Study Adds to Debate over Heart Tests for Athletes
Every week or two, there's a new story about a young ball player or runner who drops dead without warning.
Sixteen-year-old John Babbitt of Chatham, N.J., was one of them — a strapping, three-season athlete.
One evening, he went down to play basketball in an intramural league that was part of his church youth group.
"He was running down the court and he just collapsed and died instantaneously," says Joanne Babbitt, his mother.
That was Feb. 26, 2006.
An autopsy showed that John Babbitt died from hypertrophic cardiomyopathy (HCM), an enlarged and thickened heart. It's the most common cause of sudden death among young athletes.
"His heart was extremely thick," his mother says. "There was a 95 percent chance that if he had had an electrocardiogram, that would have shown up, because the progression of the disease within John at that time was quite significant."
Each time one of these tragedies occurs, it raises the question of whether anything can be done to prevent them.
A study in this week's New England Journal of Medicine shows that abnormal electrocardiograms (EKGs) do sometimes predict cardiac disease in young athletes.
The study documents the experience of a 26-year-old screening program in Italy. By law, every Italian athlete, from elementary school through the pros, must have an EKG before he or she can play sports.
Those with abnormal EKGs get other tests to see if their hearts are structurally abnormal.
"The Italian experience clearly demonstrates that screening is feasible and also is very efficient," says Dr. Antonio Pellaccia of the Italian Institute of Sports Medicine and Science, an arm of the Italian National Olympic Committee. Pellaccia is the lead author of the new study.
Pellaccia and his colleagues went through the records of 12,550 athletes who had screening EKGs and identified 81 who had severely abnormal tracings.
Initially there wasn't anything obviously wrong with their hearts. There was nothing to disqualify them from competition. In fact, 14 were Olympic athletes.
But over an average follow-up of nine years, five of those athletes with abnormal EKGs developed cardiomyopathy. One died suddenly at the age of 24; another survived cardiac arrest.
The bottom line: A severely abnormal EKG does sometimes predict later heart disease. Some had thought an abnormal EKG could be a harmless result of athletic training, the so-called "athlete's heart."
Dr. Barry Maron says the new results tell doctors they ought to monitor young people who have abnormal EKGs, even if their hearts appear normal. But Maron says the study does not mean that all U.S. athletes should — or could — get EKG screening.
Maron, of the Minneapolis Heart Institute Foundation, is a leading expert on sudden death in athletes. He tends a national registry that has recorded 1,900 such cases, and he's also a co-author of the new study.
"I wouldn't take the position that we don't want to do EKG screening because it costs too much. I wouldn't want to put a price tag on a young athlete's life that could be saved through screening," Maron says. "But the issue is resources and the practicality. It just can't be done in the United States."
Maron says sudden deaths due to HCM in apparently healthy young people occur on average once a week, or about 60 a year. The cases are getting increasing attention from news media and Internet postings, he says, but taken in context, the deaths are actually pretty rare. There are more than 10 million young athletes in the United States.
"We're talking about a country of 300 million people with 100 or fewer sudden premature deaths due to cardiomyopathy," Maron says. "And only some of these would be detectable through EKG screening."
Screening everybody, he says, would be prohibitively expensive. "It's hard to know exactly, but it could be as much as $2 billion a year."
Maron adds that it would also expose doctors to emotional disputes — and lawsuits — when they recommend that a young athlete be barred from play.
Lisa Salberg tends to agree, even though she was diagnosed with cardiomyopathy when she was 12, and the disease killed her sister. Salberg founded an advocacy group called the Hypertrophic Cardiomyopathy Association. She, her father and her daughter all have had automatic defibrillator devices implanted to shock their hearts back to life if they suddenly stop beating.
"There are some people that say we can only do so much to protect" young people with underlying HCM, Salberg says. "Others say if it costs a million dollars to save a life, we should do it. Others like myself are somewhere in between."
Salberg advocates tightening up screening programs already in place in most high school and collegiate athletic programs that ask parents to disclose any family history of premature cardiac death. But she acknowledges that's not foolproof.
"I'll tell you, some families choose purposely to not disclose information about family history for fear of being disqualified from competition," Salberg says.
Maron says neither high school nor college athletic officials have shown any interest in a screening program that tells some young athletes that they can't play.
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