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MEDICINA DELLO SPORT
A Journal on Sports Medicine
Official Journal of the Italian Sports Medicine Federation
Indexed/Abstracted in: BIOSIS Previews, EMBASE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 0,163
Medicina dello Sport 2016 September;69(3):395-404
language: English, Italian
Sports physicals: is the introduction of a focused echocardiogram feasible?
Vincenzo BIASINI 1, Geza HALASZ 2, Alessia NARDECCHIA 3, Piero FACCINI 4, Silvio ROMANO 2, Marco CICCONETTI 2, Maria PISERI 2, Fabrizio CRISTOFARI 5, Maria PENCO 2
1 FMSI AMSD, L’Aquila, Italia; 2 Dipartimento MESVA, Università dell’Aquila, L’Aquila, Italia; 3 Dipartimento Diritto ed Economia delle Attività Produttive, Università di Roma Sapienza, Roma, Italia; 4 Istituto di Medicina e Scienza dello Sport CONI, Roma, Italia; 5 Dipartimento di Emergenza, Ospedale “F. Spaziani”, Frosinone, Italia
BACKGROUND: The sports physical is the only means of implementing a strategy for the prevention of sudden cardiac death; however, on an international level, there are still differing opinions as to how this can be achieved. In this context there are essentially two schools of thought: the European, which is in favor of introducing the ECG as part of the sports physical, and the American view, which does not consider this test indispensable because it is not yet sufficiently specific. At the same time, the growing use of echocardiography and our growing understanding of the athlete’s heart have led a number of authors to imagine its possible use in the context of pre‑competition screening. The purpose of this study was to assess the improvement in effectiveness that could be obtained by including a “focused” echocardiogram as part of pre‑competition screening in Italy.
METHODS: The study was based on a sample of 920 athletes (75.80% male; 24.20% female; average age 28.39), who were tested in order to renew their competitive and non‑competitive certificates. The study analyzed the incremental effectiveness of three different pre‑participation screening strategies. Strategy 1: physical examination and family and personal medical history; strategy 2: physical examination, family/personal medical history and 12-lead ECG; strategy 3: physical examination, family/personal medical history, 12-lead ECG and Focused ECHO. In all three options a standard echocardiogram was performed to calculate the sensitivity and specificity of the tests. For each option, we also calculated the direct and indirect costs of each screening method right up to the final diagnosis. The cost of the pre‑participation screening examination was estimated to be: €20 for the first option, €45 for the second option and €80 for the third option.
RESULTS: The introduction of the ECG has significantly increased the sensitivity of the diagnostic test, enabling us to identify two conditions that are potential causes of sudden death; however, it also identified a false positive rate of 7.5%, corresponding to a specificity of 87.17%. On the other hand, the introduction of the focused echocardiogram resulted in a considerable increase in both specificity and sensitivity (specificity of 96.57%, sensitivity of 80.50%). The total cost of each individual option (considering the total cost of the screening, the cost of any second and third level tests, any daily income lost due to supplementary testing) increases over all to: €34,752.70 for the first strategy; €68,761.55 for the second strategy; €90,297.89 for the third strategy.
CONCLUSIONS: Based on these results we can state that a focused echocardiogram can be included as part of a screening physical at a reasonable cost and could, in our opinion, be a strategy to improve the specificity of the screening in particular.