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.