Colleges struggle balancing heart screenings with costs

KNOXVILLE, Tenn. -- The mother of Duke Crews is pretty sure Tennessee basketball saved his life.

Crews seemed healthy until a heart echocardiogram he received as part of health screenings administered to all Tennessee athletes found the forward had hypertrophic cardiomyopathy, a condition blamed for the sudden death of more than a hundred athletes each year.

“If they hadn’t done it, no one would have ever known he had it,” said his mom, Louise Poindexter. “There’s a possibility they did save his life.”

Tennessee is one of only a few colleges that routinely perform echocardiograms on all athletes. A Vols fan last year volunteered to provide the screenings for free.

The expense of such a test -- between $500 and $1,500 for each athlete -- is why some schools don’t offer it to all athletes, said Dr. Douglas Zipes, past president of the American College of Cardiology and distinguished professor of medicine at Indiana University.

Cardiologists and other heart experts argue the screenings could help save the lives of the approximately 125 U.S. athletes under age 35 who die each year of sudden cardiac death. Most show no symptoms of heart disease until it turns fatal.

An analysis of 387 cases from the Minneapolis Heart Institute Foundation, which tracks sudden deaths in a national registry, showed the vast majority were cardiac-related. About a quarter involved hypertrophic cardiomyopathy, which causes an enlarged heart.

Heart conditions can be exacerbated by rigorous exercise but don’t necessarily prevent athletes from competing. After medical monitoring, Crews was cleared to return to the lineup at Tennessee, where he is averaging six points and 4.6 rebounds.

Zipes said athletic officials often think echocardiograms aren’t worth the cost because they catch so few cases of heart disease. There’s also a chance of false readings -- either falsely identifying a case of cardiomyopathy or missing signs of the condition.

Still, heart experts in Italy, where athletes are required to undergo an echocardiogram before competing, say the tests have led to a tenfold reduction in sudden deaths.

“If it were my son playing ball I would like him to have an echo, even though it is cost inefficient,” Zipes said.

NCAA-sanctioned programs are required to give their athletes physicals and many give electrocardiograms, which test the electrical activity of the heart. An echocardiogram is an ultrasound of the heart.

When an athlete’s medical history indicates he or she might be at risk for heart disease, team physicians usually recommend an echocardiogram.

The NCAA doesn’t track which colleges provide echocardiograms to all athletes, and Zipes said the American College of Cardiology hasn’t recommended offering them.

He suggests schools that can’t afford to provide echocardiograms should purchase an automatic external defibrillator, or AED, which can be used to revive a person who has gone into cardiac arrest.

The echocardiograms that have been performed on Tennessee’s 523 athletes during the 2007-08 season were paid for by Mickey King, president and CEO of UltraScan, part of Digirad Ultrascan Solutions.

His Suwanee, Ga.-based company provides ultrasounds and other screening services and was already offering low-cost echocardiograms for high school athletes. The self-described “UT nut” said he wanted to do something that made Tennessee special and might help with recruiting.

King, who grew up some 240 miles west of Knoxville in Parsons, Tenn., and attended Tennessee-Martin, also arranged for cardiologists at Vanderbilt University Medical Center to read the test results for free.

King has agreed to provide the free tests to all incoming Tennessee athletes after this season.

“If we scan more athletes, we could save more lives,” he said. “It was a personal thing for me, wanting to do something.”

The echocardiograms did do something: Two athletes’ tests turned up significant problems while a third discovered a minor condition. Besides Crews’ cardiomyopathy, doctors discovered a rare kind of tumor on linebacker Shane Reveiz’s heart.

“To hear something like that, it was the biggest shock of my life,” Reveiz said.

Reveiz needed surgery to remove the tumor from his right ventricle, but like Crews, is back to playing the sport he loves.

Neither Crews nor Reveiz had any sort of medical history that would have prompted doctors to suggest an echocardiogram, which made the news of their heart conditions all the more surprising to their parents.

Reveiz’s father, Fuad Reveiz, a former NFL kicker, said he’s heard the argument that it’s not worth the money to perform echocardiograms on athletes who don’t appear to need them.

“I resent that. That means Shane’s life wouldn’t have counted,” he said.