Utilization and Implementation of Sports Medical Screening Examinations – Survey of More Than 10 000 Long-Distance Runners: Sudden Cardiac Death

by Prof. Dr. med. Dr. Sportwiss. Dieter Leyk, Dr. Sportwiss. Thomas Rüther, Dipl.-Sportwiss. Max Wunderlich, Dipl.-Sportl. Alexander P. Sievert, Dr. med. Oliver M. Erley, Prof. Dr. med. Herbert Löllgen in volume 36/2008

We agree wholeheartedly with the authors in emphasizing the great importance of examinations performed by qualified sports physicians. They also rightly emphasize that the proportion of overweight, untrained persons and other risk carriers is increasing steadily in open, competitive sports and popular sports. On this background, we are surprised to find that the cited guidelines on preventive examinations in sports list merely a resting ECG as an obligatory apparative investigative measure for each subject, whereas the exercise ECG is apparently indicated only for certain subgroups and further tests-such as lung function and echocardiography—only in persons in whom certain conditions are suspected or symptoms found.

It has been sufficiently confirmed that cases of sudden cardiac death during sports activity—even in celebrated athletes—are often caused by cardiomyopathies or other structural cardiac anomalies, which were not known during the person's lifetime. Coronary heart disease is also increasingly found at a younger age. The youngest patient with a coronary bypass who is personally known to me was operated on at the age of 25; the youngest patient known to me who died suddenly from infract-related cardiac death without any preceding symptoms (diagnosis made at postmortem) was only 24.

In view of these aspects it seems to make sense to extend the apparative part of a sports medical screening examinations to include a 12–lead exercise ECG and echocardiography. Both methods can make a great contribution to detecting hemodynamically relevant coronary insufficiencies, potentially life threatening exercise induced arrhythmias, cardiomyopathies, right ventricular dysplasias and aortic stenoses even at clinically inapparent stages. Such additional diagnostics are likely to facilitate a far wider reaching diagnostic clarification that would enable to select early on those subjects with a potential risk factor. Future guidelines should reflect this state of affairs.
DOI: 10.3238/arztebl.2008.0900a

Prof. Dr. med. Jörg Piper
Meduna-Klinik
Clara-Viebig-Str. 4
56864 Bad Bertrich, Germany
E-Mail: [e-mail]