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Screening athletes for cardiovascular disease in Africa: a challenging experience
  1. Christian Schmied1,
  2. Fernando M Di Paolo2,
  3. A Yacine Zerguini3,
  4. Jiri Dvorak4,
  5. Antonio Pelliccia2
  1. 1Cardiovascular Center/Sports Cardiology, University Hospital Zurich, Zurich, Switzerland
  2. 2Institute of Sport Medicine and Science, CONI, Rome, Italy
  3. 3Clinique Chahrazed, FIFA Medical Center of Excellence, Cheraga, Alger, Algeria
  4. 4Fédération Internationale de Football Association (FIFA), and Schulthess Clinic, Zurich, Switzerland
  1. Correspondence to Dr Antonio Pelliccia, Institute of Sport Medicine and Science, Department of Medicine, Largo P. Gabrielli, 1, Rome 00197, Italy; ant.pelliccia{at}libero.it

Abstract

Aims Preparticipation cardiovascular (CV) screening has been advocated as an efficient strategy to reduce sudden cardiac death in Caucasian athletes. At present, uncertainty remains if such strategy is feasible and efficient in native African athletes. To this scope, we performed a CV screening in an African setting.

Methods 210 male Gabonian football players were examined with history, physical examination, ECG and echocardiography.

Results On history, 19 players (9%) referred atypical chest discomfort/oppression. Familial sudden death was referred by 36 (17%). No anomalies were detected at physical examination. ECG showed large proportions of ‘training-related’ abnormalities, that is, ST-segment elevation in precordial leads in 150 (71.4%), and isolated increase in R/S-wave voltage in 116 (55.2%). A substantial subset (12.4%) showed ‘training-unrelated’ abnormalities, that is, inverted T-waves in 10 (4.8%), left atrial enlargement in 8 (4%), deep Q-waves in 3 (1.4%). On echocardiography, one athlete meet criteria for hypertrophic cardiomyopathy (HCM); none showed evidence for arrhythmogenic right ventricular cardiomyopathy (ARVC) or dilated cardiomyopathy (DCM). Other abnormalities included mitral valve prolapse in three, atrial septal defect in two and pulmonary hypertension in one.

Conclusions About 12% of native African athletes showed ECG abnormalities unrelated to training and requiring additional testing and periodical follow-up. Structural abnormalities were found, however, in a minority (5%), including HCM in one, but no ARVC or DCM. In conclusion, this study demonstrates that preparticipation CV screening is efficient to identify (or raise suspicion) for CV abnormalities in native African athletes, but challenging for conclusive identification of cardiac diseases in the difficult scenario of a developing African country.

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