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

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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.