Care of the Athletic Heart conference spotlights challenges for sports cardiologists
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Key takeaways:
- The Care of the Athletic Heart conference covered a wide range of sports cardiology topics.
- Cardiologists responsible for athletes’ care must be proficient in the interpretation of the athlete ECG.
The Care of the Athletic Heart Conference, held at Heart House in Washington, D.C., in early June, covered the entire scope of sports cardiology, with sessions tailored to new and seasoned sports cardiologists.
The 3-day conference, held by the American College of Cardiology, had a faculty that included national and international sports cardiology experts.
Cardiopulmonary exercise testing
An optional preconference started with an introduction to exercise physiology and reviewed a systematic approach to cardiopulmonary exercise testing (CPET) interpretation. This was followed by pearls and nuances in the interpretation of the athlete CPET. To help synthesize this information, there was a live CPET demonstration and session on CPET cases to reinforce the key learning points. The session provided a great introduction for those interested in starting a sports cardiology CPET program.
Challenges for sports cardiologists
The official course commenced with a keynote address, titled Sports Cardiology: The Dawn of a Great Era, by Michael Papadakis, MBBS, MD, MRCP, FESC, president of the European Association of Preventive Cardiology and professor of cardiology, St. George’s, University of London. Papadakis reviewed some of the earliest data dating back to 1899 that described the physiologic remodeling seen in response to vigorous exercise training. He reviewed the challenges encountered by cardiologists in caring for athletes including ECG interpretation, defining structural adaptations, the impact of endurance training and providing exercise prescription for athletes with heart disease. He compared and contrasted the American and European approaches to cardiac screening in the athlete and ultimately encouraged us to work together to achieve the common goal: prevention of sudden cardiac death in athletes and safe return to sport for those with heart disease.
Given the rapid growth of the field and need for comprehensive understanding of the nuances in the care of the athlete, Papadakis advocated for increased collaboration, structured education and the development of a competency in sports cardiology.
The first day concluded with a comprehensive review of the athlete ECG. This included a didactic that covered data on incidence of sudden cardiac arrest and sudden cardiac death in athletes, highlights from the perennial debate of ECG screening in athletes and progress made in athlete ECG interpretation criteria over time. The lecture concluded with considerations for future iterations of the criteria, which included questioning the use of race in the criteria, the need for more data in female athletes and QRS fragmentation. In addition, the audience was asked to ponder the concept of AI in ECG interpretation. This was followed by live case-based ECG interpretation by an expert panel who discussed their approach to athlete ECG interpretation and subsequent work up for abnormal ECGs. This was a great opportunity to see the experts work through ECGs in real time and to appreciate that there may not always be a definitive normal/abnormal answer.
Consideration of athlete needs
The second day began with a session focused on atherosclerosis in the masters athlete, which started with a review of the data on atherosclerosis in masters athletes and was followed by a didactic on the evaluation and management of ASCVD risk in these athletes. The session concluded with a debate on how to manage obstructive CAD in the asymptomatic athlete, which has increasing relevance as we have a growing number of masters athletes participating in endurance sports, and CAD is the main cause of cardiac arrest in older athletes.
The next session covered the social determinants of athlete health and updates in sudden cardiac arrest and death in athletes. That was followed by important insights on how to effectively perform cardiac screening and key considerations for emergency action planning. The morning concluded with a powerful session on shared decision-making that highlighted the athlete’s perspective by having Nicholas Knapp tell his story and the negative impact of a paternalistic approach to his care after a cardiac arrest; Knapp, a basketball player at Northwestern University, had cardiac arrest during a pickup game in 1994 and was barred by the university from returning to play despite no confirmation that he had a condition preventing him from playing. Through a didactic and interactive cases, this session highlighted the process of shared decision-making and the importance of highlighting the data we have while also acknowledging uncertainties as it pertains to return to sport with different types of CVD.
Interpretation of cardiac imaging of the athlete’s heart kicked off the afternoon session on day 2. This was a high-yield session highlighting the common pitfalls in interpreting the athlete’s cardiac imaging and also acknowledged that while cardiac MRI tends to be considered the gold standard, it is still reader-dependent, and clinical context is important while interpreting studies.
New this year was a session focused on the care of the young athlete that included cases and didactics on the approach to assessment the aorta in athletes and how to approach genetic testing in this population.
The world of extremes
The first session on day 3 took us beyond bread-and-butter sports cardiology and into the world of extremes; altitude, extreme temperatures and dive medicine. This was followed by a session on CV care of the tactical athlete, which emphasized differences between the tactical athlete and the competitive athlete. In caring for tactical athletes, one must understand both the tasks required of the athlete but also consider the austere environment that may preclude comprehensive emergency action planning and access to medical support that may be readily available for the competitive athlete. Additionally, an adverse cardiac event has larger consequences, including putting other tactical team members at risk, and mission failure has societal impacts. This was a session that included panelists and speakers from the military and drew audience engagement from the spectrum of tactical backgrounds — military, fire and police.
The conference concluded with a session on arrhythmias in athletes. Didactic lectures covered our current understanding of atrial fibrillation in athletes and updates in the management of channelopathies in athletes. This was followed by three cases that sparked great discussion among the expert panelists, which included civilian and military cardiologists and electrophysiologists and the chair and co-chair from the recent Heart Rhythm Society Expert consensus statement on arrhythmias in athletes.
The course was led by chair Meagan Wasfy, MD, MPH, FACC, co-chair Jeffrey Hsu, MD, FACC, and planning committee members; Elizabeth Dineen, DO, FACC, Dermot Phelan, MD, PhD, FASE, FACC, Ankit Shah, MD, MPH, FACC, Eli Friedman, MD, and Eileen Handberg, PhD, ARNP, FACC.
For those interested in continued engagement in sports cardiology, for the first time ever, there will be a joint European Association of Preventive Cardiology and American College of Cardiology joint sports cardiology conference in London and virtually on Sept. 3.
Reference:
- Care of the Athletic Heart; June 6-8, 2024; Washington, D.C. (hybrid meeting).
For more information:
Ankit B. Shah, MD, MPH, FACC, is president of Sports & Performance Cardiology LLC in Chevy Chase, Maryland, and associate professor of medicine at Georgetown University School of Medicine. He can be reached at ankitshah@spcardiology.com; X (Twitter): @sp_cardio.
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