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Cardiac Screening in Young Athletes: The Role of Diagnostics in Preventing Sudden Cardiac Death and Exploring Clearance Protocols
Journal article   Open access   Peer reviewed

Cardiac Screening in Young Athletes: The Role of Diagnostics in Preventing Sudden Cardiac Death and Exploring Clearance Protocols

Ala W. Abdallah, Darren Nguyen, Osama Odeh, Noyan Ramazani, Jaineet Chhabra, Nazanin Houshmand and Tahir Tak
Journal of clinical medicine, Vol.15(5), 1895
03/02/2026
DOI: 10.3390/jcm15051895
PMID: 41827312
url
https://doi.org/10.3390/jcm15051895View
Published (Version of record) Open Access

Abstract

Background: Sudden cardiac death (SCD) and sudden cardiac arrest (SCA) remain leading causes of mortality in young athletes, highlighting the importance of cardiac screening prior to play. The guidelines on screening protocol are continually evolving but are often inconsistent across organizations. We explore the role of different screening modalities including electrocardiography (ECG) and various cardiac imaging testing; their effectiveness, cost considerations and clinical utility regarding sports cardiac screening, comparing European and American cardiac screening protocols. Additionally, we also discuss the divergence between the European and American guidelines and appraise the literature surrounding this topic. Methods: A comprehensive literature review was conducted using studies published between 2010–2025 on cardiac screening for young athletes. Parameters included an English filter with review of observational studies, systematic reviews, meta-analyses, and randomized controlled trials (RCTs). Manual searches of PubMed, Embase, and Google Scholar libraries were also performed to enhance the reach of our investigation. Articles were chosen based on relevance to the topic. Results: When compared to PPCS physical exam, ECG advantages include increased detection of cardiac conditions leading to SCD, improved sensitivity and specificity compared to history alone, Disadvantages are the need for trained specialists to complete testing properly, unreliability for detecting congenital coronary anomalies, cost-effectiveness concerns, and false positive risk. However, these disadvantages can be improved with improved ECG interpretation training for non-cardiologists and policies easing access to advanced cardiac care. Conclusions: ECG remains the cornerstone of cardiovascular screening due to its affordability and sensitivity in detecting electrical abnormalities, its limitations necessitate a multimodal approach. Integrating targeted ECG screening with echocardiography and advanced imaging in select cases may enhance diagnostic accuracy while balancing cost-effectiveness and accessibility. While the benefits of routine ECG are strongly supported by the literature, nationwide implementation of it remains challenging due to economic, geographical and logistical restraints. Therefore, more research needs to be conducted on the mortality benefits and cost-effectiveness of routine ECGs implementation in PPCS screening for young athletes.
 preparticipation cardiac clearance sports sudden cardiac death electrocardiogram imaging guidelines

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