Sports Death Risk in Harvard Athletes Seen With $88 Heart Scan

March 2 (Bloomberg) -- Screening for heart defects in high school and college athletes should be expanded after an $88 heart scan detected life-threatening conditions in Harvard University athletes, researchers said.

Tests known as electrocardiography, or ECG, identified two players who were deemed healthy in routine examinations despite having dangerous defects that should bar them from competition, according to a study published in the Annals of Internal Medicine. Scientists in three of the journal’s articles debated the merits of routine ECG tests for all competitive athletes.

Genetic heart defects caused the courtside deaths of Hank Gathers, an All-America 23-year-old basketball forward at Loyola Marymount University in Los Angeles, and Reggie Lewis, a 27- year-old All Star guard for the Boston Celtics of the National Basketball Association. Such defects are the top cause of sudden death in sports, killing 1 of every 220,000 young athletes each year, according to previous studies.

“The most important thing in screening is that you don’t miss people,” said Aaron Baggish, a cardiologist at Massachusetts General Hospital in Boston and a clinical instructor at Harvard Medical School. “We’d much rather screen a bunch of people and have to do more testing on a select few than miss one or two people and have them collapse.”

The biggest drawback to the tests was the number of young athletes who were incorrectly identified as having a risk, Baggish said yesterday in a telephone interview. That’s because athletes undergoing intense training develop a natural stiffening of the heart wall that can be incorrectly diagnosed as a heart defect with an ECG, he said.

False Positives

The rate of so-called false positives tripled to 17 percent for ECG-tested patients, compared with 5.5 percent under normal screening. New guidelines for how to analyze results in trained athletes and increased doctor training would be needed before tests are given as part of routine examinations of competitive athletes, Baggish said.

False readings require expensive follow-up tests and “would unavoidably promote inappropriate disqualifications, unnecessary anxiety, and possibly chaos in a national program,” said Barry Maron, director of the Hypertrophic Cardiomyopathy Center of the Minneapolis Heart Institute Foundation, in an editorial published yesterday with the study.

Loyola’s Gathers collapsed and died after scoring in a tournament game in 1990, and the Celtics’ Lewis died during practice in 1993. Both deaths were blamed on a detectable heart defect, prompting some doctors to call for expanded testing. The defect, hypertrophic cardiomyopathy, is the most common cause of sudden fatalities in young athletes according to a study last year in the journal Circulation.

Dangerous Rhythms

Cardiomyopathy causes some areas of the heart to harden, forcing muscles to work harder and sometimes causing dangerous rhythms, according to the National Institutes of Health in Bethesda, Maryland. The risk from such hardening often goes undiagnosed until someone faints or dies during exercise.

In an ECG, 10 electrodes are attached with sticky circles to a patient’s arms, legs and chest. The electrodes monitor pulses of electricity that flash through a beating heart as the muscles constrict and pump blood. The readings detect unusual patterns that may indicate a birth defect or diseased heart.

The American Heart Association doesn’t endorse mandatory sports testing with ECG, though some colleges have begun screening on their own, according to yesterday’s report. Italy adopted mandatory ECG testing in the 1980s, a policy that has reduced sudden deaths by almost 90 percent, according to previous studies.

Routine Screening

Routine ECG screening in the U.S. would cost about $88 per athlete, or about $42,900 for each year of life saved, according to a separate study by Stanford University researchers, also published yesterday in the Annals. The Stanford study relied on data collected from Italy’s program, adjusting the model to reflect higher expenses and lower rates of defects in the U.S. The study estimates screening a population of 3.7 million competitive athletes in the U.S.

Procedures costing less than $100,000 for each year saved, also known as Quality-Adjusted Life Year, or QUALY, are usually considered “a good deal,” said William Schaffner, chairman of the department of preventive medicine at Vanderbilt University in Nashville, Tennessee.

In the Harvard study, heart abnormalities that may affect sports participation were detected in 2.2 percent of the study population. A routine physical and family history consultation detected the risk in 5 patients. ECG testing found 5 additional patients with abnormalities.

Missed Patients

Additional testing using cardiac ultrasound, a sensitive scanning tool that gives a definitive diagnosis, found that three students had sufficient risk to bar them from competitive exercise. Only one of the highest-risk patients was detected by standard screening methods.

Previous studies have suggested that monitoring the heart’s activity should be more widely used to save lives. An Italian study of more than 30,000 athletes, published in the British Medical Journal in 2008, found 159 patients were disqualified from sports because of heart problems identified through ECG tests. Only six would have been identified through history and physical examination alone, according to the report.

To contact the reporter on this story: Tom Randall in New York at trandall6@bloomberg.net.