August, 2015
Italy…the magical country with beauty AND brains!
Summer Vacation in Italy! This was a dream come true for the Lopynski family. Five cities in two weeks with no car…what an adventure! We flew to the Island of Venice and traveled through the winding canals by vaporetto. Two days later we arrived in Florence, touring the rich regions of the Italian Renaissance; Tuscany, Cinque Terre, Siena, Naples, and Rome. Finally, our journey ended at the Amalfi Coast taking in Sorrento, Positano and the island of Capri. From the soaring mountains and breathtaking coastline, to the welcoming natives who greeted us at every turn with their romantic language and mouth-watering cuisine, Italy was indeed magical!
Mandatory EKG screening in Italy! Our family’s love for Italy was further ignited as we were reminded of a law that was formulated back in 1982. This Italian law mandates routine EKG screenings for young athletes fueling the debate about feasibility of such testing in the US. The general thinking in the US is that heart testing is a good idea but it is too expensive, especially when the prevalence of death is so low. An Italian study was done from the onset of the screenings indicating that sudden death during competition had decreased nearly 90 percent since testing began. This would indicate that EKG screenings can work!
Below are a few successful models of interventions using EKG’s. The contrasting policies with regard to national standards on screening young athletes for cardiovascular abnormalities are as follows:
Italy By law, all competitive athletes are required to undergo physiological testing prior to competing. This consists of a history, physical examination, urinalysis, resting and exercise ECG, and pulmonary functioning test. All of these tests are conducted by a sports physician. If there are abnormalities, further screening of ECHO (echocardiography) is required.
- A study of 4,050 Italian national team athletes revealed high levels of efficiency of 12-lead ECG in detecting HCM in young athletes. Athletes with HCM were not allowed to compete.
- Trends in cases of sudden death in screened and unscreened athletes were monitored over 25 years. Sudden cardiovascular death accounted for 55 deaths in screened athletes and 265 in unscreened athletes. Overall, there was an 89% decrease in incidence of athlete death due to cardiovascular abnormalities.
European Association for Cardiovascular Prevention in Sports Cardiology: Heart screening is supported by the International Olympic Committee, and follows the Italian strategy, with personal and family history, physical examination, and 12-lead resting ECG. FIFA also performed pre participation screening of all soccer players in the world championships in Germany in 2006.
United States: As of 2014 there was no national policy for the screening of CVD or sudden cardiac death in young athletes, though many screening programs were being run by private entities and various non-profit organizations. Most state laws require competitive athletes to undergo a physician-mediated physical examination and history. ECG or echocardiograms are rarely used. A medical history and physical examination were found to have little sensitivity or power to detect HCM or other risk conditions. It is considered that routine screening is not justified due to the low incidence of HCM, approximately 2 in 1,000 individuals.
Through 2015, the Ryan Lopynski Big Heart Foundation has provided EKG screenings to over 2,000 young adults. Of those screened, 100 came up abnormal and they were referred for additional tests. We received feedback from 2 families whose children had Wolfe Parkinson’s White Syndrome and had to have operations to correct this heart abnormality. The Ryan Lopynski Big Heart Foundation understands that abnormal EKG readings may result in no heart problem after further evaluation. We will continue to educate parents and young adults on the potential for false positives and we are working with the medical community to identify ways to reduce them. We believe that the value of EKG screening is compelling. Given the studies that we have reviewed and our own experience we believe that EKG screenings of young adults save lives.