March Mad­ness: It’s a time of buzzer-​​beaters and bracket-​​busters, seed debates and the Sweet 16, as the 68-​​team NCAA men’s bas­ket­ball tour­na­ment hijacks our lives over a three-​​week stretch known as the Big Dance.

But it’s also a stark reminder of a fright­ening trend: the preva­lence of sudden car­diac death, or SCD, among young com­pet­i­tive ath­letes. It was 26 years ago this month that Loyola Mary­mount star Hank Gathers, just 23, col­lapsed on the court at the university’s Ger­sten Pavilion and died shortly there­after. Diag­nosis: SCD.

He’s not the only one. On average, every three days a com­pet­i­tive ath­lete in the U.S. dies from SCD, according to an article in the journal Cir­cu­la­tion, often due to an unde­tected con­gen­ital heart con­di­tion called hyper­trophic cardiomyopathy—an abnormal thick­ening of mus­cles in the heart’s left lower chamber.

Gian­michel Cor­rado, head team physi­cian at North­eastern, is on a mis­sion to change that.

Cor­rado leads a research team that is devel­oping a new pre-​​participation screening prac­tice to iden­tify ath­letes at risk for SCD: Echocar­dio­g­raphy per­formed by front­line physi­cians using portable ultra­sound machines to detect heart abnor­mal­i­ties. Early results with North­eastern ath­letes show the pro­tocol to be sig­nif­i­cantly faster, less costly, and more accu­rate than cur­rent screening methods, reducing the rate ath­letes are referred to car­di­ol­o­gists for false-​​positive heart abnor­mal­i­ties by 33 percent.

A review of the research appears in an article in the March issue of Advanced Sports Med­i­cine Con­cepts and Controversies.

Echo, done reg­u­larly, shows how much a heart can change struc­turally over time,” says Cor­rado, who prac­tices sports med­i­cine and is the asso­ciate sports med­i­cine fel­low­ship director at Boston Children’s Hos­pital. It uses high-​​frequency sound waves to pro­duce moving images of the heart, including the cham­bers and valves. “So if someone has an under­lying patho­log­ical con­di­tion, you can track any abnormal thick­ening and mis­align­ment of the muscle fibers and pro­vide treat­ment before it’s too late.”

Cur­rent methods insufficient

Cor­rado knows whereof he speaks: He wit­nessed SCD first­hand as a 22-​​year-​​old premed stu­dent playing pickup bas­ket­ball in Raleigh, North Car­olina. “A young African Amer­ican man just died,” he recalls. “I sat there and watched the resus­ci­ta­tion, another kid screaming at him to breathe and live.”

The screening pro­posed by Dr. Cor­rado is quick and has the poten­tial to pre­vent an ath­lete with a heart abnor­mality from dying while exer­cising.
— Jonathan Finnoff, med­ical director, Mayo Clinic Sports Med­i­cine Center

Two screening methods are used today: the Amer­ican Heart Association’s 14-​​element his­tory and phys­ical exam, which is “very vague,” says Cor­rado, and elec­tro­car­dio­grams, or EKGs, which mea­sure the heart’s elec­trical activity. EKGs, which are gen­er­ally not part of U.S. screen­ings, have been roundly crit­i­cized for their high rate of false pos­i­tives. Indeed, last March, when the NCAA’s chief med­ical officer rec­om­mended that all male col­lege bas­ket­ball players have the test, some 100 uni­ver­sity team physi­cians fired off a peti­tion in protest. EKGs also miss impor­tant clues: According to the Amer­ican Heart Asso­ci­a­tion, at least one in 10 people with hyper­trophic car­diomy­opathy have a normal EKG.

An echocar­dio­gram, on the other hand, has “an incred­ibly high ceiling” when it comes to pos­sible appli­ca­tions, says Cor­rado. They range from catching abnor­mal­i­ties before a con­di­tion goes over the edge to under­standing how non­patho­log­ical changes in the heart from inten­sive exer­cise relate to performance.

The screening pro­posed by Dr. Cor­rado is quick and has the poten­tial to pre­vent an ath­lete with a heart abnor­mality from dying while exer­cising,” says Jonathan Finnoff, med­ical director of the Mayo Clinic Sports Med­i­cine Center, in Min­neapolis, Min­nesota, and a team physi­cian for the Min­nesota Tim­ber­wolves and Lynx. “Although fur­ther research is required, per­forming it during the pre-​​participation phys­ical exam may enable physi­cians to cor­rectly iden­tify struc­tural abnor­mal­i­ties of the heart, helping to lower the risk of SCD and the need for unnec­es­sary tests.

Metic­u­lous research

Cor­rado and his col­leagues began their research cau­tiously. After writing sev­eral papers on the fea­si­bility of the prac­tice, they learned how to best use portable ultra­sound machines at the knee of Fred­erick C. Basilico, physician-​​in-​​chief for med­i­cine at Boston’s New Eng­land Bap­tist Hos­pital and car­di­ol­o­gist to the Boston Celtics. They then con­ducted two clin­ical studies (found here and here) to ensure that their echo mea­sure­ments were as accu­rate as those of Basilico and a reg­is­tered car­diac sono­g­ra­pher at the hos­pital. They were.

In a follow-​​up clin­ical study, pub­lished in 2014, they put the new pro­tocol into prac­tice at North­eastern. They screened 65 male student-​​athletes, ages 18 to 25, three ways: with the stan­dard his­tory and phys­ical exam, with an EKG, and with an echocar­dio­gram per­formed by Corrado.

Corrado’s pro­tocol cut the referral rate to car­di­ol­o­gists resulting from false pos­i­tives by one-​​third. “That showed the world: Look how effec­tive this can be on a col­lege campus,” he says.

By relying on just the his­tory and phys­ical exam, there is an under­lying risk that we’re clearing ath­letes who poten­tially have under­lying dis­ease that could put them at risk for SCD,” says Basilico, a co-​​author on sev­eral of the studies. “Med­i­cine is moving toward using bed­side ultra­sound as a help in eval­u­ating patients in gen­eral in set­tings such as emer­gency rooms. It’s low-​​cost, there’s no radi­a­tion, and it takes just one to five min­utes. Gian Cor­rado asked, ‘Why can’t we train the sports med­i­cine physi­cians to do a brief ultra­sound during screening to help deter­mine if an ath­lete is eli­gible to par­tic­i­pate in sports?’ I think the idea is very good; it gives us addi­tional information.”

North­eastern could be the head­quar­ters of a mul­ti­center trial that helps end these tragedies.
— Gian­michael Cor­rado, Northeastern’s head team physician

Corrado’s com­mit­ment to the prac­tice extends beyond its diag­nostic value to its social rel­e­vance: Only cer­tain seg­ments of society, he says, have access to screening by a car­di­ol­o­gist. Pre-​​participation echocar­dio­g­raphy by a front­line physi­cian brings us one step closer to lev­eling that playing field.

Sports med­i­cine physi­cians at sev­eral other uni­ver­si­ties in the NCAA have expressed interest in the echo pro­tocol, says Cor­rado, who has another clin­ical study ready for pub­li­ca­tion that includes both a cost and an effi­ciency analysis of the three screening methods. “Our hope now is to get the funds to send 10 portable ultra­sounds to 10 NCAA insti­tu­tions and to train the team physi­cians,” he says. “North­eastern could be the head­quar­ters of a mul­ti­center trial that helps end these tragedies.”