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Screening for heart disease in sports – nonsense or necessary?
Matthias WILHELM
Friday, Sept. 22, 2017 · 11:16 a.m. · 21m 25s
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00:00:01
thank you for the nice introduction have to excuse i just the recovered from code so my voice is not the best
00:00:07
or would like to thank the organ others in particular boris beyond which to invite
00:00:12
it's a very exciting meeting i think a multi disciplinary to if the key
00:00:17
in madison and of course also in the care of our young outlet
00:00:22
so before starting in the these huge accident cutting this was maybe a little
00:00:27
bit scanning it's very important to to to to make the statement
00:00:32
and it's at let's live longer than the general population and
00:00:35
they have a lower risk of cardiovascular disease and cancer
00:00:39
even if we go to high risk sports like erin tunes boards
00:00:43
and and cycling was all the problems about hoping if you
00:00:47
compare these uh let's to the general population get on in
00:00:50
france they have a lower mortality than the average population
00:00:56
and this has been concluded by philip clark survival of
00:00:59
the fittest so many explanations but i think
00:01:02
if you are capable of doing athletic activities you may have better gene so
00:01:07
you are prepared for doing so and i think this is very important
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if the council our young children want to stop and let a carrier there on no
00:01:18
no really dangerous or harms for the hot but having fed this
00:01:23
there has situation and that's yeah selected individuals at risk
00:01:27
and of course you can imagine if you see situations like this on the television
00:01:32
where you see and apparently hell see at let's call that thing in a large stadium
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and this is a talking point in the made yeah then there's of course the
00:01:41
question of society can't be proved prevent
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situations like this cannot be screen
00:01:48
b. s. medical doctors uh sometimes also a little bit for so
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doctors do something against why these later had to die
00:01:57
and there are working group to ask for this is
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an example from the european society of cardiology
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and in two thousand five they pro host a
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screening propel per protocol in addition to other
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uh medical tests done always young athletes a young
00:02:15
competitive at that's the definition is not
00:02:18
very clear it may start between twelve or fifteen years of age normally squat athletes
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beside the family and personal history and
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physical examination this working group suggested
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to include also a special cardiology work about twelve lead
00:02:36
e. c. g. addressed to screen for optimum optics
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but this protocol has to be in a discussed uh and it's still discussed very controversial
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and was some groups speak of compelling evidence this this
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may reduces the risk of sudden cardiac death
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others say that we have insufficient data and that we
00:02:58
also have to expect the autonomy or of
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the object so the objectives of my talk am to i choose to ski in picture that
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don't to me d. over the likely more still some whites who you can start skiing soon he uh maybe
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and i will do a slap on about the incidence in courses of sudden cardiac that's in sports
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pray participation screen of the role of the electric carter graham and also some words
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on the bottom of the at that i think this is very important
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when we speak of incidences of sudden cardiac desk doing athletic
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activity there are different numbers and rough you can say
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two athletes out of one hundred thousand per year will die however
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age sex or level and ethnicity have a major impact on so
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on the the left side you see a high school that
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and in high school that lets this maybe as low as zero point one per hundred thousand per year
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so maybe concussion is a much more problem in these at that then some cutting yes
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but on the other hand they asked selected risk loop especially black eye it's because black missy t.
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as a higher risk for some on the line mile kind of disease
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and if these that let's play in the premier league the risk is high up to nineteen
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per one hundred thousand per year and it becomes quite a problem in this population
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the traditional view is that there are some major on the line crosses off these diseases they have
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very difficult to pronounce names i just picked out two on the left side
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you see a normal hard on the upper panel you see a
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normal hopping autopsy and on the lower part to see a micro cock
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oscar preview of the meyer cardio fibres in in the middle
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is the hype the traffic condom obviously if you see that the walls of the
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maya condom effect and this is quite prevalent in the us and you see then on the
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micro should be area that they are some blue lines this is fibrosis call again
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on the right side it's it's more prevalent and in italy especially in that we need to region of italy
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i read more jenna gripe ventricular condom obviously the term
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con you might oppose the use or with that
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so it's a disease of the mile card and and you
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see that muscle is replaced by scar infected tissue
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and this may create as substrate from eventually could i recently
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us under exertion souls yeah that's maybe completely fine address
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they may be completely out into magic but i'm just sit via
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exercise condition especially in start stop sports like soccer also basketball
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this may lead to venture colour is mute and then to some cut it does and of course you can screen for these
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uh i i reserve for these on the line cut him up sees because normally they can be detected by nice e. g.
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however it's very important to look uh what can
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be other courses and that you'd distribution
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of courses of sports related some card i guess depends also on what does
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the uh forensic medicine the pathologist does because uh
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the results that you receive then say the proportion this is out to the real busy
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graph just illustrating that they um many other courses
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uh that can produce some contact us and not or courses for example on the right side
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coronary artery abnormalities you cannot screen for this so you will miss this during screen
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there's some conditions well sporting activity may also e. t.
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uh to a condom up the this is shown here in the
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case of c. i. with magenta cried ventricular cloudy morbidity
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where i came with patient that mail each to dress most normal
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dysfunction these are some proteins connecting muscles in the heart
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and sports activity may lead to affect not
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to pick expression of the genetic disease
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so if you do not to sports you will never develop this phenotype
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but if you do high volume sports you may develop this final
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type of these aren't magenta right ventricular card remote with the
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and then sports activity may lead to disease progression
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ventricular dysfunction and also it may trigger a reason yes
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like on the right side ventricular is met them beating tucson project s. due to
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cardiac arrest and we have to keep in mind that the the driving
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for us for screening this comes from italy namely from that we need to region of italy
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where this form the i read magenta cried ventured black friday more but these very prominent
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this is a very uh most of the cases in this area up but
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you two are right magenta cried ventricular cut him up to see
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and you see here what way prevented it's uh just an observation of study
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and when they started a mandatory easy g. screening in sport athletes
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i would drop the dramatic drop of screen i let's so off to several
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years they reach the level of non screen to on screen not outlet
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and this is the reason why they say look we introduce the
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screening and then the rate of sudden cardiac guys were reduced
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however these results when not rapid used in other countries for example the user l.
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they also had a sports lore and they did not found the substantial
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decrease interestingly they did not only compound the period after the key
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well you might have the impression that there's a drop like you
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need to be they also compared the period before they speak
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and the explanation is maybe these key is just by chance and
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overall we did not change it and of course we
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have to be reminded from statistics association it's never causality so
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this study from it really does not prove anything
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well in the german speaking part of switzerland to see this is north of
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the us this the need to reason we have the option to compare
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also the inhabitants back comparable the courses of sudden cardiac guess he and switzerland
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set up a red just is was registry of sports related sudden cardiac does swiss we got
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and you see we included that it's from the age of ten up to the age of thirty nine
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and what we found in switzerland is comparable to israel we had lower
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foreign cardiac death during competitive sports come out and support
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and early screening late screening no real trends so also in switzerland not right
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interesting when we look for the cost to see and switzerland we found
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that the most prevalent courses in the young competitive upload well and
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we were very astonished that she would smile card infraction
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should mile cardin function is a disease of the coronary arteries may have blocks
00:10:00
then maybe a lot rapture then the across and then these arteries on what
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so reading to a mile caught inflection and this may also each worrisome yes
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first you cannot screen for this and on the other hand the
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condom artist sees the very low in switches with that so
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and we first supported by the now nearly best study in the field
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published in the new england journal this is a prospective study was a very
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good follow up of the autopsy cases in australia and new zealand
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and they look for sudden cardiac death cake is in the young and what you see here is the same picture like in switzerland
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coronary artery disease and unexplained cases where the
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most common causes whereas our agenda cried
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country club plenty more with the and hyper tropical democracy will not so prevalent
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some really speaking for that then maybe regional differences in distribution
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course it till you had a high prevalence of origin it right front regular
00:11:00
cut him up with the in their region they found this to secrets
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moreover it's very interesting we always speak of exercise related sudden cardiac
00:11:09
desk but we have to keep in mind that in
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absolute numbers for the young it's much more likely to have
00:11:16
on the line diseases way of died when sleep rest
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all light activity and exercise and post exercise are rare condition
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if we speak of young children then we have just
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a risk increases after an age of sixteen
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all the very young at the very look like leaves those this sudden infant death syndrome here
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a directory of to both the then when the youngsters
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start the sport activity their wrist is very low
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and it's status increases with the age of thirty one to thirty five so
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children and young adults had in addition to what i said
00:11:56
so if we then come to the principles and cracked just for
00:12:00
screening published by wilson and younger for the w. h. o.
00:12:05
the first if the conditions so not to be an important health problem
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and when we prevent the destined young individuals aged lower than twenty five
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if you put whiskey into effect of light in this prophecy we have
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motor vehicle accidents we have can so we have major cardiovascular disease
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and at its with the disease detectable by u. c. g.
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screening is here so from and public health perspective
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definitely not a real big problem and as previous speakers said
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in our society the most important problem is inactivity and not letting cacti
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but on the other other hand while i prepared to see
00:12:47
patients screening wasn't easy she has to be evidenced based
00:12:51
and follow general general principles of screening there other tools that we use
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if you wind the swiss mountains and you have a chalet and you have a fireplace of course
00:13:02
have a file extinction but you never use it so what is the evidence base for using this tool
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so what is the question is what is about the u. c. g. is it necessary that is has to be
00:13:13
evidence based there are several statement this is the reason to
00:13:17
want published by launch society youth in the field
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and at least they say it should be considered for individuals
00:13:25
performing regular intense exercise after proper information of both benefits
00:13:31
but also of its limitations but when we then look what what's
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what's happening out there in in in in in the
00:13:39
sports uh so side to use the international olympic committee lodge
00:13:43
societies they recommend screening protocols including the e. c. d.
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so never that if we do a scientific debate about the evidence
00:13:54
of the u. c. g. screening yes or not it will be done anyway they just implemented it in screening
00:14:00
and you see the ah federation internet so the more the cyclone they also do and
00:14:04
echo card you run i think if you if you if you are a drive the
00:14:09
car then you have other is then then then coronary artery disease like rapture
00:14:13
but on the other hand national basketball association that they're useful to
00:14:19
have an e. c. g. implemented because of the high
00:14:22
proportion of black updates as as i showed higher cardiovascular base
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so coming back for example to to some examples from
00:14:31
to switzerland but we participation screening for whom
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i think definitely not a mouse screening of the very on these
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uh pictures of the ten mile radius run clear i've been
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these are very youngsters they can participate of course without screening
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despite the fact that we do some competitive running
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if you wanna gymnast clout if you ah john female your risk is extremely low
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no benefits of screening but if it comes in terms of sport athletes
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one can say you should you could do is especially since it's implemented it's very easy to
00:15:06
implement the easy g. in the read shoot every routine physical examination of these that that's
00:15:13
so when it comes to the test s. would use you to build test to examination
00:15:18
and this test should be acceptable to the population and that we can say yes
00:15:23
the elect to got carted around his chest best suitable it's non invasive
00:15:28
it's can be done very very shortly so so i think the
00:15:32
test every at bat can have any c. g. without uh
00:15:36
uh problems it's not a has risk uh for the at its its opposite to an x. ray for exam
00:15:42
and there have been proposed several i recent how to interpret the admit of the the usage of
00:15:49
see at that because it's difficult because of the changes of the hardly at its heart
00:15:54
you cannot use standardise criteria you use for sedentary people and you see
00:15:59
the evolution of this recommendation when you was just published this year
00:16:04
yeah and now consensus documents international recommendations for electric
00:16:08
product graphic interpretation net let's and these recommendations
00:16:13
let's do something very important they increased
00:16:17
specificity was out reducing sensitivity
00:16:21
sensitivity means if you have really and and it was a disease it should be detected by the other reason
00:16:27
these are the evolving uh who wasn't and these are at its was hyper tropic condom up with the
00:16:32
and with the higher sensitivity you detect these that lets the really the the new ones
00:16:38
but on the other hand you increased specificity meaning the athletes that have uh
00:16:44
oh wrong easy g. an abnormally c. g. is no always the newest
00:16:48
criteria and this is very important because if you tell the outlet
00:16:52
you have an abnormally c. g. this has also psychological consequences and increase the cost
00:16:58
for downstream stuff things so if you use the s. e. c. g. you
00:17:01
have to be trained and you have to use one crutch yep
00:17:05
and we have enough for you from t. c. no has uh done a nice a publication where he
00:17:10
this is for athletes in the southern part or for switzerland and the italian speaking part of switzerland
00:17:16
and he came to the conclusion that party was cloud screening is feasible in switzerland
00:17:21
also at reasonable cost a diagnosis and we did a study together with this
00:17:27
with them big medical centre in marketing and where we come hat
00:17:32
different criteria and if you take your hands with valid
00:17:36
outlets mostly caucasian this is a limitation because
00:17:40
if you have are the this is to use then your false positive maybe higher
00:17:44
but you end up with one percent or three percent of up
00:17:49
normal easy jeez and so you can clear immediately more than
00:17:53
ninety seven percent of outlets and can say well everything is okay and this gives them of course also good got
00:18:01
let me finish with one case to come to the point of autumnal me
00:18:05
this is a professional track cyclists attract a cyclist wasn't normally c. g.
00:18:10
if you are familiar with c. c. g. you will find here t. wave in versions this is definitely not
00:18:16
uh commenting on it since it's not training related this is a clear up normally
00:18:21
easy g. but this ad let happen also the terms and no history for some cutting destinies them like a ah
00:18:29
several downstream tests were done so it became very costly up to an m. r. i. of the hot
00:18:35
unfortunately is not running but you may see that the walls of this hard a little bit second
00:18:40
and this you know straight that we have sometimes the problem that we are in a grey area
00:18:45
where we cannot differentiate the o. needs art form for example hype the traffic on democracy
00:18:53
but what should we do now with these ugly the problem is
00:18:56
he's competing at international nettles and pick out for world championship
00:19:00
and we told him well the training would be the best way to look whether these
00:19:05
changes associated only restraining or whether these are related to what the topic audio
00:19:10
property but he said no i do not want that i want to continue anti
00:19:15
participated against our recommendation in suisse in world championship he won several prizes
00:19:21
still healthy no problem and this leads to a very famous cost maybe some of you may
00:19:26
know the case of god as someone use the we're originally from guyana german soccer player
00:19:33
and he has been diagnosed type shopping cart him up with the already in
00:19:37
the late nineteenth like at let's have a high risk of other
00:19:41
topic condom up c. and several physicians suggested to disqualify him from professional
00:19:47
sports at s. m. s. s. now i want to continue sport
00:19:51
and they both suffered a great regulations you had to
00:19:55
fulfil the german soccer federation for example told
00:19:58
him and i d. have to be on the field party participated without any uh reason yes
00:20:04
two world championships and because of his disease he also found it um
00:20:10
foundation for children with heart disease and she's but off so well
00:20:14
and so we do not know whether every hyper topic
00:20:17
i'm not cut him up with a really may lead to
00:20:20
life threatening or re smells like nicely illustrated book
00:20:25
so uh we are at the finish i might take all measures would be the risk of sudden cardiac death in sports
00:20:31
overall it's very low in individuals capable of athletic
00:20:34
activities but there are selected high risk groups
00:20:38
pretty participation screening with easy geometric athletes it may detect underline cause of some card i guess
00:20:44
we have no evidence for mortality reduction but of course we may have good gut feeling
00:20:50
yes we should do it because it will be done every anyway but when
00:20:53
we do it it should be done was expertise is used criteria
00:20:58
and be at its autonomy has to be respected in the way of a shared decision making
00:21:04
into coming back to my initial questions screening for heart disease
00:21:07
in sports is definitely nonsense from our fought mass screening
00:21:12
it may be useful in all elite athletes and it's definitely necessary
Conference Program
Opening address
Boris GOJANOVIC
Sept. 21, 2017 · 1:22 p.m.
244 views
Biological Maturation and the Path to Success: Before and After the Fact
Manuel COELHO-E-SILVA, Biological Maturation and the Path to Success: Before and After the Fact
Sept. 21, 2017 · 1:31 p.m.
977 views
Designing pathways to success – part kaleidoscope, part microscope
Jason GULBIN, Designing pathways to success – part kaleidoscope, part microscope
Sept. 21, 2017 · 1:53 p.m.
930 views
Talent ID and Development: Why doing the “right thing” is not always the “best thing
Ross TUCKER , Talent ID and Development: Why doing the “right thing” is not always the “best thing
Sept. 21, 2017 · 2:16 p.m.
749 views
BIOLOGICAL DEVELOPMENT AND PATHWAYS TO SUCCESS - Q&A
Panel
Sept. 21, 2017 · 2:41 p.m.
202 views
Resistance training during long-term athlete development
Urs GRANACHER
Sept. 21, 2017 · 2:52 p.m.
783 views
The development of aerobic power in young athletes
Grégoire MILLET
Sept. 21, 2017 · 3:15 p.m.
2631 views
Fueling the young athlete
Asker JEUKENDRUP
Sept. 21, 2017 · 3:36 p.m.
449 views
Training young athletes: challenges and opportunities
Marco CARDINALE
Sept. 21, 2017 · 4:01 p.m.
384 views
TRAINING THE YOUNG ATHLETE - Q&A
Panel
Sept. 21, 2017 · 4:33 p.m.
150 views
Coaching from junior to the top of the world (Lara Gut)
Patrick Flaction, Elitment
Sept. 21, 2017 · 5:20 p.m.
580 views
Keep your athletes close and their parents closer: Working effectively with parents
Olivier SCHMID
Sept. 21, 2017 · 5:52 p.m.
199 views
Combine sport and studies, are the schools doing enough ?
Florian ETTER
Sept. 21, 2017 · 6:11 p.m.
219 views
COACHING, PARENTING AND DEVELOPMENT - Q&A
Panel
Sept. 21, 2017 · 6:28 p.m.
DÉBAT PUBLIC (IN FRENCH) : Children and competitive sport, for the best or the worst ?
Panel
Sept. 21, 2017 · 8:07 p.m.
238 views
Knee ligament injuries in immature athletes
Franck CHOTEL
Sept. 22, 2017 · 7:48 a.m.
352 views
Osteochondral lesions
Franck ACCADBLED
Sept. 22, 2017 · 8:11 a.m.
988 views
The influence of athletic activities during growth on hip development
Rintje AGRICOLA
Sept. 22, 2017 · 8:35 a.m.
164 views
INJURIES WITH THE ORTHOPEDISTS - Q&A
Panel
Sept. 22, 2017 · 8:54 a.m.
Back pain in young athletes
Liba SHEERAN
Sept. 22, 2017 · 9:34 a.m.
215 views
Injuries and illnesses amongst young elite athletes – so healthy it hurts?
Christine HOLM MOSEID
Sept. 22, 2017 · 9:57 a.m.
200 views
Long term sequelae of youth overuse injuries
Mark BATT
Sept. 22, 2017 · 10:19 a.m.
OVERUSE INJURIES - Q&A
Panel
Sept. 22, 2017 · 10:40 a.m.
Concussions in young athletes : myths and reality
Christopher NEWMAN
Sept. 22, 2017 · 10:52 a.m.
Screening for heart disease in sports – nonsense or necessary?
Matthias WILHELM
Sept. 22, 2017 · 11:16 a.m.
123 views
Energy deficiency in young athletes – prevalence, consequences and screening
Anna MELIN
Sept. 22, 2017 · 11:39 a.m.
723 views
Competitive Sport & Health: hidden issues
Gordon MATHESON
Sept. 22, 2017 · 12:04 p.m.
117 views
THE COMPLEX MEDICAL PROBLEMS - Q&A
Sept. 22, 2017 · 12:33 p.m.
Injury prevention in youth : What is learned in the cradle is carried in the tomb ?
Evert VERHAGEN
Sept. 22, 2017 · 1:46 p.m.
176 views
Injury prevention programs : The 11+ Kids Project
Mario BIZZINI
Sept. 22, 2017 · 2:12 p.m.
185 views
Sports specialized training: what are the true effects and is it really all bad ?
Neeru JAYANTHI
Sept. 22, 2017 · 2:29 p.m.
141 views
What is “load” and how does it impact athletes’s risk of injury ?
Torbjorn SOLIGARD
Sept. 22, 2017 · 2:49 p.m.
344 views
Instituting a unique public health approach to ACL injury risk management
Joseph Janoski
Sept. 22, 2017 · 3:47 p.m.
Instituting a unique public health approach to ACL injury risk management - Q&A
Joseph Janoski
Sept. 22, 2017 · 3:54 p.m.
Parents’ Knowledge of Sport Psychology and Nutrition
Dr Camilla J. Knight
Sept. 22, 2017 · 3:57 p.m.
152 views
Injuries and injury risk factors in youth alpine ski racing: A two-season prospective study
Lisa, Müller
Sept. 22, 2017 · 4:09 p.m.
FREE COMMUNICATION AND BEST ABSTRACT PRESENTATION - Q&A
Panel
Sept. 22, 2017 · 4:21 p.m.
610 views
Closing Address
Frederic Koehn, President Young Athletes Forum Foundation
Sept. 22, 2017 · 6:04 p.m.
140 views