Copyright © 2005, The European Society of Cardiology
Response to the letter to the editor from E. Kasikcioglu
Cardiovascular Diagnostic Centre, Nicosia, Cyprus
Received 17 October 2005; .
anast{at}spidernet.com.cy
Dr Kasikcioglu in his letter reviews the current state of affairs on the issue of how athletes should be effectively screened. The aim of the case report by Chee et al.1 was not to provide an answer to this important question but to illustrate that there is still discrepancy among experts and that specific guidelines need to be formulated.
As regards the family history we stated clearly that the athlete had no relevant family history. The athlete's father and two brothers even underwent echocardiographic evaluation which was unremarkable.
The importance of the 12-lead ECG is widely accepted as an initial and cheap screening test. Dr Kasikcioglou is correct in concluding that "echocardiography could be evaluated as a step between routine examination and further examinations".
Tissue Doppler Index, endomyocardial biopsy, genetic testing and imaging with current generation echo equipment could be pursued, in a similar situation, for differentiation of HCM and physiological hypertrophy. We are sure, he will agree, however, that such a work-up is far from being practical in order to be widely applied in a screening program. Such thorough evaluation could be useful in specific selected cases. Regarding our case, it is important to remember that the issue of our patient was first raised in 1990. Obviously in 2005, a more detailed evaluation would be pursued in a similar situation.
Dr Kasikcioglu is right in stating that "wrong decision (in such case) may lead to different catastrophies in competitive athletes – social, psychological and financial". That is exactly what happened to our athlete. He also agrees that the data of the "Cypriot case" looked highly suspicious for hypertrophic cardiomyopathy and he concurs that "the results of all examinations did not suffice as disqualification criteria for the competitive athlete in the article". Indeed our athlete was able to conclude his athletic career without further heart breaking.
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- Chee C.E., Anastassiades C.P., Antonopoulos A.G., Petsas A.A., Anastassiades L.C. Cardiac hypertrophy and how it may break an athlete's heart. Eur J Echocardiogr (2005) 6:301–307.
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