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突然死亡的心脏病。背景每周只需运动四个小时，心脏就会因增加活动的需求而出现变化。这些可以在心电图（心电图）上显示出来心脏）和超声心动图（心脏超声扫描）称为 T 波倒置的特定心电图模式可能是由于运动引起的，但也可能表明患有称为心肌病的心肌疾病，识别可能患有心肌病的 T 波倒置的年轻人至关重要。因为这种情况使心源性猝死的几率增加了三倍，最近发生了一些备受瞩目的运动员心脏骤停的事件，例如法布里斯·穆安巴 (Fabrice Muamba)、马克·维维安·福 (Marc Vivien Foé) 以及最近在 2021 年欧洲杯上出现的克里斯蒂安·埃里克森 (Christian Eriksen)。仅在英国，每年就有超过 1,000 名年轻人（14-35 岁）因心源性死亡，而与 T 波倒置相关的心肌病是其主要原因。在黑人运动员中很常见，但由于很难确定足够多的处于危险中的人群，因此这项研究提供了一个独特的机会来回答这个问题，我打算调查是否存在任何早期的问题。我们可以在运动员身上检测到的变化，例如心电图上的 T 波倒置或超声波上的心脏变化，可用于预测年轻白人和黑人运动员更严重的疾病。 设计和方法 已确定由 1010 名青少年运动员组成的队列心电图 T 波倒置异常但在 16 岁时进行超声检查时心脏正常，根据足协统计，有 505 名是白人（欧洲白人血统），505 名是黑人（非洲/加勒比裔）运动员，大多数是男性（90%），反映了当前的人口统计。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患有心肌疾病。患者/服务用户、护理人员和公众参与 我与慈善机构“年轻人心脏风险 (CRY)”合作，为患有遗传性心脏病的个人建立了“我的心”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、6 名患者组成。其中 4 名是 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。我还参与了对死者家属的临床评估。 FC）已同意担任该研究的大使。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 名患者），但其解释尚不清楚，无法识别并告知处于危险中的个体。考虑到这些疾病的遗传基础，将定制患者路径，利用 NHS 资源有效缓解患者焦虑和不必要的调查，这些好处将惠及超过 300,000 名一级亲属。我的研究将与国际科学组织和体育机构推荐的所有年轻运动员参与前心脏评估相关，我将与研究大使和主流媒体合作，通过专门的网页、社交媒体和主流媒体分享研究的最新动态和结果。利用我在 FA 和欧洲心脏病学会的角色，我之前的工作报告了 FA 心脏筛查项目的结果，这是欧洲同类中规模最大的项目，已经为国内和国际决策者提供了指导，例如《英国医学杂志》中的心脏评估频率有所增加。足协、橄榄球、板球委员会、英国自行车赛和美国全国大学田径协会。