Cardiac imaging delivers mixed results in preventing heart-related deaths in young athletes

A 20-year study compiled cardiovascular screening exams from more than 11,000 adolescent soccer players in the U.K. It found that routine cardiac imaging tests prevented an insufficient amount of heart-related deaths from physical activity.  

The findings showed that diseases associated with sudden heart-related death were identified in 42 (0.38 percent) of the soccer players that underwent cardiovascular screening, according to the research published Aug. 9 in the New England Journal of Medicine.  

Data for the study were from the English Football Association (EFA)’s mandatory cardiac screening program that consisted of health questionnaires, physical examinations, electrocardiography and echocardiography testing for adolescent soccer players in the U.K. from 1997 to 2016.  

The EFA also partly funded the cardiac screening research, which until recently has been lacking and therefore making risk of sudden cardiac death difficult to measure, explained lead author Aneil Malhotra, PhD, a cardiologist at St. George’s, University of London, and colleagues. 

In total, 225 (2 percent) of athletes with congenital or valvular problems were identified in the study cohort, Malhotra and colleagues wrote.  

After screening, 23 deaths occurred from any cause, eight (35 percent) of which were due to cardiac disease. Seven of those eight deaths were attributed to cardiomyopathy, according to the researchers, and six individuals had normal cardiac screening results.  

The researchers also found that sudden cardiac death occurred in one per 14,800 person-years, or 6.8 per 100,000 athletes. Most of these deaths were attributed to cardiomyopathies not initially detected on screening, the researchers noted.  

The average time between screening and cardiac death for the adolescent soccer players was 6.8 years. But researchers explained that their study does discourage athletes from cardiac screening.   

“Screening at this age seems logistically appropriate, given that most people will be post-pubertal and will have overt evidence of any electrical or structural cardiac abnormalities,” Malhotra et al wrote. “However, this study shows that screening during late adolescence will fail to detect a substantial proportion of athletes who have or will eventually have a cardiomyopathy, either because the disease is not yet manifest or because electrocardiograms and echocardiography are not sensitive enough to detect early disease in some adolescents.”