SCREENING FOR HYPERTROPHIC CARDIOMYOPATHY IN YOUNG ATHLETES

Background For more than 20 years in Italy, young athletes have been s creened before participating in competitive sports. We assessed whethe r this strategy results in the prevention of sudden death from hypertr ophic cardiomyopathy, a common cardiovascular cause of death in young athletes. Methods We prospectively studied sudden deaths among athlete s and nonathletes (35 years of age or less) in the Veneto region of It aly from 1979 to 1996. The causes of sudden death in both populations were compared, and the pathological findings in the athletes were rela ted to their clinical histories and electrocardiograms. Cardiovascular reasons for disqualification from participation in sports were invest igated and follow-up was performed in a consecutive series of 33,735 y oung athletes who underwent preparticipation screening in Padua, Italy , during the same period. Results Of 269 sudden deaths in young people , 49 occurred in competitive athletes (44 male and 5 female athletes; mean [+/-SD] age, 23+/-7 years). The most common causes of sudden deat h in athletes were arrhythmogenic right ventricular cardiomyopathy (22 .4 percent), coronary atherosclerosis (18.4 percent), and anomalous or igin of a coronary artery (12.2 percent). Hypertrophic cardiomyopathy caused only 1 sudden death among the athletes (2.0 percent) but caused 16 sudden deaths in the nonathletes (7.3 percent). Hypertrophic cardi omyopathy was detected in 22 athletes (0.07 percent) at preparticipati on screening and accounted for 3.5 percent of the cardiovascular reaso ns for disqualification. None of the disqualified athletes with hypert rophic cardiomyopathy died during a mean follow-up period of 8.2+/-5 y ears. Conclusions The results show that hypertrophic cardiomyopathy wa s an uncommon cause of death in these young competitive athletes and s uggest that the identification and disqualification of affected athlet es at screening before participation in competitive sports may have pr evented sudden death. (N Engl J Med 1998;339:364-9.) (C)1998, Massachu setts Medical Society.