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

目的研究为什么年轻运动员会患上可能导致猝死的心脏病。研究背景每周只需锻炼4个小时，心脏就会因运动量增加而出现变化。这些可以在ECG（心脏电描记）和超声心动图（心脏超声扫描）上显示出来。一种被称为t波反转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，即心肌病。鉴别出可能发展为心肌病的t波倒置的年轻人是至关重要的，因为这种情况会使心源性猝死的几率增加三倍。近年来，有许多备受瞩目的运动员心脏骤停，如法布里斯·穆安巴、马克·维维安·弗格尔，以及最近在2021年欧洲足球锦标赛上的克里斯蒂安·埃里克森。仅在英国，每年就有超过1000名年轻人（14-35岁）死于心源性死亡，而与t波倒置相关的心肌病是主要原因。这种关联在黑人运动员中是六倍多，但原因从未被探索过，因为很难确定一个足够大的风险人群，可以长期研究。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，比如心电图上的t波反转，或者超声上的心脏变化，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1010名16岁少年运动员在英国足球协会（Football Association）的检查中，心电图t波反转异常，但超声显示心脏正常，其中505名是白人（欧洲白人血统），505名是黑人（非洲/非洲-加勒比）运动员。大多数是男性（90%），反映了目前足球界的人口构成。我的目标是在他们第一次筛查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会发展为心肌疾病。我与慈善机构“青少年心脏风险”（CRY）合作，为患有遗传性心脏病的个人建立了一个“我的心脏”患者支持小组。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名是运动员，4名是SCD受害者的亲属。研究小组就研究设计进行了咨询，并审查了参与者信息表。我也参与了丧亲家庭的临床评估。法布里斯·穆安巴和达波·阿佛利安（现任博尔顿足球俱乐部职业球员）已经同意担任这项研究的大使。t波倒置是NHS遗传性心脏病门诊患者中最常见的心电图模式（每年影响约22万例患者），但其解释尚不清楚。识别和通知个人的风险将量身定制病人的途径，有效地利用NHS资源，减轻病人的焦虑和不必要的调查。鉴于这些疾病的遗传基础，这些福利扩大到30多万一级亲属。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加前心脏评估相关。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，并利用我在英足总和欧洲心脏病学会的角色。我之前的工作报告了英足总心脏筛查项目的结果，这是欧洲同类项目中规模最大的，已经指导了国内和国际上的政策制定者，例如，英国足协、橄榄球、板球委员会、英国自行车和美国全国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.