Coronary Artery Evaluation by Screening Echocardiogram in Intercollegiate Athletes

Introduction: Coronary artery anomalies are the second most common congenital cause of sudden cardiac death in young athletes. Some centers have advocated for limited transthoracic echocardiogram (TTE) protocols in the screening of college athletes, which may miss important causes of sudden cardiac death. Purpose: The purpose of this study was to evaluate the ability of screening TTE to determine the origin and proximal course of the coronary arteries in intercollegiate athletes. Methods: An institutional review board-approved retrospective review of all incoming National Collegiate Athletic Association Division-I athletes at a single institution for the 2013-2014 academic year was performed. Two pediatric cardiologists independently reviewed all TTE studies for right coronary artery (RCA) and left coronary artery (LCA) ostia, proximal course, and measurable course. Proximal course was defined as a measurable course 91 cm for the RCA and a measurable course 91 cm or observation of the bifurcation for the LCA. Measurable course was defined as the maximum continuously observable distance of coronary artery from a clearly delineable ostium. Results were compared among athlete characteristics, and interobserver reliability was evaluated. Results: Chart review identified 146 athletes, representing 22 sports and 6 ethnicities. No coronary anomalies were found. The average measurable course was 2.1 cm for the RCA and 1.5 cm for the LCA. Both readers observed the RCA ostium in 143 athletes (98%), LCA ostium in 143 athletes (98%), RCA proximal course in 119 athletes (82%), and LCA proximal course in 118 athletes (81%). Statistical analysis showed good interobserver reliability for observation of the ostia and proximal course. Conclusions: The origin and proximal course of the coronary arteries were readily and reliably observed in the majority of athletes, suggesting coronary artery evaluation should be included in athlete screening TTE protocols.