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Editorial Comment: Routine Screening of Young Athletes for Aneurysm
Editorial Comment: R o u t i n e S c re e n i n g o f Yo u n g A t h l e t e s for Aneurysm John A. Elefteriades, MD In his article in this issue of Cardiology Clinics, Dr Jaime Gerber makes an excellent, wellreasoned case that all sudden cardiac deaths are extremely rare in young athletes and that aortic-related deaths are a very small subgroup of sudden deaths (Table 1). He recognizes that echocardiography is very effective at imaging the aorta but indicates that exactly what constitutes aortic enlargement is not totally clear. He
makes the case that the cost of screening is unjustifiable. The article by Dr John A. Elefteriades establishes the link of strength training–type exercise with hypertension. He links hypertension with high wall tension in the human aorta. He makes an emotional plea for routine, low-cost, mass echo screening. The weight of evidence is on the con side of the argument, as shown in Fig. 1.
Table 1 Routine echo screening of young athletes for aortic aneurysms Pro: Athletes Should be Screened (Elefteriades)
Con: Athletes Need Not be Screened (Gerber)
Aortic dissection does occurs in young athletes with unsuspected moderate aortic enlargement (4–5 cm) This senseless loss of promising young lives needs to be stopped
Sudden death of young athletes is not sufficiently common to justify screening (1866 cases over 27 years in the United States) Of those deaths, more than 50% were judged to be because of arrhythmia, as there was no structural cardiac abnormality. Only 3.3% were caused by acute aortic disease
Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, Yale-New Haven Hospital, PO Box 208039, New Haven, CT 06520-8039, USA E-mail address: [email protected] Cardiol Clin 28 (2010) 237–238 doi:10.1016/j.ccl.2010.02.009 0733-8651/10/$ – see front matter ª 2010 Elsevier Inc. All rights reserved.
cardiology.theclinics.com
The link between exercise and extreme instantaneous hypertension has been demonstrated Aortic wall tension ‘‘flirts’’ with the ultimate tensile strength of the aorta in patients with moderate aortic enlargement and moderate hypertension Although there are socio-economic issues, the cost of a mass echo is less than that of high-end sports shoes
238
Elefteriades
Fig. 1. Although the emotional impact of the needless loss of the life of a promising young athlete is strong, socio-economic reasoning (especially vis-a`-vis the rarity of exercise-related sudden aortic death) holds sway.
makes the case that the cost of screening is unjustifiable. The article by Dr John A. Elefteriades establishes the link of strength training–type exercise with hypertension. He links hypertension with high wall tension in the human aorta. He makes an emotional plea for routine, low-cost, mass echo screening. The weight of evidence is on the con side of the argument, as shown in Fig. 1.
Table 1 Routine echo screening of young athletes for aortic aneurysms Pro: Athletes Should be Screened (Elefteriades)
Con: Athletes Need Not be Screened (Gerber)
Aortic dissection does occurs in young athletes with unsuspected moderate aortic enlargement (4–5 cm) This senseless loss of promising young lives needs to be stopped
Sudden death of young athletes is not sufficiently common to justify screening (1866 cases over 27 years in the United States) Of those deaths, more than 50% were judged to be because of arrhythmia, as there was no structural cardiac abnormality. Only 3.3% were caused by acute aortic disease
Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, Yale-New Haven Hospital, PO Box 208039, New Haven, CT 06520-8039, USA E-mail address: [email protected] Cardiol Clin 28 (2010) 237–238 doi:10.1016/j.ccl.2010.02.009 0733-8651/10/$ – see front matter ª 2010 Elsevier Inc. All rights reserved.
cardiology.theclinics.com
The link between exercise and extreme instantaneous hypertension has been demonstrated Aortic wall tension ‘‘flirts’’ with the ultimate tensile strength of the aorta in patients with moderate aortic enlargement and moderate hypertension Although there are socio-economic issues, the cost of a mass echo is less than that of high-end sports shoes
238
Elefteriades
Fig. 1. Although the emotional impact of the needless loss of the life of a promising young athlete is strong, socio-economic reasoning (especially vis-a`-vis the rarity of exercise-related sudden aortic death) holds sway.