AIMS: Hypertrophic cardiomyopathy (HCM) is a leading cause of sudden death in 
young athletes, and substantial interest persists in strategies for timely 
identification. We assessed the diagnostic efficacy of Italian pre-participation 
screening programme with 12-lead ECG (in addition to history and physical 
examination) for identification of HCM.
METHODS AND RESULTS: Four thousand four hundred and fifty members of the Italian 
national teams, initially judged eligible for competition as a result of 
systematic pre-participation screening across Italy, subsequently underwent 
clinical and echocardiographic examination at the Institute of Sports Medicine 
and Science (Rome) to assess the presence of previously undetected HCM. None of 
the 4450 athletes showed clinical evidence of HCM. Other cardiac abnormalities 
were detected in only 12 athletes, including myocarditis (n=4), mitral valve 
prolapse (n=3), Marfan's syndrome (n=2), aortic regurgitation with bicuspid 
valve (n=2), and arrhythmogenic right ventricular cardiomyopathy (n=1). In 
addition, echocardiography identified four athletes with borderline left 
ventricular wall thickness (i.e. 13 mm) in the 'grey zone' of overlap between 
HCM and athlete's heart. In two of these athletes, subsequent genetic analysis 
or clinical changes over an average 8-year follow-up resulted, respectively, in 
a definitive or possible diagnosis of HCM.
CONCLUSION: The Italian national pre-participation screening programme including 
12-lead ECG appears to be efficient in identifying young athletes with HCM, 
leading to their timely disqualification from competitive sports. These data 
also suggest that routine echocardiography is not an obligatory component of 
broad-based screening programmes designed to identify young athletes with HCM.