OFFICIALLY published on March 14, this first societal guideline dedicated exclusively to echocardiography significantly reflects advances in the understanding of the athlete’s heart (and differentiation from inherited cardiac conditions).
Enhanced diagnostic techniques and new evidence on the prevalence and incidence of sudden cardiac death (SCD) in young athletes make this guideline both timely and essential, providing a structured and systematic approach to echocardiographic assessment, designed to be practical and user-friendly.
Professor Sanjay Sharma (St George’s, University of London) has served as CRY’s Consultant Cardiologist for almost 3 decades. Here, he shares his comments on CRY’s involvement and support for the BSE’s new guidelines:.
He said:
“Whereas the benefits of exercise on the heart are well-documented, it is also recognised that some individuals with an underlying silent heart disorder may succumb to a sudden cardiac arrest during vigorous exercise.
“Although relatively rare, these tragic events send shockwaves through the community, particularly when a young, high-profile individual is affected. Among young athletes aged below 35 years old, deaths are due to a diverse spectrum of electrical and structural heart diseases, which may be inherited, congenital or acquired.
“The prevalence of these diseases in the young British population, including athletes, is 1 in 300, and the relative risk of dying with these conditions during vigorous exercise is increased 3 to 5-fold compared with adopting a relatively sedentary life. Most athletic individuals have no symptoms before sudden death; hence, there is an incentive to identify these vulnerable individuals through cardiac screening.
“One of the main concerns about cardiac screening in athletes is the risk of a false positive result due to the overlap between electrical and structural changes resulting from cardiac adaptation to vigorous and cardiac diseases implicated in an exercise-related sudden cardiac death.
Prof Sharma added:
“The aim of this comprehensive, up-to-date guideline, which includes numerous authors who are CRY physiologists, cardiac Research Fellows and senior CRY cardiologists, is to highlight the role of echocardiography in identifying athletes with potentially serious structural disease.
“Apart from describing several structural diseases implicated in exercise-related sudden cardiac deaths, such as cardiomyopathy, valvular heart disease, and myocarditis, the document provides a clear methodology for measuring cardiac dimensions accurately in athletes, describes the upper limits of cardiac dimensions due to regular exercise and the role of various demographic factors that influence these measurements. For example, it is recognised that large male athletes engaging in endurance sports, such as long-distance running or cycling, may exhibit large ventricular dimensions, whereas male athletes of African or African Caribbean origin may demonstrate thickening of the heart muscle that overlaps with hypertrophic cardiomyopathy.
“Notably, the document provides evidence-based methods for differentiating large cardiac dimensions due to exercise from those associated with cardiomyopathy, thereby reducing the risk of false-positive results, which can have serious consequences.”
So, what does this mean for practicing echocardiographers? Well, the guideline focuses on young athletes aged 14–35 years who engage in more than 3 hours of structured exercise per week and aims to:
- Standardise and improve the quality of echocardiographic assessments
- Empower echocardiographers to contribute to a multi-disciplinary diagnostic pathway
- Provide a valuable resource for accreditation curricula, ensuring echocardiographers are well-prepared to assess athletic hearts confidently and accurately
Professor Sharma added:
“Cardiac Risk in the Young is proud to endorse the guideline, which will facilitate accurate interpretation of cardiac dimensions in athletes, minimising the chances of a false positive result and promoting safe exercise in this group while mitigating the risk of potential sudden cardiac death.”
Dr Steven Cox, Chief Executive of CRY, concluded:
“The publication of the new echocardiography guideline is such an important achievement – and something which CRY is pleased to have been involved with through our research and honoured to endorse. The accurate understanding of the ‘athlete’s heart’ has been at the core of much of CRY’s research programme over the past 30 years, underpinning one of our key missions to better understand how a fit and healthy young person could be at risk of a cardiac arrest and young sudden cardiac death.
“There have always been ‘grey areas’ when assessing the hearts of elite and grass-roots athletes, and so it’s fantastic that the new guideline has integrated the latest advances in scientific knowledge about these conditions. This represents a significant step forward in improving, streamlining, and standardising how we assess the hearts of young athletes using this vital diagnostic tool – and will play a crucial role in identifying risks early and helping to save young lives.”
The new ‘Echo Guidelines’ can be read here.
