Eighteen years' experience applying old and current strategies in the pre-participation cardiovascular screening of athletes.

INTRODUCTION: Cardiovascular pre-participation screening (PPS) is recommended for the identification of athletes at risk for sudden cardiac death. However, there is currently no universally accepted screening protocol.

METHODS: Two distinct PPS strategies were studied in a large cohort of Greek athletes (5 to 39 years old): PPS I, with routine 12-lead ECG and echo, in addition to personal and family history, and physical examination; and PPS II, without routine echo. PPS I (12,353 athletes) was performed from 1992 to 2002, and PPS II (9852 athletes) from 2003 to 2010.

RESULTS: "Abnormal" findings were observed in 49.3% of the athletes (49.6% in PPS I and 48.9% in PPS II, p=0.299). Most of them were age- or exercise-related. Further evaluation was recommended for 8.3% of the athletes. Finally, 39 athletes (22 from PPS I) were excluded from competitive sports. Hypertrophic cardiomyopathy was found in 7 athletes. Other abnormalities were: dilated cardiomyopathy; complete heart block; coronary artery disease; Wolf-Parkinson-White syndrome; and severe hypertension. The ECG played a critical role in the exclusion of 13 athletes, compared to only one for echo. Both PPS methods revealed an almost equal incidence of findings.

CONCLUSIONS: We suggest that the routine use of ECG alone is sufficient for the successful screening of athletes.