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

了解年轻运动员心肌疾病和心源性猝死的预测因素。

• 批准号: MR/W025167/1
• 负责人: Aneil Malhotra
• 金额: $ 152.92万
• 依托单位: University of Manchester
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2022
• 资助国家: 英国
• 起止时间: 2022 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FW025167%2F1
• 关键词: Understanding; predictors; heart; muscle; disease

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.

目的研究为什么年轻运动员会患上可能导致他们猝死的心脏病。背景每周只需4小时的运动，心脏就会对增加的活动需求做出反应。这些可以显示在ECG（心脏电描记）和超声心动图（心脏超声扫描）上。被称为T波倒置的特定ECG模式可能是由于运动，但也可能表明称为心肌病的心肌疾病。识别可能患心肌病的T波倒置的年轻人至关重要，因为这种情况会使心脏性猝死的几率增加三倍。近年来，在运动员中发生了许多引人注目的心脏骤停事件，例如Fabrice Muamba，Marc Vivien Foé，以及最近的2021年欧洲杯足球赛中的Christian Eriksen。仅在英国，每年就有超过1，000名年轻人（年龄在14-35岁之间）遭受心脏死亡，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普遍性是其六倍，但其原因从未被探索过，因为很难定义一个足够大的风险人群，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。我打算调查是否有任何的早期变化，我们可以检测到的运动员，如T波倒置的心电图，或心脏的变化，超声，可以用来预测更严重的疾病，在年轻的白色和黑人运动员。设计和方法一个队列的1010名青少年运动员已被确定为异常T波倒置的心电图，但正常的心脏超声时，筛选年龄16岁，根据足球协会。505名是白色（白色欧洲血统）运动员，505名是黑人（非洲人/非洲加勒比人）运动员。大多数是男性（90%），反映了目前足球的人口构成。我的目标是在第一次筛查15年后重新评估这个定义明确的群体，使用新技术来确定谁继续发展为心肌疾病。患者/服务用户，护理人员和公众参与我已经建立了一个“我的心”患者支持小组，为受遗传性心脏病影响的个人，与慈善机构合作，年轻人的心脏风险（CRY）。该小组每年举行一次会议，由10名受影响的个人组成，其中6人是运动员，4人是SCD受害者的亲属。该小组就研究设计进行了咨询，并审查了参与者信息表。我还参与了对丧亲家庭的临床评估。Fabrice Muamba和Dapo Afolyan（博尔顿足球俱乐部的现任职业足球运动员）已同意成为这项研究的大使。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220，000例患者），但其解释尚不清楚。识别和告知有风险的个人将定制患者路径，有效利用NHS资源，减轻患者焦虑和不必要的调查。考虑到这些疾病的遗传基础，这些好处可以惠及超过300，000名一级亲属。传播我的研究结果将与国际科学组织和体育机构推荐的所有年轻运动员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联系分享研究更新和结果，与研究大使合作，并利用我在FA和欧洲心脏病学会的角色。我以前的工作报告的结果，英足总的心脏筛查计划，最大的同类在欧洲，已经指导决策者在国内和国际上，例如心脏评估的频率增加了在英国足总，橄榄球，板球板，英国自行车和美国国家大学田径协会。