Looking Back at 25: CRY at the annual ESC Congress

This year, like so many other events, conferences and public gatherings, the 2020 European Society of Cardiology (ESC) Congress (29 August – 1 September) was held remotely, for the first time in its 50-year-history.

In a statement released during lockdown, organisers explained to delegates; “When one door closes, another opens.’ Due to the current pandemic… ESC Congress 2020 cannot take place as planned in Amsterdam. This, however, provides us with a most exciting opportunity: to disseminate the best ground-breaking cardiovascular science in a totally new, digital experience.”

CRY has a long track record of presenting impressive and important research at the ESC (as well as other international conferences) and this year was no exception, with Dr Joyee Basu delivering her pre-recorded talk on Tuesday 1st September (more details on this exciting CRY research to come soon… watch this space!)

So, looking back five years ago, to August 2015, a team of researchers, based at CRY’s Centre for Inherited Cardiac Conditions and Sports Cardiology, London and led by Dr Gherardo Finocchiaro (who at the time had been awarded one of CRY’s much sought-after Research Fellowships, under the supervision of Professor Sanjay Sharma) presented the results of an innovative new study looking into the most common causes of sudden death in athletes.

At the time, the findings were widely considered to be bringing new insight and evidence to the debate about proactive screening of elite athletes – and the potential implications on participation (and ultimately the career prospects) of sportsmen and women identified with specific conditions.

Dr Finocchiaro (whose abstract was also nominated for a Young Investigator Award) selected 357 cases of sudden death (from a cohort of 3684), all of whom had been engaged in regular (i.e. 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 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. Crucially, he noted, both of these conditions can be identified during cardiac screening and positive identification of such abnormalities would likely lead to immediate evaluation of the safety of an athlete continuing to take part in their sport at a competitive level.

Overall, SADS (sudden arrhythmic death syndrome) was the most common cause of death amongst the athletes analysed (indicating a problem with the ‘electrical wiring’ of their heart leading to a fatal arrhythmia rather than the structure of the heart as seen in ARVC and LV). SADS caused 44% of the sudden deaths in the age group 18-35 and 56% in the under 18s – although of these deaths, 54% were observed in athletes who were “at rest” rather than involved in physical activity at the time.

The study – which also went on to receive unparalleled praise from, Dr Valentin Fuster (Editor in Chief of prestigious journal, JACC) – highlighted the need for further research into why heart muscle conditions, such as ARVC pose such a threat to healthy young athletes whilst exercising.

Studies into the causes and “triggers” of ARVC or arrhythmogenic right ventricular cardiomyopathy, (a hereditary condition, with very few, obvious symptoms to raise “alarm bells”) had a special resonance for CRY back in 2015 as the charity marked its 20th anniversary year. Two decades before, in 1995, some of the very first bereaved parents to become involved with CRY were John and Maureen Marshall from Ormskirk in Lancashire. Their 16-year-old son John had collapsed and died suddenly, the day before he was due to sign with Everton. He was later found to have been suffering from ARVC.  Their experience and subsequent support of CRY led to high-profile and unprecedented media awareness of ARVC and other devastating conditions that could cause sudden cardiac death.

Speaking in August 2015, Dr Steven Cox, said; “Since the collapse of Fabrice Muamba in March 2012, we have seen a significant increase in awareness of young sudden cardiac death, especially in football and other elite sports.

This has led to the view and possible misapprehension that the incidence of these young, sudden cardiac deaths in sport is rapidly increasing. However, what we should be focusing on is the need to widen 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.

He added: “The fact is most elite athletes will now undergo regular screening via by their club or governing body – whether routine or mandatory. That’s why CRY continues to campaign for 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.

Dr Finocchiaro went on to say; “Young sudden cardiac death, whatever the circumstance or the cause, has a catastrophic effect on families and entire communities. Our team of CRY researchers are all committed to improving the overall understanding of why these seemingly inexplicable deaths occur and ultimately, how they can be prevented. 

“Research – underpinned by a widespread screening programme – holds the answer to identifying those people most at risk and will allow us to be able to develop robust, evidence-based advice for young people, especially those wishing to pursue sporting careers.”

5 years on, CRY continues to fund a pioneering programme of research that has an international reputation for building on the understanding of cardiac conditions in young people (whether athletes at an elite or grass roots level or within the general population). CRY-funded research also continues to inform national policy on best practice to minimise the incidence and impact.

CRY’s “digital delegates” continued to have a presence and a voice at the 2020 ESC Congress (a conference which attracted 120,000 people to register and join online), ensuring we are always at the heart of cutting-edge progress and developments. Professor Mary Sheppard from the CRY Centre for Cardiac Pathology gave a presentation entitled “Autopsy investigation and the need of uniform protocols in sudden cardiac death,” while Dr Joyee Basu discussed her research which underlines the need for a personalised approach to ‘safe exercise’ for young people living with heart conditions. Again, we will be looking at Dr Basu’s research in more depth soon, so keep a look out here on the CRY website.