In April, CRY’s Research Fellows attended EuroPRevent 2011. Organised by the European Society of Cardiology (ESC), it is the biggest meeting in Europe on Cardiovascular prevention and rehabilitation. Held over 3 days, it includes meetings, presentations and courses with the aim of advancing knowledge. Both existing and previous CRY Research Fellows presented their research to attendees from all over the world.
CRY Research Fellow Dr Nabeel Sheikh was nominated for the Young Investigator of the Year Award.
- What is the Young Investigator Award?
The Young Investigator Award is something that’s open to those under 35 years old and for original research. When everybody submits abstracts to EuroPRevent those abstracts are marked and the ones deemed to be of the most outstanding quality and with the potential to have significant clinical impact in day to day practice get shortlisted to go forward to the Young Investigator Award.
- What was your research about?
My work was an extension of work that Professor Sanjay Sharma has done previously looking at ethnicity and changes that people get on their ECG and on their ECHO. We know from work in adult athletes that African/Afro-Caribbean (black) athletes are prone to get more changes on their ECG and ECHO in terms of a larger wall thickness compared to Caucasian (white) athletes and that has a significant impact because we think that a lot of these changes are related to race rather than pathology. However, those changes can also overlap with pathology so the question is therefore when we see these changes does this mean that this is just a normal ECG and ECHO for a black person or is this something more? From the work we’ve done previously in adult athletes we’ve got quite good evidence that certain changes are more in keeping with ethnicity. So if we see certain changes on an ECG in a black person we know from past experience that those could well be normal for them so that prevents them undergoing unnecessary investigation, reduces potential for false and unfair disqualification and also stops anxiety. To an athlete it’s a big deal if somebody tells them that ‘oh, you’ve got a problem with your ECG, you’ve got a problem with your ECHO, you’ve got to have more investigations’. They’re not only worried about themselves but it’s their whole career that we’re talking about.
This previous work has only been looking at the adult population but nobody’s ever looked at black adolescent athletes. Obviously that’s a completely different age group and our question was: should we be extrapolating data that we’ve got from adults to adolescents? Can we apply the same criteria to young people? Does that work? And that’s what I was looking at. This is also important because black athletes and adolescent athletes are two groups that have been shown in various studies to be at the highest risk of sudden death. So we were looking at the group that are at highest risk of sudden death in terms of athletes and paradoxically they’re at highest risk but they’ve never been looked at before so that’s why we felt it was important to do.
- What did the research actually show?
We took a group of black adolescent athletes and compared them to a group of white adolescent athletes and also compared them to a black control group – a sedentary group defined as somebody who exercises for 2 hours or less a week. We showed that compared to white athletes even black adolescent athletes develop more changes on their ECG and more changes on their ECHO. It is in keeping with the same things that we found in adults although the values are less. For example, in terms of the maximum amount of left wall thickness they do get more than white athletes but less than the adult population do. So that’s important because it does show that we can’t extrapolate the adult results to them.
- When you say ECG changes, do you just mean changes from what is considered normal?
Yes. There are changes that are quite common in athletes which we know are related to athletic training and those are found across the board; black, white etc., but there are ECG changes that should not be found in an athlete and those changes in particular are the ones that are found in diseased states. However, those changes are also more common in black adolescent athletes due to race rather than problems so that’s the thing that we were trying to clarify.
You mention that the black adult data can’t be extrapolated to black adolescents. Is it also the case that white adult data can’t be extrapolated to white adolescents?
Absolutely. Obviously there are a number of issues, by definition adult athletes are older in terms of age but some of them might tend to do more exercise or more intense exercise compared to youngsters. So it is important to have different sets of values for different age groups.
- How did you find giving your presentation? Were you quite nervous?
It was the first time I’ve done anything like this so I was nervous, but I was also looking forward to it because it’s a great opportunity to advertise CRY, and the kind of research we’re doing through CRY, and also a good opportunity for me to put out the research that I’ve done. It was also a great opportunity to get experience in an international conference presenting to an audience. Although it was nerve-wracking, and for a 10 minute presentation it did require weeks and weeks of work if not months of work, it was still worth it because it gave me great experience of something I’ve never done before.
- How would this relate to the CRY research programme and the CRY screening programme and how can we use this data?
It’s really important actually, especially now we’re doing more and more school screenings and, even though schools are technically not classed as athletic or sports screenings, you do find that a lot of young people do a lot of exercise. It gives us a basis to be able to correctly interpret the ECG and ECHO findings rather than just using adult values. We’ve now got another set of values that we can use that will enable us to be better able to judge ECG changes and ECHO changes in young adolescents, what they mean and whether they have any significance or not.
We hope to publish the research, but it is still incomplete. We need to follow-up these people, looking particularly at those who have got ECG and ECHO changes, and see what happens to them. Whilst we have tested them all comprehensively and not found any problems in anyone, it’s still important to follow them up long-term to see whether that remains the case. It’s only then that we will have a complete picture and be in a position to say ‘yes these ECG changes mean nothing’ and ‘these ECG changes, because we’ve followed these people up and maybe one or two of them have got problems, might warrant more investigations at the time of screening’.