Introduction:

Pre-participation screening aimed at the detection of disorders associated with sudden cardiac death is universally supported by major medical societies. However, the best method for screening remains controversial. The aim of this study was to evaluate the prevalence of structural cardiac lesions identified by echocardiography in apparently healthy athletes referred for pre-participation screening.

Material and methods:

We conducted an observational retrospective study (January 2017-December 2019) performed in a single center. We evaluated echocardiograms of athletes under 35 years of age, performed in the first evaluation for pre-participation screening.

Results:

A total of 1,981 different athletes’ echocardiograms were included; 36 exams (1.8%) reported structural cardiac lesions. The most common cardiac lesions found were mitral valve prolapse (n = 5), atrial septal aneurysm (n = 5) and atrial septal defect (n = 4). The bicuspid aortic valve and left ventricular hypertrophy were each present in 3 athletes (n = 3); ventricular septal defects, left ventricular noncompaction, aortic dilatation and dilated cardiomyopathy were each found in 2 athletes (n = 2). Less frequent lesions were present in only one athlete, such as hypertrophic cardiomyopathy, surgically-corrected transposition of the great arteries, and pulmonary valve stenosis. Notably, among 36 patients with structural abnormalities in echocardiography, only 6 (16.7%) had positive standard pre-participation screening (combining personal and family history, physical examination and electrocardiogram).

Conclusions:

Echocardiography plays an important role in detecting cardiac structural abnormalities that would otherwise escape standard screening protocols and could be left unnoticed. This study suggests a potential benefit of including echocardiography in the first evaluation for pre-participation screening of competitive athletes.

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