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The goal of this study was to define electrocardiographic (ECG) and echocardiographic characteristics of adolescent African athletes.Recent observations in African athletes reported large prevalence of left ventricular (LV) hypertrophy and ECG abnormalities. No data, so far, exist for adolescent Africans, which comprise a growing proportion of competitive/professional athletes.The study included 154 soccer players participating at the 8th African Under-17 Championship of 2009, representing Algeria, Burkina Faso, Cameroon, Gambia, Guinea, Malawi, Nigeria, and Zimbabwe. For comparison, 62 Italian players with similar ages, sport achievements, and training schedules were included.African athletes showed higher R5/S1-wave voltages than Caucasian athletes (48.6 ± 12.1 mm vs. 34.1 ± 8.9 mm; p0.01), larger prevalence of ECG LV hypertrophy (89% vs. 42%; p0.001), ST-segment elevation (91% vs. 56%; p0.001), and deeply inverted, or diffusely flat/biphasic, T waves (14% vs. 3% [p0.05] and 25% vs. 8% [p0.008], respectively). LV wall thicknesses were increased in Africans by 5% compared with Caucasians, and exceeded normal limits (≥13 mm) in 4 Africans but in no Caucasians. No athlete showed evidence of cardiomyopathies (i.e., hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy). On individual analysis, Algerians showed lower R/S-wave voltages compared with other African athletes. Increased wall thickness (≥13 mm) was observed only in sub-Saharian athletes (from Burkina Faso, Cameroon, and Niger).African athletes displayed large proportion of ECG abnormalities, including a striking increase in R/S-wave voltage, ST-segment elevation, and deeply inverted or diffusely flat T waves by adolescence. LV remodeling in African athletes was characterized by a disproportionate wall thickening than in Caucasians but similar cavity size. Finally, distinctive peculiarities existed in African athletes according to the country (and ethnic) origin.

Sudden cardiac arrest is most often the first clinical manifestation of an underlying cardiovascular disease and usually occurs in previously asymptomatic athletes. The risk benefit ratio of physical exercise differs between young competitive athletes and middle-age/senior individuals engaged in leisure-time sports activity. Competitive sports are associated with an increase in the risk of sudden cardiovascular death (SCD) in susceptible adolescents and young adults with underlying cardiovascular disorders. In middle-age/older individuals, physical activity can be regarded as a 'two-edged sword': vigorous exertion increases the incidence of acute coronary events in those who did not exercise regularly, whereas habitual physical activity reduces the overall risk of myocardial infarction and SCD. Although cardiovascular pre-participation evaluation offers the potential to identify athletes with life-threatening cardiovascular abnormalities before onset of symptoms and may reduce their risk of SCD, there is a significant debate among cardiologists about efficacy, impact of false-positive results and cost-effectiveness of routine screening. This review presents an appraisal of the available data and criticisms concerning screening programmes aimed to prevent SCD of either young competitive athletes or older individuals engaged in leisure-time sports activity.

Objectives: To screen all players registered for the 8th CAF African Under-17 Championship for risk factors of sudden cardiac death. Design: Standardised cardiac evaluation prior to the start of the competition. Study population: 155 male football players from all eight qualified teams; mean age 16.4 (SD 0.68) years (range 14 to 17). Methods: The cardiac evaluation consisted of a medical history, clinical examination, 12-lead resting electrocardiogram (ECG) and echocardiography, and was performed by three experienced cardiologists using established guidelines. Results: Nine (5.8%) players reported cardiac symptoms, and the clinical examination was abnormal in only two players with elevated blood pressure. A total of 40 players (25.8%) showed abnormal ECG patterns. None of the players with a positive ECG showed correlating echocardiographic findings. The echocardiogram of one player appeared highly suspicious for early-stage hypertrophic cardiomyopathy, and in another player the myocardium was suspicious for non-compaction cardiomyopathy, but both had normal ECGs. Thirteen (8.4%) players showed echocardiographic findings that needed further follow-up. The percentage of players with pathological ECG patterns and some abnormal echocardiographic measurements varied substantially between different ethnic groups. Conclusion: Cardiological screening for risk factors of sudden cardiac death of football players prior to an international competition proved feasible, and conduction by independent experts allowed high-quality standards and a consistent protocol for the examinations. Differences observed between ethnic groups indicate that guidelines for the analysis of ECGs and echocardiography might be adjusted to the target population.

To create a model for the precompetition medical assessment (PCMA) of international elite football players aimed at identifying risk factors and to assess the feasibility of standardized requirements for teams from countries with variable medical standards.Descriptive feasibility study.Medical assessment of professional football players before a major international competition.Thirty-two national football teams comprising 736 players participating in the 2006 FIFA World Cup.A standardized football-specific PCMA was developed, and all team physicians were asked to perform the PCMA before the 2006 FIFA World Cup.Response rate, completeness of documentation forms, and quality of data.Of all 32 teams participating in the 2006 FIFA World Cup, the precompetition assessment forms of 26 teams (response rate 81%) were returned. Of the initial target population of 736 players, the data of 582 players (79%) were analyzed. The average completeness of the forms ranged from 34% to 94% among teams and average completeness of the different sections of the forms from 78% to 98%. Quality of data provided varied considerably.The response rate of 81% demonstrated that a standardized approach is possible, whereas results and quality of data required adaptations of the form and review of the implementation procedure.

Competitive sport can serve as a trigger for sudden cardiac death (SCD). The majority of athletes who die suddenly have previously unsuspected structural heart disease. Medical evaluation before competition offers the potential to identify cardiovascular abnormalities in asymptomatic athletes. Consensus on the ideal screening programme has not been reached. So, a cardiovascular pre-competition screening of elite football players was developed and implemented prior to the 2006 FIFA World Cup Germany to detect SCD risk factors.Medical history, physical examination, 12-lead resting- and exercise electrocardiogram (ECG) and echocardiography results of the players were recorded on a standardised form by the team physicians and submitted after the final match for retrospective evaluation by two blinded independent cardiologic reviewers.Response rate was 82% (605 of 736 players). Completeness and quality of the recordings and examination methods differed amongst teams. In 25 players (4.8%), the examining physicians evaluated the resting ECG as pathological. Suspicious echocardiographic findings demanding further investigations to rule out serious cardiovascular disease existed in 1% of the players.Cardiovascular pre-competition screening proved feasible in international elite football teams, but turned out to be vital to ensure high quality of data, particularly with regard to stress testing and echocardiography. The screening concept was revised mainly to improve completeness and quality of data acquisition. Resting ECG and echocardiography were retained, but it is questionable if exercise testing should be included in this context.

Increasing requirements lead to an evolutionary increase in complexity. As a result, direct and indirect costs also increase significantly, while value propositions for customers often stagnate. Hence, there are many interdependencies between complexity, costs and values. We present Variant Value Management (VVM) that systematically uses DSM-based interdependency analysis in the product portfolio to visualize the optimum between resource usage, customer value and generated complexity for each requirement, function and component of a product variant by means of target/actual cost comparisons of different product variants. Based on this, value-enhancing and value-destroying effects can be more specifically identified in current and future variant decisions for competitive and attractive product portfolios. The VVM was developed based on existing scientific approaches and in close cooperation with the technology company Voith and has already been successfully validated. The application of the VVM is demonstrated on the industrial case study of the Voith-Schneider Propeller (VSP).