CRY Medical Conference

After a few successful years, the CRY Conference was held online for the third time in 2022. On October 20th and 21st, the conference was held in partnership with CRY and the European Association of Preventative Cardiology (EAPC). We were delighted to welcome leading experts in cardiology from around the world for presentations, discussion of case-based scenarios, and interactive debates for the audience to follow along and engage with.

These “case based scenarios” highlight the basis for the decisions experts make when advising patients with cardiac conditions. The advice the experts provide will be informed by consensus statements, which are informed by the latest research. At the conference the team will typically choose difficult decisions which provide an opportunity to demonstrate the different way in which research is applied, and debated, in the decision making process.

The first item of Day 1 was ‘Debates in Sports Cardiology: Elite Athlete with PKP2 Variant; end of the Road’. This was led by Professor Michael Papadakis of St. George’s, London, and Maria Sanz De Le Garza from Hospital Clinic de Barcelona, Spain, and presented a case asking if an athlete should be cleared for competitive sport.

The athlete in this case is a twenty-three-year-old recreational footballer and runner, asymptomatic with no family history, who was found to have an abnormal ECG at a CRY screening; and was diagnosed with Arrhythmogenic Right Ventricular Cardiomyopathy after further testing. This testing also identified the genetic variant PKP2. Professor Papadakis went on to show the results of the athlete’s family being screened, where it was established that the father and sixteen-year-old brother also had the PKP2 variant, but showed no evidence of underlying cardiomyopathy.

Dr Kristina H Haugaa, Head of Unit for Genetic Cardiac Diseases at Oslo University Hospital joined to argue the case that this athlete should not be cleared for competitive sport; while Andre Le Gerche, a cardiologist and researcher at the Baker Heart and Diabetes Institute in Melbourne, Australia, came in to counter this argument.

The second debate of the day, ‘Athlete post myocarditis and persistent LGE; Let sleeping dogs lie’ was led by Maria Sanz De Le Garza. The athlete in this case is a nineteen year old elite rugby player at an international level, training fourteen hours per week and presenting with sharp chest pains post training.

Blood tests and an ECG showed slight inflammation, and the echocardiogram was completely normal, however taking into consideration the chest pain and inflammation, a Cardiac MRI was carried out. The initial CMRI confirmed Myocarditis in the acute phase and the athlete was advised to cease training. This test was repeated six months later and showed improvements, but there was scarring of the left ventricular wall still remaining. At this six month point, there were no significant symptoms, normal function and no arrhythmia.

The debate was opened with Alessandro Zorzi from the University of Podova, Italy, arguing that this athlete should be clear for competitive sport again and was followed up with Viviana Maestrini from Sapienza University of Rome, Italy, opposing this argument.

Both debates were followed by Q & A sessions with questions from audience members before the next session of the day began.

These afternoon sessions were introduced by Sabiha Gati from the National Heart and Lung Institute Imperial College and the Royal Brompton, and the discussion panel for the afternoon Jonathan Drezner from the University of Seattle, Antonio Pelliiccia from the Institute of Sport Medicine and Science, Italy, and Maite Tome from St George’s Hospital, London.

There were three cases to be covered, beginning with CRY Research Fellow Saad Fayaz with ‘Devil in the Detail; coronary artery anomaly’. The case looked at a seventeen year old black elite American football player considered the fittest in his academy and completely asymptomatic. The athlete had a cardiac screening through CRY and received abnormal results suggesting Hypertrophic Cardiomyopathy (HCM); they were then referred to St George’s hospital for further testing including echocardiogram and CMRI.

Dr Fayaz went on to discuss the athlete’s heart and normalities that overlap with signs of HCM, family history, and how this can complicate a diagnosis. The athlete’s CMRI also showed a potential coronary artery anomaly which provided some discussion amongst the panel as to what this, combined with the potential HCM, would mean for their future in high impact sports.

Next, Eleni Nakou from St George’s University Hospital, London, looked at a case of a sixteen-year-old, Nigerian club football player who attended a pre-participation screening event. The athlete was asymptomatic, with no family history but his ECG showed abnormal results, suggesting Hypertrophic Cardiomyopathy.

Dr Nakou goes on to speak about the results shown, including T-Wave inversions and explains the clinical significance of lateral T-Wave inversions in black athletes. After further testingthe diagnosis was still not clear, with the panel discussing the possibility of ‘Athlete’s Heart’ or mild HCM. Dr Nakou continued with discussion over management of the potential condition long-term and whether the athlete could continue participating in competitive sport.

The first sessions of day two ‘Updates in Sports Cardiology; the CRY experience’ were chaired by Dr Aneil Malhotra from Wythenshawe Hospital & Manchester Royal Infirmary, alongside Professor Meagan Wafsy from Massachusetts General Hospital.

The first speaker was Professor Michael Papadakis, who began by talking about his experience screening young individuals and working with the CRY screening programme. Michael then went on to discuss the methodology and results of a study aiming to determine: the diagnostic yield of a nationwide screening programme; report the frequency of false-negative results; and show the incidence of sudden cardiac arrest and sudden cardiac death.

The second item of the morning was presented by Professor Sanjay Sharma from St George’s University Hospital; ‘The veteran athlete’s heart; does sex matter?’. Professor Sharma discusses differences in heart tissue, the cardiovascular system, genetics, aging and cardiovascular risk-factors in men and women, concluding that indeed, sex does matter when it comes to cardiovascular adaptation to sport among veteran athletes.

The final speaker of the morning was introduced, Professor Domenico Corrado from the University of Padova, Italy, presenting ‘’Low QRS voltages in athletes; What do they mean?’. Professor Carrado discussed low QRS voltages in athletes, and the prevalence of this ECG pattern in familial cases and those with cardiomyopathies.

Audience members were encouraged throughout the session to send in their questions, and these presentations were followed by a Q&A session led by Dr Malhotra, Professor Michael Papadakis and co-chair Dr Silvia Castaletti from Istituto Auxologico Italiano, Milan, and welcomed the expert panel Dr Jonathan Kim from Emery Healthcare, USA, and Professor Sanjay Sharma to begin the presentation of the first case.

The first talk of the afternoon was ‘Cases in Sport Cardiology; Athlete with chest pain post COVID-19 vaccine’, presented by Dr Raghav Bhatia from St George’s University, covering the case of a thirty-nine year old, white professional runner with no history of cardiac conditions, who had two doses of the COVID 19 vaccine. The athlete presented to A&E after experiencing chest pain during exercise, and there received an abnormal ECG result and was recommended for further testing. The panel then discussed the next steps in terms of testing and treatment for the athlete, and debated how they would make a diagnosis in this case.

The second debate of the afternoon ‘Athlete with dilated ventricle’ was presented by CRY Research Fellow, Dr Saran Marwaha from St George’s University, London. The patient in this case is a cyclist, completing roughly 20km per week and presented to clinic with an Athlete’s Heart diagnosis from ten years ago in Australia. Upon new tests being completed, the results showed improvements and a possible different diagnosis. The panel then discussed treatment and management of the condition.

The final presentation of the day ‘Athlete with Ventricular Arrythmia’ was presented by Dr Emmanouil Androulakis from the Royal Brompton, London. This case was a referred patient; a 70 year old, veteran endurance athlete. The panel discussed which further investigations might be the most useful in this case followed by what possible diagnosis could be made. The panel discussion was followed by a Q & A session and the day was concluded with the Great Imaging Quiz.

We are grateful to the panel of experts who gave their time and knowledge over the two-day conference. We would also like to thank our sponsors as well as Wondr Medical, our digital partner who streamed the event.