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Standardised pre-competitive screening of athletes in some European and African countries: the SMILE study

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An Erratum to this article was published on 02 July 2014

Abstract

Most of the available data on the cardiovascular screening of athletes come from Italy, with fewer records being available outside of Italy and for non-Caucasian populations. The goals of the SMILE project (Sport Medicine Intervention to save Lives through ECG) are to evaluate the usefulness of 12-lead ECGs for the detection of cardiac diseases in athletes from three European countries and one African country and to estimate how many second-level examinations are needed subsequent to the initial screening in order to classify athletes with abnormal characteristics. A digital network consisting of Sport Centres and second and third opinion centres was set up in Greece, Germany, France and Algeria. Standard digital data input was carried out through the application of 12-lead ECGs, Bethesda questionnaires and physical examinations. Two hundred ninety-three of the 6,634 consecutive athletes required further evaluation, mostly (88.4 %) as a consequence of abnormal ECGs. After careful evaluation, 237 were determined to be healthy or apparently healthy, while 56 athletes were found to have cardiac disorders and were thus disqualified from active participation in sports. There was a large difference in the prevalence of diseases detected in Europe as compared with Algeria (0.23 and 4.01 %, respectively). Our data confirmed the noteworthy value of 12-lead resting ECGs as compared with other first-level evaluations, especially in athletes with asymptomatic cardiac diseases. Its value seems to have been even higher in Algeria than in the European countries. The establishment of a digital network of Sport Centres for second/third opinions in conjunction with the use of standard digital data input seems to be a valuable means for increasing the effectiveness of screening.

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Authors and Affiliations

  1. Department of Medical and Surgical Sciences, Chair of Sports-Internal Medicine, University of Brescia, 2a Medicina, P.le Spedali Civili 1, 25100, Brescia, Italy

    Assanelli Deodato

  2. Sports Medicine Division, Department of Medicine, University of Padova, Padova, Italy

    Ermolao Andrea

  3. Unité Biologie et Medicine du Sport, Hôpital Pontchavillon, Rennes, France

    Carré François

  4. Chair of Sport Medicine, University of Tessaloniki, Tessaloniki, Greece

    Deligiannis Asterios

  5. Heart Center NRW, University Hospital, Bad Oeynhausen, Germany

    Mellwig Klaus

  6. Service de cardiologie, CHU de Tizi-Ouzou, Tizi-Ouzou, Algeria

    Tahmi Mohamed

  7. Chair of Statistics, University of Brescia, Brescia, Italy

    Cesana Bruno Mario

  8. Chair of Health Economics, University of Brescia, Brescia, Italy

    Levaggi Rosella

  9. ET Medical Devices, Milan, Italy

    Aliverti Paola

  10. Department of Heart Muscle Disorders and Sports Cardiology, St Georges Hospital, London, UK

    Sharma Sanjay

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  1. Assanelli Deodato
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Correspondence to Assanelli Deodato.

Electronic supplementary material

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Online Resource 1 and 2: The system generates two files in acrobat reader format. The first file regards family history, personal history, physical examination, and symptoms occurrence. Online resource 1 is an example of an 18-year-old black professional athlete; in this athlete, all the above-mentioned aspects resulted normal. Online resource 2 presents the second file, consisting of a resting ECG recorded during the screening in the same athlete. In the example negative T waves were detected on V1, V3 and V4 (positive ECG). The two files, both coded with the same number (6_7_1_6), are sent as attachment, using a regular mail, on a dedicated address, for second opinion. In this young athlete, a stress ECG, Echocardiography and 24-hour ECG monitoring were suggested, resulting normal. A regular follow-up was decided. Today, 5 years after the first evaluation, the athlete still competes and performs a follow-up screening, yearly.

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Deodato, A., Andrea, E., François, C. et al. Standardised pre-competitive screening of athletes in some European and African countries: the SMILE study. Intern Emerg Med 9, 427–434 (2014). https://doi.org/10.1007/s11739-013-0955-5

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