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Browsing by Author "Chung, Eugene H."
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Item International Criteria for Electrocardiographic Interpretation in Athletes(Elsevier, 2017-02) Sharma, Sanjay; Drezner, Jonathan A.; Baggish, Aaron; Papadakis, Michael; Wilson, Mathew G.; Prutkin, Jordan M.; La Gerche, Andre; Ackerman, Michael J.; Borjesson, Mats; Salerno, Jack C.; Asif, Irfan M.; Owens, David S.; Chung, Eugene H.; Emery, Michael S.; Froelicher, Victor F.; Heidbuchel, Hein; Adamuz, Carmen; Asplund, Chad A.; Cohen, Gordon; Harmon, Kimberly G.; Marek, Joseph C.; Molossi, Silvana; Niebauer, Josef; Pelto, Hank F.; Perez, Marco V.; Riding, Nathan R.; Saarel, Tess; Schmied, Christian M.; Shipon, David M.; Stein, Ricardo; Vetter, Victoria L.; Pelliccia, Antonio; Corrado, Domenico; Medicine, School of MedicineSudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural, or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly over the last decade; pushed by a growing body of scientific data that both tests proposed criteria sets and establishes new evidence to guide refinements. On February 26-27, 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington, to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD.Item Prevalence of Clinical and Subclinical Myocarditis in Competitive Athletes With Recent SARS-CoV-2 Infection: Results From the Big Ten COVID-19 Cardiac Registry(AMA, 2021-05-27) Daniels, Curt J.; Rajpal, Saurabh; Greenshields, Joel T.; Rosenthal, Geoffrey L.; Chung, Eugene H.; Terrin, Michael; Jeudy, Jean; Mattson, Scott E.; Law, Ian H.; Borchers, James; Kovacs, Richard; Kovan, Jeffrey; Rifat, Sami F.; Albrecht, Jennifer; Bento, Ana I.; Albers, Lonnie; Bernhardt, David; Day, Carly; Hecht, Suzanne; Hipskind, Andrew; Mjaanes, Jeffrey; Olson, David; Rooks, Yvette L.; Somers, Emily C.; Tong, Matthew S.; Wisinski, Jeffrey; Womack, Jason; Esopenko, Carrie; Kratochvil, Christopher J.; Rink, Lawrence D.; Medicine, School of MedicineImportance: Myocarditis is a leading cause of sudden death in competitive athletes. Myocardial inflammation is known to occur with SARS-CoV-2. Different screening approaches for detection of myocarditis have been reported. The Big Ten Conference requires comprehensive cardiac testing including cardiac magnetic resonance (CMR) imaging for all athletes with COVID-19, allowing comparison of screening approaches. Objective: To determine the prevalence of myocarditis in athletes with COVID-19 and compare screening strategies for safe return to play. Design, Setting, and Participants: Big Ten COVID-19 Cardiac Registry principal investigators were surveyed for aggregate observational data from March 1, 2020, through December 15, 2020, on athletes with COVID-19. For athletes with myocarditis, presence of cardiac symptoms and details of cardiac testing were recorded. Myocarditis was categorized as clinical or subclinical based on the presence of cardiac symptoms and CMR findings. Subclinical myocarditis classified as probable or possible myocarditis based on other testing abnormalities. Myocarditis prevalence across universities was determined. The utility of different screening strategies was evaluated. Exposures: SARS-CoV-2 by polymerase chain reaction testing. Main Outcome and Measure: Myocarditis via cardiovascular diagnostic testing. Results: Representing 13 universities, cardiovascular testing was performed in 1597 athletes (964 men [60.4%]). Thirty-seven (including 27 men) were diagnosed with COVID-19 myocarditis (overall 2.3%; range per program, 0%-7.6%); 9 had clinical myocarditis and 28 had subclinical myocarditis. If cardiac testing was based on cardiac symptoms alone, only 5 athletes would have been detected (detected prevalence, 0.31%). Cardiac magnetic resonance imaging for all athletes yielded a 7.4-fold increase in detection of myocarditis (clinical and subclinical). Follow-up CMR imaging performed in 27 (73.0%) demonstrated resolution of T2 elevation in all (100%) and late gadolinium enhancement in 11 (40.7%). Conclusions and Relevance: In this cohort study of 1597 US competitive athletes with CMR screening after COVID-19 infection, 37 athletes (2.3%) were diagnosed with clinical and subclinical myocarditis. Variability was observed in prevalence across universities, and testing protocols were closely tied to the detection of myocarditis. Variable ascertainment and unknown implications of CMR findings underscore the need for standardized timing and interpretation of cardiac testing. These unique CMR imaging data provide a more complete understanding of the prevalence of clinical and subclinical myocarditis in college athletes after COVID-19 infection. The role of CMR in routine screening for athletes safe return to play should be explored further.