From U Washington: Etiologies of Sudden Cardiac Death in NCAA Athletes

Circ Arrhythm Electrophysiol. 2014 Mar 1. [Epub ahead of print]

Etiologies of Sudden Cardiac Death in National Collegiate Athletic Association Athletes.

Harmon KG1, Drezner JA, Maleszewski JJ, Lopez-Anderson M, Owens D, Prutkin JM, Asif IM, Klossner D, Ackerman MJ.

Author information

• 11Department of Family Medicine, University of Washington, Seattle, WA.

Abstract

BACKGROUND:

-The etiology of sudden cardiac death (SCD) in college athletes has not been defined by systematic case identification.

METHODS AND RESULTS:

-45 cases of SCD were identified in National Collegiate Athletic Association (NCAA) athletes from 2004 - 2008 based on an internal reporting system and review of media reports. Autopsy reports were reviewed and adjudicated by a multi-disciplinary panel. Cause of death could be reasonably determined in 36 cases. 3 athletes had no autopsy, 5 autopsy reports could not be obtained, and 1 autopsy had insufficient information to determine cause of death. The most common finding at death was a structurally normal heart or autopsy-negative sudden unexplained death (11, 31%), followed by coronary artery abnormalities (5, 14%), dilated cardiomyopathy (3, 8%), myocarditis related (3, 8%), aortic dissection (3, 8%), and idiopathic left ventricular hypertrophy (LVH)/possible hypertrophic cardiomyopathy (HCM) (3, 8%). There was one case each (3%) of HCM, arrhythmogenic right ventricular cardiomyopathy, long QT syndrome, commotio cordis, and Kawasaki's disease. There was one case of death in a sickle cell positive athlete who also had LVH. The adjudicated diagnosis agreed with the official pathology report in only 59% of cases.

CONCLUSIONS:

-Unexplained death with a structurally normal heart is the most common finding after suspected SCD in NCAA athletes. HCM is infrequently seen, and conclusions in autopsy reports may not accurately reflect the pathologic findings. Standardized protocols for cardiovascular autopsies in athletes are needed, including post-mortem genetic testing, particularly in autopsy-negative cases.