Abstract 4363475: Murmur Screening Patterns Among High School Athletes

Background: While murmurs in youth are commonly benign, some may represent underlying pathology associated with an increased risk of sudden cardiac death. This study aims to characterize the pattern of murmurs among high school athletes. Methods: The HeartBytes National Youth Database produced by Simon’s Heart, a nonprofit organization that organizes sports pre-participation examinations (PPEs) of adolescents, was used for this study. The database contains demographic, exercise-related symptoms, and ECG data obtained during Simon’s Heart PPEs. To investigate the association of murmur findings with comorbidities, exertional symptoms, and ECG outcomes, logistic regression was used to control for confounding influences of age, race, sex, BMI, and exercise intensity. A p-value threshold of 0.05 was used to evaluate statistical significance. Results: Among 4078 high school athletes, 61% were white, with a BMI of 22.4±4.1kg/m 2 and a median age 15.9 years (IQR 14.9-17.0). The prevalence of murmurs was 4.5% (n=184). Multivariable logistic regression analysis demonstrated significant associations: increased odds of murmurs with >2 hours weekly exercise (p=0.034, OR=3.49, 95% CI [1.30, 14.25]), and higher odds of murmurs in Black versus White athletes (p=0.030, OR=1.7, 95% CI [1.03, 2.57]). Linear regression also showed a significant association between increasing age and decreasing murmur prevalence (p=0.028, slope=−0.47, 95% CI [−0.86, −0.084]). No significant associations were found between murmurs and sex, comorbidities (asthma, hypertension, hypercholesterolemia, diabetes), exertional symptoms, obesity, or other ECG abnormalities (all p-values>0.05). Conclusion: Murmur findings were associated with increased weekly exercise among high school athletes. Black athletes also demonstrated a higher prevalence of murmurs compared to White athletes. However, socioeconomic status was not available for adjustment, so the role of social determinants of health in this association cannot be excluded. The prevalence of murmurs in high school athletes declined with age. Further evaluation, including imaging and consideration of socioeconomic factors, is needed to better understand the clinical significance and risk of murmurs in youth athletes.