CRY Research Fellow’s paper receives praise from leading cardiologist

CRY research continues to underline the importance of cardiac screening for athletes

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CRY Research Fellow Dr Gherardo Finocchiaro

After a successful three days at the BCS Annual Conference (June 6 – 8 2016), where the team from Cardiac Risk in the Young (CRY) really was at the “heart” of the debate about the benefits of proactive cardiac screening, – CRY is also pleased to report that recent research has just received unparalleled praise from a leading commentator, Dr Valentin Fuster.

Editor in Chief of prestigious journal, JACC (Journal of the American College of Cardiology), Dr Fuster, posted a 10-minute audio recording, discussing the findings of research paper published by CRY Research Fellow, Dr Gherardo Finocchiaro (“The Etiology of Sudden Death in Sports”, JACC, Vol. 67 No. 18 2016). His opening phrase was testament to the standard of current CRY funded research, “This is one of the best papers I have read on the subject and the authors have to be congratulated.”

First presented at the European Society of Cardiology Congress (August 2015) the study looks at the most common causes of sudden death in athletes whilst participating in sport.

The research team (based at St George’s University, London) selected 357 cases of sudden death (from a cohort of 3684), all of whom had been engaged in regular (ie more than 3 hours a week), organised physical training. 70% of the cases analysed were competitive athletes. In 219 of the cases (61%) sudden death had occurred during exercise or exertion – with the two most common causes of these tragic incidents linked to the conditions being arrhythmogenic right ventricular arrhythmia, ARVC (20%) and Left Ventricular fibrosis (39%). In particular, athletes with ARVC were 6 times more likely to die on exertion compared to those with other cardiac pathologies, with 29% experiencing sudden cardiac death on the athletic field. Both of these conditions can be identified during cardiac screening although positive identification of such abnormalities would normally lead to immediate evaluation of the safety of an athlete continuing to take part in their sport at a competitive level.

In response to the publication of Dr Finocchiaro’s paper, CRY’s Consultant Cardiologist – and one the world’s leading experts in inherited heart conditions and sports cardiology, Prof Sanjay Sharma was interviewed by Cardio Source World News TV.

Speaking in Chicago, Prof Sharma said; “There is currently much contention about whether we should be spending a lot of money screening athletes who may be at risk.

“So we felt that one way of looking at this was to identify the true causes of sudden cardiac death to inform decisions as to how many of these would be picked up through pre-participation screening and in how many cases you would need an AED.

“We took advantage of our sudden cardiac death register (we have the largest in the UK).….and what we found was that 42% of the athletes had structurally normal heart, suggesting that in these cases the cause of death was an inherited or congenital electrical abnormality that could well have been picked up with an ECG, as part of pre-participation screening.

“Whereas the world often believes that the common case of sudden death in sport is a condition known as HCM, we found that is only made up 20% of all sudden cardiac deaths in our athletes”

Prof Sharma added; “The clinical message is that the vast majority of athletes die from electrical faults in the heart that could be picked up. The second point is that the conditions that are most commonly associated with exercise related sudden cardiac death are ARVC and a rather novel condition called LV that we need to investigate in more detail. Is this just a variant of HCM or is this something that could be acquired due to intensive exercise, when the heart becomes abnormally enlarged. Or could it be something completely different that needs further study?”

“In 42% of the cases there was nothing wrong – it was structurally normal! In our experience, when families are referred to our clinic, and all first degree relatives are screened, in around 52% of cases there is evidence of an electrical hereditary fault.

“So, the big debate is between taking a medical history and examination, versus history, examination and an ECG, which is the ESC viewpoint. If we are going to be looking after our athletes and we are the ambassadors of our athletes (man of whom are high profile) – then we should do things properly and we should include the ECG.”

Every week in the UK, 12 young (that is, aged 35 and under) apparently fit and healthy people die from a previously undiagnosed heart condition. Sport does not cause young sudden cardiac death, however, it will increase the risk by threefold if a person – who is pushing themselves to the limit physically – has an underlying condition they are unaware of.

80% of young sudden cardiac deaths will occur with no prior symptoms – which is why CRY believe screening is so vitally important. As such, CRY now screens over 23,000 young people aged 14-35 every year and one in every 300 of these young people will be identified with a potentially life threatening condition.

And, although screening will not identify all young people at risk, in Italy, where screening is mandatory for all young people engaged in organised sport, they have reduced the incidence of young sudden cardiac death by 89%.”

CRY funds a wider research programme that is building on understanding of the incidence of cardiac conditions in young people and informing national policy on best practice to minimise the incidence and impact of young sudden death.

Dr Steven Cox, CRY’s Chief Executive says; “We are delighted to see Gherardo’s research receiving such international recognition – including an editorial comment that praises his “meticulous study” and calls for further investigations based on his findings to “aid the worldwide efforts to improve screening’.

However, I still passionately believe that we also need to be focusing on widening access to screening to ensure that all aspiring young athletes – whether at an elite or grass roots level – can be tested and any potential risk can be assessed by experts.

“Many elite athletes will now undergo regular screening via by their club or governing body – whether routine or mandatory. That’s why CRY wants all young people to have access to cardiac testing. The captain of a school rugby team may well be playing almost as many hours as his friend playing in the youth academy of a professional team but will not have equal access to expert screening and therefore, protection.

“But, by simply clicking onto everyone – sporty or not – has the same opportunity to be checked out.”

For more details about the causes and diagnosis or ARVC, please watch this short film with CRY’s consultant cardiologist, Professor Sanjay Sharma