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.

Does heterozygous beta-thalassemia confer a protection against coronary artery disease?

Six hundred and thirty-eight patients who presented with clinical symptoms and/or electrocardiographic findings suggestive of stable angina pectoris were studied; they were also investigated by coronary arteriography. Hemoglobin electrophoresis was performed on all patients to detect the presence of the beta-thalassemia trait. Results were analyzed by logistic regression analysis to determine whether the latter confers any protective effect against advanced coronary artery disease (aCAD; defined as the presence of atheromas in coronary arteries, resulting in stenosis at least 70%). The role of the currently accepted risk factors (smoking, hypertension, hypercholesterolemia, and diabetes) in developing aCAD were reconfirmed, while at the same time it was found that beta-thalassemia heterozygosity is associated with a reduced risk against aCAD (odds ratio 0.39, 95% confidence interval 0.16-0.98). The lipoprotein and blood rheology profile of these individuals may be the underlying causes of this protective effect.

Hypoparathyroidism and heart failure in thalassemic patients: a case report.

Hypocalcemic cardiomyopathy due to primary or secondary hypoparathyroidism is usually refractory to conventional treatment for cardiac failure but responds favorably to the restoration of normocalcemia. We report on a thalassemic patient with severe cardiac failure due to hypocalcemia. Cardiac echocardiography showed impaired biventricular performance and laboratory analyses revealed hypoparathyroidism due to hemosiderosis. Concomitant treatment for heart failure and calcium supplementation was initiated. Thereafter, clinical and laboratory improvement was achieved. In the literature of thalassemic disorders, this is the first case of heart failure associated with hypoparathyroidism in which the patient recovered significantly after the correction of hypocalcemia, providing strong evidence to support our hypothesis of hypocalcemic myocardiopathy.