The preparticipation cardiovascular screening of competitive athletes: is it time to change the customary clinical practice?

The recent 'Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update', state that it is not 'either prudent or practical to recommend the routine use of test such as 12-lead ECG' into the preparticipation screening, in contrast to previous Recommendations of the European Society of Cardiology (ESC) and the International Olympic Committee (IOC). This comment was, therefore, prompted by the personal consideration that it is timely and appropriate to clarify the rationale of the European Recommendations, in an effort to achieve an agreement on this controversial issue. The strongest evidence supporting the need for 12-lead ECG into the screening programme is the demonstration for substantial decrease in sudden deaths in screened individuals, compared with not screened ones (i.e. 3.6-0.4 deaths x 100 000 person-years in the period 1979-2004), associated with a concomitant increase in individuals identified with cardiomyopathies (4.4-9.4%). Indeed, implementation of the 12-lead ECG appears to be associated with only a small proportion of abnormal findings requiring additional testing (such as inverted T waves, increased R/S wave voltages suggestive for LV hypertrophy, major conduction disorders), i.e. about 5% of a large, unselected population of 32 652 individuals. We believe, therefore, that a critical reassessment of the current customary clinical practice is needed for preparticipation screening. In particular, this change seems appropriate for elite athletes, a selected cohort of top-level competitors who have financial resources for a more comprehensive screening process.