Original article Usefulness of Echocardiography in Preparticipation Screening of Competitive Athletes Gonzalo Grazioli, a Beatriz Merino, a Silvia Montserrat, a Ba ` rbara Vidal, a Manel Azqueta, a Carles Pare, a Georgia Sarquella-Brugada, b Xavier Yangu ¨ as, c Ramon Pi, c Lluis Til, c,d Jaume Escoda, e Josep Brugada, a and Marta Sitges a, * a Grup de Treball Cardiologia Esportiva, Institut del To `rax, Hospital Clı´nic de Barcelona, Universitat de Barcelona, IDIBAPS, Institut d’Investigacions Biome `diques August Pi i Sunyer, Barcelona, Spain b Servicio de Cardiologı´a, Hospital Sant Joan de De ´u, Universitat de Barcelona, Sant Joan Despı´, Barcelona, Spain c Servei Me ´dic, Futbol Club Barcelona, Barcelona, Spain d GIRSANE, Consorci Sanitari de Terrassa-Centre d’Alt Rendiment, Sant Cugat del Valle `s, Barcelona, Spain e A ´ rea de Medicina, Consell Catala ` de l’Esport, Generalitat de Catalunya, Barcelona, Spain Rev Esp Cardiol. 2014;xx(x):xxx–xxx Article history: Received 23 July 2013 Accepted 28 November 2013 Keywords: Echocardiography Sport Athletes Sudden death Preparticipation screening A B S T R A C T Introduction and objectives: Despite the established diagnostic value of the electrocardiogram in preparticipation screening of athletes, some cardiac structural changes can be missed, particularly in early disease stages. The aim of this study was to evaluate the prevalence of cardiac structural changes via the systematic use of echocardiography in preparticipation screening of competitive athletes. Methods: Professional athletes or participants in a competitive athletic program underwent a screening that included family and personal medical history, physical examination, electrocardiography, exercise testing, and Doppler echocardiography. Results: A total of 2688 athletes (67% men; mean age [standard deviation], 21 [10] years) were included. Most of the echocardiographic evaluations (92.5%) were normal and only 203 (7.5%) showed changes; the most frequent change was left ventricular hypertrophy, seen in 50 athletes (1.8%). Cessation of athletic activity was indicated in 4 athletes (0.14%): 2 for hypertrophic cardiomyopathy (electrocardi- ography had shown changes that did not meet diagnostic criteria), 1 pectus excavatum with compression of the right ventricle, and 1 significant pulmonary valve stenosis; the rest of the changes did not entail cessation of athletic activity and only indicated periodic monitoring. Conclusions: Although rare, some cardiac structural changes can be missed on physical examination and electrocardiography; in contrast, they are easily recognized with echocardiography. These findings suggest the use of echocardiography in at least the first preparticipation screening of competitive athletes to improve the effectiveness of programs aimed at preventing sudden death in athletes. ß 2013 Sociedad Espan ˜ola de Cardiologı ´a. Published by Elsevier Espan ˜a, S.L. All rights reserved. Utilidad del ecocardiograma en la revisio ´n preparticipativa de deportistas de competicio ´n Palabras clave: Ecocardiografı ´a Deporte Atletas Muerte su ´ bita Revisio ´n preparticipativa R E S U M E N Introduccio ´n y objetivos: A pesar del establecido valor diagno ´ stico del electrocardiograma en la revisio ´n preparticipativa de sujetos deportistas, algunas alteraciones estructurales cardiacas podrı ´an pasar inadvertidas, en especial en fases precoces de la enfermedad. El objetivo de este estudio es valorar la prevalencia de alteraciones estructurales cardiacas mediante el uso sistema ´ tico de la ecocardiografı ´a en la revisio ´n preparticipativa de deportistas de competicio ´ n. Me ´todos: Se estudio ´a los deportistas incluidos en un programa de competicio ´n o profesionales. Se realizo ´a todos los deportistas una revisio ´n que incluyo ´ historia familiar y personal, examen fı ´sico, electrocardiograma, prueba de esfuerzo y ecocardiograma Doppler. Resultados: Se incluyo ´a 2.688 deportistas (el 67% varones; media de edad, 21  10 an ˜ os). La mayorı ´a de los estudios ecocardiogra ´ ficos (92,5%) fueron estrictamente normales y solo 203 (7,5%) tenı ´an alteraciones; la ma ´s frecuente de ellas fue la hipertrofia ventricular izquierda, en 50 deportistas (1,8%). En 4 casos (0,14%) se indico ´ el cese de la pra ´ ctica deportiva: 2 por miocardiopatı ´a hipertro ´ fica (el electrocardiograma mostraba alteraciones pero no cumplı ´a criterios diagno ´ sticos), 1 pectus excavatum con compresio ´n del ventrı ´culo derecho y 1 estenosis valvular pulmonar significativa; el resto de las alteraciones no implicaron el cese de la pra ´ ctica deportiva y solo requirieron seguimiento perio ´ dico. * Corresponding author: Servicio de Cardiologı ´a, Institut Clı ´nic del To ` rax, Hospital Clı ´nic, Villarroel 170, 08036 Barcelona, Spain. E-mail address: msitges@clinic.ub.es (M. Sitges). G Model REC-1134; No. of Pages 5 Please cite this article in press as: Grazioli G, et al. Utilidad del ecocardiograma en la revisio ´n preparticipativa de deportistas de competicio ´ n. Rev Esp Cardiol. 2014. http://dx.doi.org/10.1016/j.recesp.2013.11.023 1885-5857/$ – see front matter ß 2013 Sociedad Espan ˜ola de Cardiologı ´a. Published by Elsevier Espan ˜a, S.L. All rights reserved. http://dx.doi.org/10.1016/j.rec.2013.11.023 Document downloaded from http://www.revespcardiol.org, day 22/04/2014. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. This early online article has been re