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Preparticipation screening for the detection of cardiovascular abnormalities that may cause sudden death in competitive athletes
  1. F Pigozzi1,
  2. A Spataro1,
  3. F Fagnani1,
  4. N Maffulli2
  1. 1Sports Medicine Unit, University Institute of Movement Sciences (IUSM), Plazza Lauro de Bosis, 6-00194 Rome, Italy
  2. 2Department of Trauma and Orthopaedic Surgery, Keele University School of Medicine, North Staffordshire Hospital, Thornburrow Drive, Hartshill, Stoke on Trent, Staffordshire ST4 7QB, UK
  1. Correspondence to:
 Professor Maffulli;

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Preparticipation screening may prevent sudden cardiac deaths in sporting events

The American Board of Medical Specialties lists sports medicine as a broad area of health care that includes:

  1. exercise as an essential component of health care throughout life;

  2. medical management and supervision of recreational and competitive athletes and others who exercise on a regular basis;

  3. exercise for prevention and treatment of disease and injury.

It combines disciplines from applied physiology to those encompassing clinical, therapeutic, and rehabilitative topics. The preventive aspects of sports medicine are coming of age. Sport is a vehicle for wellbeing and prevention and treatment of diseases, although it can sometimes also represent a risk to health in cases of unacknowledged or asymptomatic pathologies, the most dramatic resulting in sudden cardiac death (SCD) which occasionally strikes apparently healthy athletes.1,2 SCD is a most tragic event, stirring public opinion and commanding a high profile. It is rare, and identifying athletes at risk is a daunting problem. By considering the epidemiology of SCD in athletes and using preparticipation screening (PPS),3–5 as well as estimating the efficacy of instrumental investigations, adequate prevention can be implemented.


Compared with the risk of sudden death in general, the incidence of sports related SCD is low—about 1 event per 100 000 adult athletes per year. The risk increases with age and is more common in men.

There are striking geographical differences. In North America, hypertrophic cardiomyopathy (HCM) is the leading cause of SCD in athletes. In Italy, the most common cause is right ventricular cardiomyopathy. In Germany, there is a high proportion of myocarditis. In China, a major cause is Marfan syndrome. In athletes younger than 35, the most common cause is almost invariably severe coronary artery disease.

A primary goal for prevention should be to identify cardiac pathology …

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