Pre-participation screening for the prevention of sudden cardiac death in athletes

Table 1 Italian and United States pre-participation screening strategy

Italian pre-participation screening		United States pre-participation screening
Advantage	Disadvantage	Advantage	Disadvantage
Rest ECG screening power (ionic-channel disorders, arrhythmias and cardiomyopathies)	Higher cost	Lower cost	Low diagnostic power in the detection of silent cardiovascular diseases
Post exercise ECG diagnosis (arrhytmias, stress-induced myocardial ischemia)	More complicated logistic	Easy logistic	Impossibility to detect post exercise ECG alterations
Spyrometry (pulmonary diseases)	More false positive	Less false positive	Only clinical diagnosis of pulmonary diseases
Urine analysis (diabete, proteinuria, kidney, liver and urogenital infectious diseases)	Possible psychological ramification of the screening	Easy feasibility	Athletes can compete without permission (PPS is not mandatory)
In Italy athletes health is protected by law (PPS is mandatory)			Many cardiovascular disorders cannot be detected by physical examination

ECG: Electrocardiogram; PPS: Pre-participation.