The practical value of a mass, preventive laboratory screening of athletes is reviewed briefly from a personal perspective. The total number of exercise-induced deaths in young athletes is extremely small, and in consequence difficult to prevent. Furthermore, the relationship of cardiovascular catastrophe to the commonly suggested principal cause in young adults (ventricular hypertrophy in general or cardiomyopathy in particular) is far from established. There is a very rare inherited myocardial dystrophy that predisposes to sudden death, but this is not peculiar to athletes. Indeed, those affected by this congenital disorder usually have a low physical work capacity, and are unlikely to become involved in endurance sport. As would be anticipated from Bayes theorem, in the absence of definite symptoms, the mass pre-participatory laboratory screening of endurance athletes leads to an unacceptable toll of false positive diagnoses. Detailed laboratory examinations are warranted only if there is a strong family history of early cardiac death or other significant findings in the clinical history and physical examination. The hypertrophied heart of the athlete is usually a beneficial adaptation to endurance training. An above average ventricular mass increases not only overall survival but also quality-adjusted life expectancy; it enhances the individual.s physical work capacity and reduces the likelihood of dependency in old age. Certainly, isolated echocardiographic findings of an above average ventricular size should not become the grounds for prohibition of endurance sport.
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