This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in JAMA  Social Bookmarking   What's this?

Clinical, Demographic, and Pathological Profiles

Barry J. Maron, MD; Jamshid Shirani, MD; Liviu C. Poliac, MD; Robert Mathenge, MD; William C. Roberts, MD; Frederick O. Mueller, PhD

JAMA. 1996;276(3):199-204.

Abstract
Objective.
—To develop clinical, demographic, and pathological profiles of young competitive athletes who died suddenly.

Design.
—Systematic evaluation of clinical information and circumstances associated with sudden deaths; interviews with family members, witnesses, and coaches; and analyses of postmortem anatomic, microscopic, and toxicologic data.

Participants and Setting.
—A total of 158 sudden deaths that occurred in trained athletes throughout the United States from 1985 through 1995 were analyzed.

Main Outcome Measures.
—Characteristics and probable cause of death.

Results.
—Of 158 sudden deaths among athletes, 24 (15%) were explained by noncardiovascular causes. Among the 134 athletes who had cardiovascular causes of sudden death, the median age was 17 years (range, 12-40 years), 120 (90%) were male, 70 (52%) were white, and 59 (44%) were black. The most common competitive sports involved were basketball (47 cases) and football (45 cases), together accounting for 68% of sudden deaths. A total of 121 athletes (90%) collapsed during or immediately after a training session (78 cases) or a formal athletic contest (43 cases), with 80 deaths (63%) occurring between 3 PM and 9 PM. The most common structural cardiovascular diseases identified at autopsy as the primary cause of death were hypertrophic cardiomyopathy (48 athletes [36%]), which was disproportionately prevalent in black athletes compared with white athletes (48% vs 26% of deaths; P=.01), and malformations involving anomalous coronary artery origin (17 athletes [13%]). Of 115 athletes who had a standard preparticipation medical evaluation, only 4 (3%) were suspected of having cardiovascular disease, and the cardiovascular abnormality responsible for sudden death was correctly identified in only 1 athlete (0.9%).

Conclusions.
—Sudden death in young competitive athletes usually is precipitated by physical activity and may be due to a heterogeneous spectrum of cardiovascular disease, most commonly hypertrophic cardiomyopathy. Preparticipation screening appeared to be of limited value in identification of underlying cardiovascular abnormalities.

Author Affiliations
From the Division of Cardiovascular Research, Minneapolis Heart Institute Foundation, Minneapolis, Minn (Drs Maron, Poliac, and Mathenge); Albert Einstein College of Medicine, Bronx, NY (Dr Shirani); the National Center for Catastrophic Sports Injury Research and the University of North Carolina, Chapel Hill (Dr Mueller); and Baylor University Medical Center, Dallas, Tex (Dr Roberts).

Footnotes
Reprints: Barry J. Maron, MD, Minneapolis Heart Institute Foundation, 920 E 28th St, Suite 40, Minneapolis, MN 55407.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTER

Sudden Death and Other Risks Associated With Dry-Sand Beach Holes
Bradley A. Maron and Barry J. Maron
JAMA. 2001;285(15):1964.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Electrocardiographic amplitudes: a new risk factor for sudden death in hypertrophic cardiomyopathy
Ostman-Smith et al.
Eur Heart J 2009;0:ehp443v1-ehp443.
ABSTRACT | FULL TEXT  

Cardiovascular Health, Part 1: Preparticipation Cardiovascular Screening
Gupta et al.
Sports Health: A Multidisciplinary Approach 2009;1:500-507.
ABSTRACT | FULL TEXT  

Identification of Unexpected Nonatherosclerotic Cardiovascular Disease With Coronary CT Angiography
Knickelbine et al.
J Am Coll Cardiol Img 2009;2:1085-1092.
ABSTRACT | FULL TEXT  

Incidence and aetiology of sudden cardiac death in young athletes: an international perspective
Borjesson and Pelliccia
Br. J. Sports. Med. 2009;43:644-648.
ABSTRACT | FULL TEXT  

Distinguishing hypertrophic cardiomyopathy from athlete's heart physiological remodelling: clinical significance, diagnostic strategies and implications for preparticipation screening
Maron
Br. J. Sports. Med. 2009;43:649-656.
ABSTRACT | FULL TEXT  

Electrocardiographic screening in athletes: the time is now for universal screening
Papadakis and Sharma
Br. J. Sports. Med. 2009;43:663-668.
ABSTRACT | FULL TEXT  

Return to play? Practical considerations for young athletes with cardiovascular disease
Anderson and Vetter
Br. J. Sports. Med. 2009;43:690-695.
ABSTRACT | FULL TEXT  

Preparing for sudden cardiac arrest--the essential role of automated external defibrillators in athletic medicine: a critical review
Drezner
Br. J. Sports. Med. 2009;43:702-707.
ABSTRACT | FULL TEXT  

Cardiac findings in the precompetition medical assessment of football players participating in the 2009 African Under-17 Championships in Algeria
Schmied et al.
Br. J. Sports. Med. 2009;43:716-721.
ABSTRACT | FULL TEXT  

School Days
Reider
Am J Sports Med 2009;37:1681-1683.
FULL TEXT  

The Lausanne recommendations: a Dutch experience
Bessem et al.
Br. J. Sports. Med. 2009;43:708-715.
ABSTRACT | FULL TEXT  

Aetiology of sudden cardiac death in athletes in the United Kingdom: a pathological study
de Noronha et al.
Heart 2009;95:1409-1414.
ABSTRACT | FULL TEXT  

Commotio Cordis and the Epidemiology of Sudden Death in Competitive Lacrosse
Maron et al.
Pediatrics 2009;124:966-971.
ABSTRACT | FULL TEXT  

Outcome of patients with hypertrophic cardiomyopathy and a normal electrocardiogram.
McLeod et al.
J Am Coll Cardiol 2009;54:229-233.
ABSTRACT | FULL TEXT  

Prevalence and significance of T-wave inversions in predominantly Caucasian adolescent athletes
Papadakis et al.
Eur Heart J 2009;30:1728-1735.
ABSTRACT | FULL TEXT  

Sudden cardiac arrest in children and young athletes: the importance of a detailed personal and family history in the pre-participation evaluation
Campbell et al.
Br. J. Sports. Med. 2009;43:336-341.
ABSTRACT | FULL TEXT  

Echocardiographic tissue deformation imaging of right ventricular systolic function in endurance athletes
Teske et al.
Eur Heart J 2009;30:969-977.
ABSTRACT | FULL TEXT  

WPW Pattern in the Asymptomatic Individual: Has Anything Changed?
Klein et al.
Circ Arrhythm Electrophysiol 2009;2:97-99.
FULL TEXT  

Multiple Mutations in Genetic Cardiovascular Disease: A Marker of Disease Severity?
Kelly and Semsarian
Circ Cardiovasc Genet 2009;2:182-190.
FULL TEXT  

Advances in the prevention of sudden cardiac death in the young
Shephard and Semsarian
Ther Adv Cardiovasc Dis 2009;3:145-155.
ABSTRACT  

Sudden Unexpected Death in Young Athletes: Reconsidering "Hypertrophic Cardiomyopathy"
Rowland
Pediatrics 2009;123:1217-1222.
ABSTRACT | FULL TEXT  

Sudden Deaths in Young Competitive Athletes: Analysis of 1866 Deaths in the United States, 1980-2006
Maron et al.
Circulation 2009;119:1085-1092.
ABSTRACT | FULL TEXT  

Thick hearts, high stakes, great uncertainties: screening athletes for hypertrophic cardiomyopathy
Baggish and Thompson
Heart 2009;95:345-347.
FULL TEXT  

Applications of Cardiac Magnetic Resonance in Electrophysiology
Nazarian et al.
Circ Arrhythm Electrophysiol 2009;2:63-71.
FULL TEXT  

Heart Disease and Stroke Statistics--2009 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
WRITING GROUP MEMBERS et al.
Circulation 2009;119:e21-e181.
FULL TEXT  

The Role of Automated External Defibrillators in Athletics
Rothmier and Drezner
Sports Health: A Multidisciplinary Approach 2009;1:16-20.
ABSTRACT | FULL TEXT  

Genes, Geography and Geometry: The "Critical Mass" in Hypertrophic Cardiomyopathy
Kaludercic et al.
J. Mol. Diagn. 2009;11:12-16.
ABSTRACT | FULL TEXT  

Hypertrophic cardiomyopathy and athlete's heart: a tale of two entities
Martin et al.
Eur J Echocardiogr 2009;10:151-153.
ABSTRACT | FULL TEXT  

CHAPTER 32 Sports and Heart Disease
Corrado et al.
ESC Textbook of Cardiovascular Medicine 2009;2:med-9780199566990-chapter-med-9780199566990-chapter.
ABSTRACT | FULL TEXT  

Bethesda Conference #36 and the European Society of Cardiology Consensus Recommendations Revisited: A Comparison of U.S. and European Criteria for Eligibility and Disqualification of Competitive Athletes With Cardiovascular Abnormalities
Pelliccia et al.
J Am Coll Cardiol 2008;52:1990-1996.
ABSTRACT | FULL TEXT  

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease) Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
Warnes et al.
J Am Coll Cardiol 2008;52:e143-e263.
FULL TEXT  

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Adults With Congenital Heart Disease) Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
Warnes et al.
J Am Coll Cardiol 2008;52:1890-1947.
FULL TEXT  

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease): Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
Warnes et al.
Circulation 2008;118:e714-e833.
FULL TEXT  

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Adults With Congenital Heart Disease): Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
Warnes et al.
Circulation 2008;118:2395-2451.
FULL TEXT  

Standards for LVH in Elite Athletes
Bernhardt
AAP Grand Rounds 2008;20:65-65.
FULL TEXT  

Alterations in myocardial stiffness in elite athletes assessed by a new Doppler index
King et al.
Heart 2008;94:1323-1325.
ABSTRACT | FULL TEXT  

Preparticipation screening for cardiovascular abnormalities in young competitive athletes
Papadakis et al.
BMJ 2008;337:a1596-a1596.
FULL TEXT  

Exertional sudden cardiac death in a young athlete with anomalous origin of the left coronary artery from the opposite sinus
Wissner et al.
Europace 2008;10:1022-1023.
ABSTRACT | FULL TEXT  

Sudden cardiac death in young athletes
Drezner and Khan
BMJ 2008;337:a309-a309.
FULL TEXT  

Differences in cardiac remodeling associated with race implications for pre-participation screening and the unfavorable situation of black athletes.
Pelliccia
J Am Coll Cardiol 2008;51:2263-2265.
FULL TEXT  

Multiple source surveillance incidence and aetiology of out-of-hospital sudden cardiac death in a rural population in the West of Ireland
Byrne et al.
Eur Heart J 2008;29:1418-1423.
ABSTRACT | FULL TEXT  

A novel mouse model of X-linked cardiac hypertrophy
Leatherbury et al.
Am. J. Physiol. Heart Circ. Physiol. 2008;294:H2701-H2711.
ABSTRACT | FULL TEXT  

Age- and gender-specific mortality rates in childhood hypertrophic cardiomyopathy
Ostman-Smith et al.
Eur Heart J 2008;29:1160-1167.
ABSTRACT | FULL TEXT  

Occurrence and Frequency of Arrhythmias in Hypertrophic Cardiomyopathy in Relation to Delayed Enhancement on Cardiovascular Magnetic Resonance
Adabag et al.
J Am Coll Cardiol 2008;51:1369-1374.
ABSTRACT | FULL TEXT  

Prevalence of hypertrophic cardiomyopathy in highly trained athletes: relevance to pre-participation screening.
Basavarajaiah et al.
J Am Coll Cardiol 2008;51:1033-1039.
ABSTRACT | FULL TEXT  

Bicuspid aortic valve: a literature review and its impact on sport activity
De Mozzi et al.
Br Med Bull 2008;85:63-85.
ABSTRACT | FULL TEXT  

Efficacy of personal symptom and family history questionnaires when screening for inherited cardiac pathologies: the role of electrocardiography
Wilson et al.
Br. J. Sports. Med. 2008;42:207-211.
ABSTRACT | FULL TEXT  

Heart Disease and Stroke Statistics--2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Writing Group Members et al.
Circulation 2008;117:e25-e146.
FULL TEXT  

Rebuttal from Prof. Le Gallais
J. Appl. Physiol. 2007;103:2140-2141.
FULL TEXT  

Prevalence and significance of an isolated long QT interval in elite athletes
Basavarajaiah et al.
Eur Heart J 2007;28:2944-2949.
ABSTRACT | FULL TEXT  

An Electrocardiogram Should Not Be Included in Routine Preparticipation Screening of Young Athletes
Chaitman
Circulation 2007;116:2610-2615.
FULL TEXT  

Electrocardiograms Should Be Included in Preparticipation Screening of Athletes
Myerburg and Vetter
Circulation 2007;116:2616-2626.
FULL TEXT  

Molecular and Functional Characterization of Novel Glycerol-3-Phosphate Dehydrogenase 1-Like Gene (GPD1-L) Mutations in Sudden Infant Death Syndrome
Van Norstrand et al.
Circulation 2007;116:2253-2259.
ABSTRACT | FULL TEXT  

Enhanced Transmural Fiber Rotation and Connexin 43 Heterogeneity Are Associated With an Increased Upper Limit of Vulnerability in a Transgenic Rabbit Model of Human Hypertrophic Cardiomyopathy
Ripplinger et al.
Circ. Res. 2007;101:1049-1057.
ABSTRACT | FULL TEXT  

The preparticipation cardiovascular screening of competitive athletes: is it time to change the customary clinical practice?
Pelliccia
Eur Heart J 2007;28:2703-2705.
ABSTRACT | FULL TEXT  

Physiological upper limits of left ventricular dimensions in highly trained junior tennis players
Basavarajaiah et al.
Br. J. Sports. Med. 2007;41:784-788.
ABSTRACT | FULL TEXT  

Contribution of Inherited Heart Disease to Sudden Cardiac Death in Childhood
Hofman et al.
Pediatrics 2007;120:e967-e973.
ABSTRACT | FULL TEXT  

Causes of Late Deaths After Pediatric Cardiac Surgery: A Population-Based Study
Nieminen et al.
J Am Coll Cardiol 2007;50:1263-1271.
ABSTRACT | FULL TEXT  

Prevalence of abnormal electrocardiograms in a large, unselected population undergoing pre-participation cardiovascular screening
Pelliccia et al.
Eur Heart J 2007;28:2006-2010.
ABSTRACT | FULL TEXT  

Screening athletes for heart disease
Crawford
Heart 2007;93:875-879.
FULL TEXT  

Evidence for Microvascular Dysfunction in Hypertrophic Cardiomyopathy: New Insights From Multiparametric Magnetic Resonance Imaging
Petersen et al.
Circulation 2007;115:2418-2425.
ABSTRACT | FULL TEXT  

Automated external defibrillators in Washington State high schools * COMMENTARY
Rothmier et al.
Br. J. Sports. Med. 2007;41:301-305.
ABSTRACT | FULL TEXT  

Exercise and Acute Cardiovascular Events: Placing the Risks Into Perspective: A Scientific Statement From the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology
In Collaboration With the American College of Spor et al.
Circulation 2007;115:2358-2368.
ABSTRACT | FULL TEXT  

Anomalous Coronary Artery From the Wrong Sinus of Valsalva: A Physiologic Repair Strategy
Alphonso et al.
Ann. Thorac. Surg. 2007;83:1472-1476.
ABSTRACT | FULL TEXT  

Reviews of Translational Medicine and Genomics in Cardiovascular Disease: New Disease Taxonomy and Therapeutic Implications: Cardiomyopathies: Therapeutics Based on Molecular Phenotype
Ashrafian and Watkins
J Am Coll Cardiol 2007;49:1251-1264.
ABSTRACT | FULL TEXT  

Recommendations and Considerations Related to Preparticipation Screening for Cardiovascular Abnormalities in Competitive Athletes: 2007 Update: A Scientific Statement From the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: Endorsed by the American College of Cardiology Foundation
Maron et al.
Circulation 2007;115:1643-1655.
FULL TEXT  

Coronary Artery Anomalies: An Entity in Search of an Identity
Angelini
Circulation 2007;115:1296-1305.
ABSTRACT | FULL TEXT  

Sudden cardiac death in young athletes
Basavarajaiah et al.
Heart 2007;93:287-289.
ABSTRACT | FULL TEXT  

Heart Disease and Stroke Statistics--2007 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
Rosamond et al.
Circulation 2007;115:e69-e171.
FULL TEXT  

Reduced right ventricular ejection fraction in endurance athletes presenting with ventricular arrhythmias: a quantitative angiographic assessment
Ector et al.
Eur Heart J 2007;28:345-353.
ABSTRACT | FULL TEXT  

Preventing Pediatric Sudden Cardiac Death
Yabek
Pediatrics 2007;119:407-408.
FULL TEXT  

Myocardial Injury and Ventricular Dysfunction Related to Training Levels Among Nonelite Participants in the Boston Marathon
Neilan et al.
Circulation 2006;114:2325-2333.
ABSTRACT | FULL TEXT  

Consultation with the specialist: cardiovascular preparticipation sports screening.
Singh and Silberbach
Pediatr. Rev. 2006;27:418-424.
FULL TEXT  

The Heart of Trained Athletes: Cardiac Remodeling and the Risks of Sports, Including Sudden Death
Maron and Pelliccia
Circulation 2006;114:1633-1644.
FULL TEXT  

Protecting Athletes From Sudden Cardiac Death
Thompson and Levine
JAMA 2006;296:1648-1650.
FULL TEXT  

Brief communication: Cardiovascular screening practices of major North American professional sports teams.
Harris et al.
ANN INTERN MED 2006;145:507-511.
ABSTRACT | FULL TEXT  

Evidence for efficacy of the Italian national pre-participation screening programme for identification of hypertrophic cardiomyopathy in competitive athletes
Pelliccia et al.
Eur Heart J 2006;27:2196-2200.
ABSTRACT | FULL TEXT  

Stimulants and Sudden Death: What Is a Physician to Do?
Wilens et al.
Pediatrics 2006;118:1215-1219.
ABSTRACT | FULL TEXT  

Eisenmenger syndrome: towards identifying the risk factors for death
Sreeram
Eur Heart J 2006;27:1644-1645.
FULL TEXT  

Physiological Upper Limits of Left Atrial Diameter in Highly Trained Adolescent Athletes
Basavarajaiah et al.
J Am Coll Cardiol 2006;47:2341-2342.
FULL TEXT