Pre-participation cardiovascular evaluation in Pacific Island athletes

Abstract

Background: Pre-participation cardiovascular evaluation (PPE) aims to detect cardiac disease with sudden cardiac death (SCD) risk. No study has focused on Pacific Island athletes. Methods: A total of 2 281 Pacific Island athletes were studied with (i) a questionnaire on family, personal history and symptoms, (ii) a physical examination and (iii) a 12-lead ECG. Results: 85% presented a normal history and examination. A positive family history was 1.4-1.9 fold higher in Melanesians, Polynesians and Métis than in Caucasians, while a positive personal history, abnormal symptoms and abnormal examination was 1.3 fold higher in Melanesians and Métis than in others. Neither gender nor training level had a bearing on these results. Melanesians had higher T wave inversions (TWIs) in V2-V4 leads but had no CV abnormalities. Lateral or infero-lateral TWIs were found in 6 male and in 5 highly trained athletes and cardiomyopathies were diagnosed in 3/6 athletes. Overall, 3.9% athletes were found to have a CV abnormality and 0.8% had a risk of SCD. Polynesians and males were more at risk than the others while the level of training made no difference. In athletes at risk of SCD, the main detected CV diseases were cardiomyopathies, Wolff-Parkinson-White (WPW) and severe valve lesions of rheumatoid origin. Conclusions: PPE revealed that 3.9% presented CV abnormalities. A risk of SCD was found in 0.8% with cardiomyopathies, WPW, and severe valve lesions of rheumatoid

The Impact of Ethnicity on Athlete ECG Interpretation: A Systematic Review

“…Pacific Islander athletes were assessed in four papers [ 38 , 44 , 61 , 62 ], summarized in Table 8 . In one study, Melanesian athletes were reported to be twice as likely as other Pacific Islanders and Caucasian athletes to have TWI, comparable to Afro-Caribbean athletes [ 62 ].…”

“…Pacific Islander athletes were assessed in four papers [ 38 , 44 , 61 , 62 ], summarized in Table 8 . In one study, Melanesian athletes were reported to be twice as likely as other Pacific Islanders and Caucasian athletes to have TWI, comparable to Afro-Caribbean athletes [ 62 ]. In this study, 11 Pacific Islander groups were assessed, finding that 14% had LVH and 7.4% had right-ventricular hypertrophy (RVH), a similar prevalence to Caucasian athletes.…”

“…Studies of Pacific Islander athletes found their ECG features generally to be equivalent to Caucasian athletes., although Melanesian athletes may have TWI prevalence at a similar rate to Black athletes [ 62 ].…”

Quality of athlete screening for high‐risk cardiovascular conditions—A systematic review

“…Long-term cardiovascular mortality data were reported by three articles. 27,31,45 In the SWiM, we identified 11 167/82 417 (13.5%) athletes with screening abnormalities needing additional testing, such as ECG and TTE-if not performed-CMR or genotyping. Across the different strategies 22.1% were found through H-PE (2188/9898), 19.7% through H-PE-ECG (6374/32 369), and 6.5% through H-PE-ECG-TTE (2605/40 148), respectively (Figure 2).…”

To screen or not to screen, what do the Pacific Island athletes teach us?

“…Nearly all data on cardiovascular screening and incidence of SCD in young athletes have come from Europe or the United States, so the study by Chatard et al [8] on preparticipation cardiovascular evaluation among Pacific Island athletes published in this issue of the Journal is a welcomed addition to the rapidly growing literature on this somewhat emotional and controversial subject. The authors should be commended for conducting a study in this sparsely populated area spanning thousands of kilometers, although this lead to some difficulties in investigating the abnormal findings further, potentially affecting the results.…”