Risk of death in athletes identified with $88 heart scan

Screening for heart defects in high school and college athletes should be expanded after an $88 heart scan detected life-threatening conditions in Harvard University athletes, researchers said.

Tests known as electrocardiography, or ECG, identified two players who were deemed healthy in routine examinations despite having dangerous defects that should bar them from competition, according to a study published in the Annals of Internal Medicine.

Genetic heart defects caused the courtside deaths of Hank Gathers, an All-America 23-year-old basketball forward at Loyola Marymount University in Los Angeles, and Reggie Lewis, a 27- year-old All Star guard for the Boston Celtics of the National Basketball Association. Such defects are the top cause of sudden death in sports, killing 1 of every 220,000 young athletes each year, according to previous studies.

"The most important thing in screening is that you don't miss people," said Aaron Baggish, a cardiologist at Massachusetts General Hospital in Boston.

The biggest drawback to the tests was the number of young athletes who were incorrectly identified as having a risk, Baggish said. That's because athletes undergoing intense training develop a natural stiffening of the heart wall that can be incorrectly diagnosed as a heart defect with an ECG, he said.

False readings require expensive follow-up tests and "would unavoidably promote inappropriate disqualifications, unnecessary anxiety, and possibly chaos in a national program," said Barry Maron, director of the Hypertrophic Cardiomyopathy Center of the Minneapolis Heart Institute Foundation.

Loyola's Gathers collapsed and died after scoring in a tournament game in 1990, and the Celtics' Lewis died during practice in 1993. Both deaths were blamed on a detectable heart defect, prompting some doctors to call for expanded testing. The defect, hypertrophic cardiomyopathy, is the most common cause of sudden fatalities in young athletes.

Cardiomyopathy causes some areas of the heart to harden, forcing muscles to work harder and sometimes causing dangerous rhythms, according to the National Institutes of Health in Bethesda, Maryland. The risk from such hardening often goes undiagnosed until someone faints or dies during exercise.

The American Heart Association doesn't endorse mandatory sports testing with ECG, though some colleges have begun screening on their own. Italy adopted mandatory ECG testing in the 1980s, a policy that has reduced sudden deaths by almost 90 percent, according to previous studies.

Routine ECG screening in the U.S. would cost about $88 per athlete, or about $42,900 for each year of life saved, according to a separate study by Stanford University researchers. Procedures costing less than $100,000 for each year saved, also known as Quality-Adjusted Life Year, or QUALY, are usually considered "a good deal," said William Schaffner, chairman of the department of preventive medicine at Vanderbilt University in Nashville, Tenn.