PREVENTING EXERCISE-RELATED SUDDEN CARDIAC DEATH THROUGH SYSTEMATIC PREPARTICIPATION CARDIOVASCULAR SCREENING: A TWO-YEAR REGIONAL COHORT STUDY OF PEDIATRIC ATHLETES IN ADJARA, GEORGIA.

AIM: To determine the prevalence and risk stratification profile of cardiovascular abnormalities identified during a two-year structured preparticipation screening programme among pediatric competitive athletes in Adjara, Georgia, and to evaluate its implications for prevention of exercise-related sudden cardiac death. MATERIAL AND METHODS: A cross-sectional cohort study was conducted over two consecutive athletic seasons (2023-2025) in the Autonomous Republic of Adjara, Georgia. A total of 647 competitive athletes aged 5-17 years were enrolled through organized sports institutions. All participants underwent standardized cardiovascular evaluation comprising structured medical history, physical examination, resting 12-lead electrocardiography interpreted according to international athlete-specific criteria, and transthoracic echocardiography. Detected abnormalities were classified into low-, intermediate-, and high-risk categories for sudden cardiac death in accordance with the 2020 ESC Guidelines on Sports Cardiology and Exercise in Patients with Cardiovascular Disease. Exact 95% confidence intervals were calculated using the Wilson Score method. RESULTS: Cardiovascular abnormalities were identified in 73 of 647 athletes (11.3%; 95% CI 9.1-14.0%). High-risk conditions requiring specialist cardiology evaluation and individualized, shared decision-making-based sports eligibility assessment were detected in 4 athletes (0.62%; 95% CI 0.24-1.57%), comprising one case of hypertrophic cardiomyopathy and three cases of clinically significant conduction disorders. All four affected individuals were previously asymptomatic. The most prevalent abnormalities were patent foramen ovale (4.02%), mitral valve disease (3.09%), and mitral valve insufficiency (1.85%). The number needed to screen to identify one high-risk condition was 162 athletes. CONCLUSIONS: Structured preparticipation cardiovascular screening in pediatric athletes in Adjara identifies a clinically meaningful burden of previously undetected cardiac pathology, including life-threatening conditions in asymptomatic individuals. The timely detection of high-risk conditions facilitated specialist referral and entry into an individualized, shared decision-making-based sports eligibility process, thereby potentially preventing exercise-related sudden cardiac events in this cohort. These findings provide essential region-specific epidemiological parameters and support the systematic integration of ECG-inclusive cardiovascular screening, aligned with the 2025 AHA/ACC shared decision-making framework, within organized youth sports programmes in Georgia.