Understanding the predictors of heart muscle disease and sudden cardiac death in young athletes.

目的研究年轻运动员罹患心脏病并可能导致猝死的原因。背景每周只需运动4小时，心脏就会对增加运动的要求做出反应。这些可以在心电图(心脏电描记法)和超声心动图(心脏超声扫描)上显示出来。一种被称为T波倒置的特殊心电图模式可能是由于运动引起的，但也可能表明心脏肌肉疾病，称为心肌病。识别患有T波倒置的年轻人可能会患上心肌病是至关重要的，因为这种情况会使心源性猝死的几率增加三倍。最近，法布里斯·穆安巴、马克·维维安·福埃以及最近在2021年欧洲杯足球锦标赛上的克里斯蒂安·埃里克森等运动员发生了多起备受瞩目的心脏骤停事件。仅在英国，每年就有1000多名年轻人(年龄在14-35岁)心脏病死亡，其主要原因是与T波倒置相关的心肌病。这种关联在黑人运动员中的发生率是黑人运动员的六倍，但其原因从未被探索过，因为很难定义足够大的危险人群，可以随着时间的推移进行研究。这项研究为回答这个问题提供了一个独特的机会。我打算调查我们在运动员身上可以检测到的任何早期变化，例如心电图上的T波倒置，或者超声波上的心脏变化，是否可以用来预测年轻的白人和黑人运动员更严重的疾病。设计和方法根据足协对1010名年轻运动员进行的16岁筛查，发现他们的心电图T波倒置异常，但超声检查心脏正常。505名运动员是白人(欧洲白人血统)，505名是黑人(非洲/非洲加勒比裔)运动员。大多数是男性(90%)，这反映了目前足球的人口构成。我的目标是在第一次筛查15年后重新评估这一定义明确的群体，使用新技术来确定谁后来发展为心肌疾病。患者/服务使用者、护理者和公众参与我已经为患有遗传性心脏疾病的个人建立了一个“我的心脏”患者支持小组，与慈善机构青年心脏风险(CRY)合作。该小组每年开会，由10名受影响的人组成，其中6人是运动员，4人是SCD受害者的亲属。就研究设计征求了该小组的意见，并审查了参与者信息表。我还参与了对丧失亲人家庭的临床评估。法布里斯·穆安巴和达波·阿弗利安(博尔顿足球俱乐部现任职业足球运动员)已经同意担任这项研究的大使。T波倒置是NHS遗传性心脏病诊所患者中最常见的心电图模式(每年影响约22万名患者)，但其解释尚不清楚。识别和告知有风险的个人将量身定做患者路径，有效利用NHS资源，并缓解患者焦虑和不必要的调查。考虑到这些疾病的遗传基础，这些好处延伸到了30多万名一级亲属。播种我的研究结果将与国际科学组织和体育团体推荐的所有年轻运动员的参赛前心脏评估相关。我将通过专门的网页、社交媒体和主流媒体连接，与研究大使合作，并利用我在FA和欧洲心脏病学会的角色，分享研究的最新进展和结果。我之前的工作是报道足总心脏筛查计划的结果，这是欧洲同类项目中规模最大的，已经在国内和国际上指导了政策制定者，例如，英国足协、橄榄球、板球委员会、英国自行车和美国国家大学田径协会的心脏评估频率增加了。

AimTo study why young athletes develop heart disease that may cause them to die suddenly.BackgroundIt takes just four hours of exercise a week for the heart to show changes in response to the demands of increased activity. These can show on the ECG (electrical tracing of the heart) and echocardiogram (heart ultrasound scan). A specific ECG pattern known as T-wave inversion may be due to exercise but can also indicate heart muscle disease called cardiomyopathy. Identifying young people with T-wave inversion who may develop cardiomyopathy is crucial because this condition increases the chances of a sudden cardiac death by three times. In recent times there have been a number of high-profile sudden cardiac arrests in athletes e.g. Fabrice Muamba, Marc Vivien Foé, and most recently, Christian Eriksen in the Euros 2021 football tournament.Over 1,000 young people (aged 14-35 years old) suffer cardiac death every year in the UK alone and cardiomyopathy associated with T-wave inversion in the main cause. This association is six times more common in black athletes but the cause has never been explored, due to difficulties in defining a large enough population at risk that can be studied over time. This study provides a unique opportunity to answer this problem. I intend to investigate whether any of the early changes we can detect in athletes, such as T-wave inversion on ECG, or heart changes on ultrasound, can be used to predict more serious disease, in young white and black athletes.Design and methodsA cohort of 1010 junior athletes have been identified with abnormal T-wave inversion on the ECG but a normal heart on ultrasound when screened aged 16 years old, under the Football Association. 505 are white (white European ancestry) and 505 are black (African/ Afro-Caribbean) athletes. Most are males (90%) reflecting the current demographic make-up in football. I aim to reassess this well-defined group 15 years after their first screening, using new techniques to determine who has gone on to develop a heart muscle disorder.Patient/service user, carer and public involvement I have established a "my heart" patient support group for individuals affected with inherited cardiac conditions, working with the charity, Cardiac Risk in the Young (CRY). The group meets annually and comprises 10 affected individuals, 6 of whom are athletic and 4 are relatives of victims of SCD. The group was consulted on study design and reviewed participant information sheets. I am also involved in the clinical assessment of bereaved families. Fabrice Muamba and Dapo Afolyan (current professional footballer for Bolton FC) have agreed to be ambassadors for the study.T-wave inversion is the commonest ECG pattern seen among patients in NHS inherited cardiac conditions clinics (affecting approximately 220,000 patients/year), yet its interpretation is unclear. Identifying and informing individuals at risk will tailor the patient pathway, utilise NHS resources effectively and alleviate patient anxiety and unnecessary investigations. These benefits extend to over 300,000 first-degree relatives given the genetic basis of these conditions.DisseminationThe results of my study will be relevant to all pre-participation cardiac assessments of young athletes recommended by international scientific organizations and sporting bodies. I will share study updates and results via a dedicated webpage, social media, and mainstream media connections, working with the study ambassadors and utilising my roles at the FA and European Society of Cardiology. My previous work reporting the outcomes of the FA's cardiac screening programme, the largest of its kind in Europe, has already guided policymakers nationally and internationally e.g. frequency of cardiac evaluations have increased in The English FA, rugby, cricket boards, British cycling and the American national collegiate athletics association.