Pre-Participation Screenings Frequently Miss Occult Cardiovascular Conditions in Apparently Healthy Male Middle-Aged First-Time Marathon Runners

Inarota Laily; Tom G.H. Wiggers; Niels Van Steijn; Nick Bijsterveld; Adrianus J. Bakermans; Martijn Froeling; Sandra Van Den Berg-Faay; Ferdinand H. De Haan; Rianne H.A.C.M. De Bruin-Bon; S. Matthijs Boekholdt; R. Nils Planken; Evert Verhagen; Harald T. Jorstad

doi:10.1159/000536553

Pre-Participation Screenings Frequently Miss Occult Cardiovascular Conditions in Apparently Healthy Male Middle-Aged First-Time Marathon Runners

Inarota Laily, Tom G.H. Wiggers, Niels Van Steijn, Nick Bijsterveld, Adrianus J. Bakermans, Martijn Froeling, Sandra Van Den Berg-Faay, Ferdinand H. De Haan, Rianne H.A.C.M. De Bruin-Bon, S. Matthijs Boekholdt, R. Nils Planken, Evert Verhagen, Harald T. Jorstad

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Abstract

Introduction: The optimal pre-participation screening strategy to identify athletes at risk for exercise-induced cardiovascular events is unknown. We therefore aimed to compare the American College of Sports Medicine (ACSM) and European Society of Cardiology (ESC) pre-participation screening strategies against extensive cardiovascular evaluations in identifying high-risk individuals among 35.50- year-old apparently healthy men. Methods: We applied ACSM and ESC pre-participation screenings to 25 men participating in a study on first-time marathon running. We compared screening outcomes against medical history, physical examination, electrocardiography, blood tests, echocardiography, cardiopulmonary exercise testing, and magnetic resonance imaging. Results: ACSM screening classified all participants as "medical clearance not necessary."ESC screening classified two participants as "high-risk."Extensive cardiovascular evaluations revealed ≥1 minor abnormality and/or cardiovascular condition in 17 participants, including three subjects with mitral regurgitation and one with a small atrial septal defect. Eleven participants had dyslipidaemia, six had hypertension, and two had premature atherosclerosis. Ultimately, three (12%) subjects had a serious cardiovascular condition warranting sports restrictions: aortic aneurysm, hypertrophic cardiomyopathy (HCM), and myocardial fibrosis post-myocarditis. Of these three participants, only one had been identified as "high-risk"by the ESC screening (for dyslipidaemia, not HCM) and none by the ACSM screening. Conclusion: Numerous occult cardiovascular conditions are missed when applying current ACSM/ ESC screening strategies to apparently healthy middle-aged men engaging in their first high-intensity endurance sports event.

Original language	English
Pages (from-to)	255-263
Journal	Cardiology (Switzerland)
Volume	149
Issue number	3
DOIs	https://doi.org/10.1159/000536553
Publication status	Published - Jun 2024

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Laily, I., Wiggers, T. G. H., Van Steijn, N., Bijsterveld, N., Bakermans, A. J., Froeling, M., Van Den Berg-Faay, S., De Haan, F. H., De Bruin-Bon, R. H. A. C. M., Boekholdt, S. M., Planken, R. N., Verhagen, E., & Jorstad, H. T. (2024). Pre-Participation Screenings Frequently Miss Occult Cardiovascular Conditions in Apparently Healthy Male Middle-Aged First-Time Marathon Runners. Cardiology (Switzerland), 149(3), 255-263. https://doi.org/10.1159/000536553

@article{998b83daed1c47a0aa5e2ec26a9e6b74,

title = "Pre-Participation Screenings Frequently Miss Occult Cardiovascular Conditions in Apparently Healthy Male Middle-Aged First-Time Marathon Runners",

abstract = "Introduction: The optimal pre-participation screening strategy to identify athletes at risk for exercise-induced cardiovascular events is unknown. We therefore aimed to compare the American College of Sports Medicine (ACSM) and European Society of Cardiology (ESC) pre-participation screening strategies against extensive cardiovascular evaluations in identifying high-risk individuals among 35.50- year-old apparently healthy men. Methods: We applied ACSM and ESC pre-participation screenings to 25 men participating in a study on first-time marathon running. We compared screening outcomes against medical history, physical examination, electrocardiography, blood tests, echocardiography, cardiopulmonary exercise testing, and magnetic resonance imaging. Results: ACSM screening classified all participants as {"}medical clearance not necessary.{"}ESC screening classified two participants as {"}high-risk.{"}Extensive cardiovascular evaluations revealed ≥1 minor abnormality and/or cardiovascular condition in 17 participants, including three subjects with mitral regurgitation and one with a small atrial septal defect. Eleven participants had dyslipidaemia, six had hypertension, and two had premature atherosclerosis. Ultimately, three (12%) subjects had a serious cardiovascular condition warranting sports restrictions: aortic aneurysm, hypertrophic cardiomyopathy (HCM), and myocardial fibrosis post-myocarditis. Of these three participants, only one had been identified as {"}high-risk{"}by the ESC screening (for dyslipidaemia, not HCM) and none by the ACSM screening. Conclusion: Numerous occult cardiovascular conditions are missed when applying current ACSM/ ESC screening strategies to apparently healthy middle-aged men engaging in their first high-intensity endurance sports event.",

keywords = "Adult, Cardiology, Exercise, Marathon running, Myocardial diseases, Sports medicine",

author = "Inarota Laily and Wiggers, {Tom G.H.} and {Van Steijn}, Niels and Nick Bijsterveld and Bakermans, {Adrianus J.} and Martijn Froeling and {Van Den Berg-Faay}, Sandra and {De Haan}, {Ferdinand H.} and {De Bruin-Bon}, {Rianne H.A.C.M.} and Boekholdt, {S. Matthijs} and Planken, {R. Nils} and Evert Verhagen and Jorstad, {Harald T.}",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s). Published by S. Karger AG, Basel.",

year = "2024",

month = jun,

doi = "10.1159/000536553",

language = "English",

volume = "149",

pages = "255--263",

journal = "Cardiology (Switzerland)",

issn = "0008-6312",

publisher = "S. Karger AG",

number = "3",

}

Laily, I, Wiggers, TGH, Van Steijn, N, Bijsterveld, N, Bakermans, AJ, Froeling, M, Van Den Berg-Faay, S, De Haan, FH, De Bruin-Bon, RHACM, Boekholdt, SM, Planken, RN, Verhagen, E & Jorstad, HT 2024, 'Pre-Participation Screenings Frequently Miss Occult Cardiovascular Conditions in Apparently Healthy Male Middle-Aged First-Time Marathon Runners', Cardiology (Switzerland), vol. 149, no. 3, pp. 255-263. https://doi.org/10.1159/000536553

TY - JOUR

T1 - Pre-Participation Screenings Frequently Miss Occult Cardiovascular Conditions in Apparently Healthy Male Middle-Aged First-Time Marathon Runners

AU - Laily, Inarota

AU - Wiggers, Tom G.H.

AU - Van Steijn, Niels

AU - Bijsterveld, Nick

AU - Bakermans, Adrianus J.

AU - Froeling, Martijn

AU - Van Den Berg-Faay, Sandra

AU - De Haan, Ferdinand H.

AU - De Bruin-Bon, Rianne H.A.C.M.

AU - Boekholdt, S. Matthijs

AU - Planken, R. Nils

AU - Verhagen, Evert

AU - Jorstad, Harald T.

PY - 2024/6

Y1 - 2024/6

N2 - Introduction: The optimal pre-participation screening strategy to identify athletes at risk for exercise-induced cardiovascular events is unknown. We therefore aimed to compare the American College of Sports Medicine (ACSM) and European Society of Cardiology (ESC) pre-participation screening strategies against extensive cardiovascular evaluations in identifying high-risk individuals among 35.50- year-old apparently healthy men. Methods: We applied ACSM and ESC pre-participation screenings to 25 men participating in a study on first-time marathon running. We compared screening outcomes against medical history, physical examination, electrocardiography, blood tests, echocardiography, cardiopulmonary exercise testing, and magnetic resonance imaging. Results: ACSM screening classified all participants as "medical clearance not necessary."ESC screening classified two participants as "high-risk."Extensive cardiovascular evaluations revealed ≥1 minor abnormality and/or cardiovascular condition in 17 participants, including three subjects with mitral regurgitation and one with a small atrial septal defect. Eleven participants had dyslipidaemia, six had hypertension, and two had premature atherosclerosis. Ultimately, three (12%) subjects had a serious cardiovascular condition warranting sports restrictions: aortic aneurysm, hypertrophic cardiomyopathy (HCM), and myocardial fibrosis post-myocarditis. Of these three participants, only one had been identified as "high-risk"by the ESC screening (for dyslipidaemia, not HCM) and none by the ACSM screening. Conclusion: Numerous occult cardiovascular conditions are missed when applying current ACSM/ ESC screening strategies to apparently healthy middle-aged men engaging in their first high-intensity endurance sports event.

AB - Introduction: The optimal pre-participation screening strategy to identify athletes at risk for exercise-induced cardiovascular events is unknown. We therefore aimed to compare the American College of Sports Medicine (ACSM) and European Society of Cardiology (ESC) pre-participation screening strategies against extensive cardiovascular evaluations in identifying high-risk individuals among 35.50- year-old apparently healthy men. Methods: We applied ACSM and ESC pre-participation screenings to 25 men participating in a study on first-time marathon running. We compared screening outcomes against medical history, physical examination, electrocardiography, blood tests, echocardiography, cardiopulmonary exercise testing, and magnetic resonance imaging. Results: ACSM screening classified all participants as "medical clearance not necessary."ESC screening classified two participants as "high-risk."Extensive cardiovascular evaluations revealed ≥1 minor abnormality and/or cardiovascular condition in 17 participants, including three subjects with mitral regurgitation and one with a small atrial septal defect. Eleven participants had dyslipidaemia, six had hypertension, and two had premature atherosclerosis. Ultimately, three (12%) subjects had a serious cardiovascular condition warranting sports restrictions: aortic aneurysm, hypertrophic cardiomyopathy (HCM), and myocardial fibrosis post-myocarditis. Of these three participants, only one had been identified as "high-risk"by the ESC screening (for dyslipidaemia, not HCM) and none by the ACSM screening. Conclusion: Numerous occult cardiovascular conditions are missed when applying current ACSM/ ESC screening strategies to apparently healthy middle-aged men engaging in their first high-intensity endurance sports event.

KW - Adult

KW - Cardiology

KW - Exercise

KW - Marathon running

KW - Myocardial diseases

KW - Sports medicine

U2 - 10.1159/000536553

DO - 10.1159/000536553

M3 - Article

C2 - 38325343

AN - SCOPUS:85190382103

SN - 0008-6312

VL - 149

SP - 255

EP - 263

JO - Cardiology (Switzerland)

JF - Cardiology (Switzerland)

IS - 3

ER -

Pre-Participation Screenings Frequently Miss Occult Cardiovascular Conditions in Apparently Healthy Male Middle-Aged First-Time Marathon Runners

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