

    PubMed  Google Scholar 

  33. Cohen M, Herlong R & Silverman N. Echocardiographic imaging of anomalous origin of the coronary arteries. Cardiology in the Young 201020(Supplement 3) 26–34. https://doi.org/10.1017/S104795111000106X)

    Article  Google Scholar 

  34. Gati S, Chandra N, Bennett R, Reed M, Kervio G, Panoulas V, Ghani S, Sheikh N, Zaidi A, Wilson M, et al. Increased left ventricular trabeculation in highly trained athletes: do we need more stringent criteria for the diagnosis of left ventricular non-compaction in athletes? Heart 201399 401–408. https://doi.org/10.1136/heartjnl-2012-303418)

    Article  CAS  Google Scholar 

  35. Lang R, Badano L, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf F, Foster E, Goldstein S, Kuznetsova T, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography 201528 1–39. https://doi.org/10.1016/j.echo.2014.10.003)

    Article  Google Scholar 

  36. Pelliccia A, Culasso F, Di Paolo F, & Maron B. Physiologic left ventricular cavity dilatation in elite athletes. Annals of Internal Medicine 1999130 23–31. https://doi.org/10.7326/0003-4819-130-1-199901050-00005)

    Article  CAS  Google Scholar 

Download references

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This work did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

Author information

Authors and Affiliations

  1. Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK

    David Oxborough PhD & John Somauroo FRCP

  2. Royal United Hospitals Bath NHS Foundation Trust, Bath, UK

    Daniel Augustine MD, James Willis PhD & Abbas Zaidi MD

  3. Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, UK

    Sabiha Gati PhD & Keith George PhD

  4. Colchester Hospital University NHS Foundation Trust, Colchester, UK

    Allan Harkness MSc

  5. Nottingham University Hospitals NHS Trust, Nottingham, UK

    Thomas Mathew

  6. St Georges University, London, UK

    Michael Papadakis MD, Sanjay Sharma & Nabeel Sheikh PhD

  7. West Suffolk Hospital NHS Foundation Trust, Bury St Edmonds, UK

    Liam Ring

  8. Papworth Hospital NHS Foundation Trust, Cambridge, UK

    Shaun Robinson MSc

  9. Leeds Teaching Hospitals NHS Trust, Leeds, UK

    Julie Sandoval

  10. Oxford University Hospitals NHS Foundation Trust, Oxford, UK

    Rizwan Sarwar

  11. Royal Liverpool and Broadgreen University Hospitals, Liverpool, UK

    Vishal Sharma MD

  12. School of Healthcare Science, Manchester Metropolitan University, Manchester, UK

    Martin Stout PhD

  13. University Hospital of Wales, Cardiff, UK

    Abbas Zaidi MD

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  1. David Oxborough PhD
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  2. Daniel Augustine MD
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Correspondence to David Oxborough PhD.

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Oxborough, D., Augustine, D., Gati, S. et al. A guideline update for the practice of echocardiography in the cardiac screening of sports participants: a joint policy statement from the British Society of Echocardiography and Cardiac Risk in the Young. Echo Res Pract 5, G1–G10 (2018). https://doi.org/10.1530/ERP-17-0075

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Echo Research & Practice

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