Sudden death in an athlete is a tragic event. There is a strong social imperative to implement effective means of predicting and preventing sudden death in competitive athletes. However, the design and implementation of a proven screening solution remains elusive [2, 3].To date large scale preparticipation screening has been ineffectual because it is focused on costly disease diagnosis and risk factor associations, and not on pathophysiologic effectors known to quantify a cardiovascular (CV)"risk state". The problem is that disease diagnosis does not quantify risk, [4] and statistical associations do not adequately define cause[5].Causality can be proven only by demonstrating a quantifiable cause and effect mechanism [4, 6, 7]. A preparticipation examination should be focused on quantifiable features that have been conclusively proven to measure the magnitude of risk, and illuminate a cause-and-effect relationship between the intensity of CV risk (cause) and an emergent CV disease (effect). The barrier to changing current preparticipation screening lies in the continued acquiescence to existing opinions that are based on risk factor associations [8]. The first step to changing this approach is to break the code of silence, which sustains the status quo [9]. The medical community needs to step out of the box, applying clinical systems biology cause-and-effect prediction for the quantification and management of dynamic disease processes using echo Doppler diastolic parameters. An individual`s "pre-emergent risk" state is defined as abnormal diastolic parameters before there is phenotypic expression of disease. The diastolic parameters can be used to distinguish a benign from malignant state. This distinction is an essential component of a "focused" preparticipation screening examination. A"focused" preparticipation screening exam has the capacity to reduce cost, increase quality, and effectively address the social imperative of preventing unanticipated athletic field death across the spectrum of athletic activities and age groups.
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