Background A variety of cardiovascular abnormalities have been found to be responsible for sudden cardiac death(SCD) in competitive athletes. The lesions responsible for athletic field deaths differ with regard to age and vast majority of SCD occur in athletes aged <18 yrs. Appropriate pre-participation screening (PPS) of young competitive athletes can reduce their risk for SCD.

Objective To analyse cardiovascular findings obtained in the pre-participation screening of elite Georgian adolescent athletes.

Design Observational follow-up study.

Setting Sports Medicine and Rehabilitation Clinical Centre.

Patients 227 asymptomatic elite adolescent athletes (83% males), age 15,4±1,6 years, representatives of national teams of 9 sporting disciplines.

Interventions The participants underwent cardiovascular(CV) evaluation with medical history, physical examination, 12-lead resting and exercise ECG, and transthoracic echocardiography (TTE) in 2013–2015.

Main Outcome Measurements The participants were followed prospectively until July 2015 with respect to clinically significant cardiovascular abnormalities, and until July 2016 with respect to safe return to sport.

Results Resting ECG revealed common/training–related ECG alterations in 70 (31%) athletes, as well as uncommon/training-unrelated changes in 5 (2,2%). TTE revealed mitral valve prolapse in 8(3,5%) athletes, bicuspid aortic valve in 1(0,4%), and signs consistent with anomalous origin of left coronary artery from the pulmonary artery(ALCAPA) in 1 (0,4%) athlete. Stress test revealed decreased exercise tolerance and negative T-waves in V4-V6 in this athlete. Athlete was directed to further CV investigation and CT angiography led to the diagnosis of ALCAPA. Coronary artery bypass grafting was performed. After treatment athlete underwent cardiac rehabilitation program and risk-stratification before entering sports activity. As subendocardial ischemic pattern still existed, the athlete was advised against current participation in competitive sports. Follow-up over a longer period has been planned.

Conclusions PPS is significant tool to identify adolescent athletes at risk for exercise-induced SCD. As coronary anomalies are among the common reasons for SCD in young athletes, timely identification and appropriate clinical management, including considerations regarding safe return to sport are necessary.