Cardiovascular Screening in Pediatric Athletes: Prevalence, Risk Stratification, and Public Health Implications from a Georgian Population Cohort
DOI:
https://doi.org/10.5281/zenodo.19091480Keywords:
Pediatric athletes, Sudden cardiac death, Preparticipation screening, Electrocardiography, Echocardiography, Risk stratification, Sports cardiology, Public health policyAbstract
Background: Sudden cardiac death (SCD) in children and adolescents is a rare but catastrophic event with substantial societal and public health implications. A significant proportion of exercise-related SCD cases are attributable to previously undiagnosed structural or electrical cardiac abnormalities detectable through systematic screening [1–4]. Despite ongoing international debate regarding optimal screening models, region-specific epidemiological data remain limited in Eastern Europe and the Caucasus.
Objective: To determine the prevalence, clinical spectrum, and risk stratification profile of cardiovascular abnormalities identified during structured preparticipation screening of pediatric athletes in Adjara, Georgia, and to evaluate implications for national sports safety policy.
Methods: A population-based cross-sectional study was conducted in 2025 including 442 competitive athletes aged 7–18 years. All participants underwent standardized cardiovascular evaluation comprising structured medical history, physical examination, 12-lead electrocardiography interpreted according to contemporary international criteria, transthoracic echocardiography, and anthropometric assessment. Cardiovascular abnormalities were categorized into low-, intermediate-, and high-risk groups for SCD. Prevalence estimates were calculated with exact 95% confidence intervals (CI).
Results: Cardiovascular abnormalities were identified in 58 athletes (13.1%; 95% CI 10.1–16.6%). High-risk conditions were detected in 2 athletes (0.45%; 95% CI 0.05–1.6%), including one case of hypertrophic cardiomyopathy and one case of Wolff–Parkinson–White syndrome. The majority of abnormalities consisted of low-risk structural valvular findings. The number needed to screen to detect one high-risk condition was 221 athletes.
Conclusion: Systematic preparticipation cardiovascular screening in pediatric athletes reveals a measurable burden of clinically relevant structural and electrical abnormalities, including a small but significant proportion of high-risk conditions associated with exercise-related sudden cardiac events. The observed prevalence and detection yield are consistent with established international screening cohorts, suggesting comparable epidemiological patterns across diverse health system contexts.
While cross-sectional data do not permit inference regarding mortality reduction, these findings provide region-specific parameters necessary for proportional evaluation of screening strategies within organized youth sports. In emerging sports systems, such evidence supports informed and context-sensitive consideration of structured cardiovascular assessment frameworks aligned with available infrastructure and risk calibration.
Keywords: pediatric athletes; sudden cardiac death; cardiovascular screening; electrocardiography; echocardiography; risk stratification; public health policy
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