AIMS The role of pre-participation screening (PPS) modalities in preventing sudden cardiac death (SCD) in athletes is debated due to a high false-positive rate. Focused cardiac ultrasound (FoCUS) has shown higher sensitivity and specificity, but its cost-effectiveness remains uncertain. This study aimed to determine the diagnostic performance and cost-effectiveness of FoCUS use in PPS. METHODS AND RESULTS A total of 2111 athletes (77.4% male, mean age 24.9 ± 15.2years) underwent standardized family and medical history collection, physical examination, resting electrocardiography (ECG), FoCUS (10 min/5 views protocol), comprehensive echocardiography and exercise stress test. We prospectively evaluated three PPS incremental models: Model A, standardized medical history and physical examination Model B, Model A plus resting and stress ECG and Model C, Model B plus FoCUS (10 min/5 views protocol). We determined their incremental diagnostic accuracy and cost-effectiveness ratio. A total of 30 athletes were diagnosed with a cardiac condition associated with SCD: 3 were identified by Model A, 14 by Model B, and 13 athletes by Model C. The introduction of FoCUS markedly increased the sensitivity of PPS, compared with Model A and Model B (sensitivity 94% vs. 19% vs. 58% specificity 93% vs. 93% vs. 92%). The total screening costs were as follows: Model A 35.64 euros, Model B 87.68 euros, and Model C 120.89 euros. Considering the sole conditions at risk of SCD, the incremental cost-effectiveness ratio was 135.62 euros for Model B and 114.31 for Model C. CONCLUSIONS The implementation of FoCUS into the PPS allows to identify a significantly greater number of athletes at risk of SCD and markedly lowers the false negative rate. Furthermore, the incorporation of FoCUS into the screening process has shown to be cost-effective.

中文翻译：

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聚焦心脏超声在运动员参与前筛查中的成本效益和诊断准确性：SPORT-FoCUS 研究。

目的 由于假阳性率较高，参与前筛查 (PPS) 方式在预防运动员心源性猝死 (SCD) 方面的作用存在争议。聚焦心脏超声（FoCUS）显示出更高的敏感性和特异性，但其成本效益仍不确定。本研究旨在确定 FoCUS 在 PPS 中使用的诊断性能和成本效益。方法和结果 总共 2111 名运动员（77.4% 男性，平均年龄 24.9 ± 15.2 岁）接受了标准化家族史和病史收集、体格检查、静息心电图 (ECG)、FoCUS（10 分钟/5 个视图方案）、综合超声心动图和运动压力测试。我们前瞻性地评估了三种 PPS 增量模型：模型 A、标准化病史和体格检查模型 B、模型 A 加静息和应激心电图以及模型 C、模型 B 加 FoCUS（10 分钟/5 个视图协议）。我们确定了他们的增量诊断准确性和成本效益比。共有 30 名运动员被诊断出患有与 SCD 相关的心脏病：模型 A 诊断出 3 例，模型 B 诊断出 14 例，模型 C 诊断出 13 例。与模型 A 和模型相比，FoCUS 的引入显着提高了 PPS 的敏感性。模型 B（灵敏度 94% vs. 19% vs. 58%，特异性 93% vs. 93% vs. 92%）。总筛选费用如下：模型A 35.64欧元，模型B 87.68欧元，模型C 120.89欧元。考虑到 SCD 风险的唯一条件，模型 B 的增量成本效益比为 135.62 欧元，模型 C 的增量成本效益比为 114.31 欧元。 结论 在 PPS 中实施 FoCUS 可以识别更多数量的有 SCD 风险的运动员，并且显着提高运动员的 SCD 风险。降低假阴性率。此外，将 FoCUS 纳入筛选过程已被证明具有成本效益。