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Debate: challenges in sports cardiology; US versus European approaches
  1. Bruce Hamilton1,
  2. Benjamin D Levine2,3,
  3. Paul D Thompson4,5,
  4. Gregory P Whyte6,7,
  5. Mathew G Wilson1
  1. 1Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  2. 2Institute for Environmental Medicine, Presbyterian Hospital, Dallas, Texas, USA
  3. 3Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA
  4. 4Department of Cardiology, Hartford Hospital, Hartford, Connecticut, USA
  5. 5Department of Medicine, University of Connecticut, Connecticut, USA
  6. 6Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
  7. 7Centre for Sports Cardiology, 76 Harley St, London, UK
  1. Correspondence to Dr Bruce Hamilton, Department of Sports Medicine, ASPETAR; Qatar Orthopaedic and Sports Medicine Hospital, PO Box 29222, Doha, Qatar; bruce.hamilton{at}

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Introduction (Bruce Hamilton)

For practitioners working with elite athletes, the field of sports cardiology provides clinical, academic, administrative and fiscal challenges. These challenges are exemplified and reinforced by the lack of consistency and consensus both in the literature and academic presentations. Through the presentation of a series of clinical questions, this debate attempts to ‘cut to the chase’ on cardiovascular issues relevant to the clinician dealing with elite athletes. In so doing, we hope to crystallize some of the most important elements of the complex cardiological management of elite athletes, in a concise, readable format. Frequently over the last 10 years, many of the controversies in this field have been (rightly or wrongly) presented in a Europe versus USA paradigm. We have chosen to test whether there really are polarised views across the Atlantic, by deliberately pitting specialists from the USA against those from the UK. Professors Levine and Thompson are both internationally recognised sports cardiologists, with immense academic and clinical credibility, and who will represent the ‘US approach’. Professor Whyte and Doctor Wilson are cardiac physiologists with a wealth of experience in the testing, evaluation and screening of elite athletes, and who have equally impressive academic credibility and for the purposes of this debate, they will be representing the ‘European approach’. To initiate this process, each team was required to provide a concise answer (circa 200–300 words) to a series of five clinical conundrums. Subsequently, each team had the opportunity to provide a rebuttal to the opposing team's answers, and the following reflects the consolidation of those answers.

Question 1

A popular debate in the literature and the conference podium is the clinical utility of the ECG in the preparticipation screening of athletes. If one assumes that the overall cost:benefit of cardiac screening for athletes remains to be determined, is it now established that the …

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