Care of the athletic heart, from elite athletes to exercise enthusiasts
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Key takeaways:
- The Care of the Athletic Heart Conference focused on CV care for elite athletes and exercise enthusiasts.
- All cardiologists responsible for athletes’ care must be well-versed in the frequently observed ECG patterns.
The Care of the Athletic Heart Conference at Heart House in Washington, D.C., catered to clinicians responsible for providing cardiovascular care to athletes, including those at the elite level and exercise enthusiasts.
For 3 days in early June, the event, held by the American College of Cardiology, was conducted in person for the first time in 3 years and was presented in a hybrid format, allowing participants to join both in-person and online.
Featuring discussion from sports cardiology experts in the U.S and abroad, the format included debates, didactic lectures, panel discussions, case presentations and research posters, all designed to highlight contemporary diagnostic and management strategies in the CV care of athletes. In this column, we provide some highlights from the course.
Cardiopulmonary exercise testing
A preconference delved into the application of cardiopulmonary exercise testing (CPET) in athletes. The session began with an overview of fundamental testing parameters, followed by insightful discussions on how CPET can contribute to clinical diagnosis and be used for exercise prescription and performance optimization in athletes. The preconference concluded with a live CPET demonstration, evoking participation from both the panelists and the audience.
The official course commenced with Paul D. Thompson, MD, FACC, emeritus chief of cardiology at Hartford Hospital, emeritus professor of medicine at the University of Connecticut and staff cardiologist at Massachusetts General Hospital, delivering the keynote address, titled “Can the Heart Get a Sports Injury?” As a prominent figure in sports cardiology since its early inception as a specialized field, Thompson provided valuable insights into ongoing debates surrounding the potential paradoxical increases in certain CV diagnoses due to excessive exercise. Dr. Thompson delved into the evident comprehensive advantages of exercise while also examining the controversies surrounding potential risks associated with excessive exercise exposure. These risks include the release of cardiac biomarkers, the possibility of right ventricular injury and developing atrial fibrillation and coronary artery calcium.
The remaining sessions on the first day were dedicated to the athlete ECG. As the most prevalent CV test used in screening and diagnosing athletes, it has long been acknowledged that the athlete ECG differs from that of the general population. In a case-based session, both experts and the audience collaborated in interpreting ECGs carefully curated to showcase typical normal and abnormal findings in athletes. The interactive nature of the session allowed for insightful discussions and practical learning opportunities.
Pre-participation screening
On the second day of the course, the focus shifted to one of the most widely debated topics in sports cardiology: pre-participation screeningSpecifically, the discussion revolved around whether a screening ECG should be included as part of the pre-participation exam for young athletes.
The session began with a spirited debate, presenting the arguments both in favor and against ECG-inclusive screening. The presentation argued that adding ECGs significantly enhances the sensitivity and specificity of identifying underlying cardiac conditions. However, it was countered by highlighting a lack of substantial evidence showing that including ECGs in screening reduces the risk for sudden cardiac death in athletes, and there is a possibility of significant harm associated with this approach.
After the debate, a practical presentation followed, providing insights into how to approach the history and physical examination that make up the remaining part of the pre-participation exam. A consensus of participants emerged that the most effective pre-participation screening program for younger athletes should be tailored based on the available resources and expertise. A follow-up debate addressed the use of screening approaches for older athletes, a subject that is continuously evolving and requires further data. During this discussion, a consensus was reached on the significance of not undertreating risk factors for atherosclerotic CVD in masters athletes.
These debates on screening paved the way for subsequent sessions, which centered on key diagnoses in both younger and older athletes. These sessions were driven by dynamic case presentations, with many delivered by early-career cardiologists and fellows-in-training. The interactive case-based format allowed for engaging discussions and valuable insights from emerging medical professionals.
This year’s course dedicated two sessions to delve deeper into the intersection of sports cardiology with broader communities and how to approach shared decision-making in athlete patient management. During the session focused on community engagement, participants gained insights into the crucial role of sports cardiologists in emergency action planning (EAP). This included their support in raising community awareness about EAP and providing training in CPR. Additionally, the session highlighted the importance of advocating for EAP and CPR at both state and federal levels.
Shifting focus to the patient-doctor relationship, the deep dive on shared decision-making honed participants’ skills in navigating complex decisions concerning sports participation for athletes with CVD. Shared decision-making for athletes with heart disease involves a collaborative process between the athlete, their health care provider and other relevant stakeholders to make informed decisions about the most suitable treatment or participation in sports activities, taking into account the individual’s preferences, values and medical considerations. Experts in medical ethics and patients provided valuable perspectives, contributing to a comprehensive understanding of this crucial aspect of athlete care.
The second day of the course concluded with an interactive, rapid-fire, case-based session on CV imaging. The session shed light on typical challenges encountered in CV imaging for athletes, prompting lively discussions among the panelists and audience members on their approaches to diagnosis and management for athletes.
Care of vocational athletes
On the third day, the course’s focus transitioned to the care of vocational athletes and those who exercise in extreme environmental conditions. These two groups share some common exposures and considerations. Through intriguing cases and discussions between the panel and the audience, the unique aspects of care for vocational athletes were highlighted. This pertains to individuals with obligatory exposure to intense exercise as part of their occupation in military, fire, police and other essential services. During this discussion, the significance of strengthening guidance on approaching CV diagnoses in this population was emphasized. This focus aligns with the mission of the ACC Sports and Exercise Leadership Council to enhance health care practices for all athletes.
The ACC Care of the Athletic Heart aimed to deliver high-quality educational content for the entire community involved in caring for athletes, regardless of their level. The course successfully accomplished this objective, providing a valuable opportunity for in-person attendees to gather, network and engage while providing those joining from home an equally enriching experience.
Reference:
- Care of the Athletic Heart; June 8-10, 2023; Washington, D.C. (hybrid meeting).
For more information:
Meagan M. Wasfy, MD, MPH, FACC, is a sports cardiologist at Massachusetts General Brigham, assistant professor of medicine at Harvard Medical School and co-chair of the Care of the Athletic Heart Conference. She can be reached at mwasfy@mgb.org; X (Twitter): @meaganwasfy.
Dermot Phelan, MD, PhD, FASE, FACC, is director of the Gragg Center for Cardiovascular Performance, medical director of cardiovascular imaging and director of the Hypertrophic Cardiomyopathy Center at Atrium Health Sanger Heart & Vascular Institute and chair of the Care of the Athletic Heart Conference. He can be reached at dermot.phelan@atriumhealth.org; X (Twitter): @dermotphelanmd.
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