PPS of young athletes to prevent sudden cardiac death

Over the last 20 years, there has been much interest in the quest for the ‘ideal’ pre-participation screening (PPS) for competitive athletes that could effectively prevent sudden cardiac death. The main features requested for this screening would be (1) feasibility in very large populations (millions of people in each country), (2) cost-effectiveness, and (3) high diagnostic accuracy (identifying only athletes with cardiac diseases without producing false-positive or false-negative results). Areas of agreement: Two models of PPS are currently applied: the American and the Italian models. The Italian PPS guidelines include a 12-lead ECG, both at rest and after exercise (3 minute step-test), in addition to medical history and physical examination, in contrast to the American PPS guidelines. This model appears to be the best method for detecting cardiovascular conditions that may predispose athletes to sudden death. Areas of controversy: Controversy exists concerning the possibility of further increase the efficacy of the screening by using echocardiography. Growing points: Based on the available evidence, echocardiographic evaluation at the beginning of the competitive activity would allow for the early identification of many congenital cardiac defects otherwise undetectable, and should be included in the European screening protocol. Timely areas for developing research: Well-constructed long-term longitudinal studies will allow ascertainment of the effectiveness of the pre-participation screening programmes. On the basis of the available evidence, the screening should probably be applied to the population at large to be effective.