若年アスリートに心臓超音波検査のスクリーニングは不要

若年アスリートの心疾患検索に心臓超音波検査を含むプレ参加プログラムは有能な手段ではあるが12誘導心電図で十分な可能性がある
Pre-participation program, including echocardiography, is an efficient way to identify young athletes with cardiac disease but 12-lead ECG may be sufficient
イタリアで施行されたスタディの結果、若年アスリートの心疾患検索に心臓超音波検査を含むプレ参加プログラムは有能な手段ではあるが12誘導心電図で十分であると2008年European Society of Cardiology学会で発表された。突然死の原因となる心疾患を有する者をタイムリーに発見する最も有用な方法を探すために研究者らは、プレ参加の12誘導心電図の結果心疾患がなく競技に参加できるとされたアスリート4,450人に心臓超音波検査で器質的な心疾患の評価を行った。4,450人中、肥大型心筋症(HCM)と診断された者はいなかった。心筋炎(4人)、僧帽弁逸脱(3人)、マルファン症候群(2人)、大動脈弁逆流(2人)、および不整脈原性右室心筋症(1人)などの他の異常が発見されたのはわずか12人であった。さらに、4人のアスリートはHCMとアスリートハートの"グレイゾーン"に当たるボーダーラインの左室壁厚(13mm)が認められた。このうち2人は、引き続き行われれた遺伝子解析または平均8年間の臨床上の変化の結果HCMと診断された。
Full Text

Studies conducted in Italy suggest that a pre-participation program, including echocardiography, is an efficient way to identify young athletes with cardiac disease.

Sudden and unexpected deaths in young competitive athletes are uncommon but highly visible events, which raise concern and ethical issues in both the lay public and medical community. Which is the best strategy to timely identify individuals with cardiac disease responsible for sudden death (primarily, hypertrophic cardiomyopathy - HCM) is largely debated. Namely, the extent to which sophisticated testing, such as echocardiography, is needed is still undefined.

To address this question, researchers carried out an echocardiographic assessment of the structural cardiac diseases in a population of 4,450 athletes, initially judged free of cardiac disease and eligible for competition on the basis of pre-participation screening with 12-lead ECG.

None of the 4,450 athletes showed evidence of HCM. Other cardiac abnormalities were detected in only 12 athletes, including myocarditis (n=4), mitral valve prolapse (n=3), Marfan's syndrome (n=2), aortic regurgitation with bicuspid valve (n=2), and arrhythmogenic right ventricular cardiomyopathy (n=1). In addition, 4 athletes were identified with borderline left ventricular wall thickness (i.e., 13 mm) in the "gray-zone" between HCM and athlete's heart. In 2 of these athletes, subsequent genetic analysis or clinical changes over an average 8-year follow-up resulted, respectively, in a diagnosis of HCM.

The pre-participation screening program including 12-lead ECG appears to be efficient in identifying young athletes with HCM, leading to their timely disqualification from competitive sports. These data also suggest that routine echocardiography is not an obligatory component of large population screening programs designed to identify young athletes with HCM.