Dottorato in FISIOPATOLOGIA ED IMAGING CARDIO-TORACO-VASCOLARE

Titolo della tesi: Evaluation of the benefit of electrocardiographic screening for sudden cardiac death: comparison of pubertal and post-pubertal age and integration with cardiac imaging

BACKGROUND: Sudden Cardiac Death (SCD) in young people is a dramatic event that recognizes cardiomyopathies, channelopathies and congenital anomalies of the coronary arteries among the main causes. These pathologies are often asymptomatic and for this reason they cannot always be diagnosed before the fatal event. Screening programs with an electrocardiogram have demonstrated the effectiveness in preventing SCD, although the ECG alone is not sufficient to identify all cardiovascular diseases. AIM OF STUDY: Our study was designed primarily to evaluate the prevalence of cardiovascular diseases associated with SCD in young students 11 to 20 years old, and to compare the prevalence of those in pubertal age versus post-pubertal age. We also want to evaluate whether the addition of cardiovascular imaging during a screening program might be able to identify a greater number of subjects at risk of SCD than using an ECG alone. METHODS: We enrolled four hundred middle and high school students from Rome and Frosinone. Students were divided into two groups (pubertal and post-pubertal) according to pubertal status (11-14 vs 15 -20 years old). All subjects were screened with a personal and family history questionnaire, a resting 12-lead electrocardiogram (ECG) and an echocardiogram (ECHO). Students in the post-pubertal group underwent to a cardiac magnetic resonance (CMR). RESULTS: Pathological ECG findings were 2,25 % of total cohort. There was a statistically significant difference between the two groups (pubertal 1.36 %, post-pubertal 3,33 %; p = 0,007). Pathological echocardiograms were observed only in post-pubertal group with five cases of valvulopathies (post-pubertal 2.77 %; pubertal 0 %; p = 0.017). The CMR revealed one case of anomalous origin of coronary artery with the origin of right coronary artery from left sinus Valsalva. CONCLUSION: Our study suggests that the prevalence of pathological findings highlighted with ECG, echocardiogram and CMR is higher in the post-pubertal age than in the pubertal age. Screening with electrocardiogram is useful in identifying subjects at risk of SCD, especially those with electrical cardiac disorders. Cardiac imaging with ECHO and CMR revealed 1.25 % of students with structural heart disease that would have been undetected with ECG alone. A multimodality approach with an ECG, an ECHO and a CMR could potentially identify all cardiovascular disorders at risk of sudden cardiac death in young people.