Top Docs Q&A: Frederick Basilico

Basilico is studying a new screening protocol to prevent sudden death in athletes.

This post is part of our Top Docs Q&A series where we ask a physician who was selected as one of our Top Docs questions about their field, life as a doctor, and practicing in the Greater Boston area.

Name: Frederick Basilico

Hospital Affiliations: New England Baptist Hospital, Beth Israel Deaconess Medical Center

Title: Chair of the Department of Medicine and Chief of Cardiology at New England Baptist Hospital

Field: Cardiology

Specialty: Cardiovascular Disease

Frederick Basilico specializes in cardiovascular disease with an interest in sports cardiology. In collaboration with physicians Gianmichel Corrado and Eugene S. Yim, Basilico studied a new screening protocol to prevent sudden death in athletes.

Why did you choose to specialize in cardiovascular disease?

In medical school, I had an opportunity to see different specialties and cardiovascular disease fascinated me the most. I thought the physiology and pathophysiology of heart disease was amazing. Not only are there diagnostic and therapeutic tools, there are different types of interventions that can really improve the health of patients.

What do you like most about the field?

I like that I have many different tools to help patients with their disease, from medicines that have been developed over the last 20 to 30 years to different types of interventions, such as angioplasty and stents, pacemakers and other devices, managing arrhythmias with ablation, and the advances in cardiovascular surgery.

In the time you’ve been practicing, how have you seen the field change?

Medications have become more helpful in treating and preventing disease. When I started training, we had diagnostic tests for heart catheterizations but we didn’t have interventions such as angioplasty, stents, and drug-coated stents which have significantly improved outcomes. I think back to the days when I used to make rounds and see 40 or 50 patients who were really sick with heart disease. Now we don’t see that [because] the medicines and prevention [efforts] are so good.

What are the latest advancements in the field?

In cardiac surgery, we have advanced techniques for managing valvular heart disease with repairs instead of valve replacements, as well as fixing aneurisms in the aorta and chest. Coronary artery stents have revolutionized cardiology. Now that patients can get stents, the frequency of undergoing procedures like coronary bypass surgery has decreased.

What is your hope for the future of cardiovascular disease?

I expect that there are drugs in the pipeline to further reduce the risk of heart attack and coronary disease. On occasion, patients still have heart attacks even if they’re on cholesterol-lowering medications. There are new ones in the pipeline that may reduce the risk even further. Stem cell therapy is still in its infant stages, although it’s been around quite a while. There may be a niche for that in healing the heart after a heart attack, but that’s still to be determined.

Along with two other doctors, you recently studied a new screening protocol to prevent sudden death in athletes. What can you tell me about it?

On rare occasions, a healthy athlete can have underlying heart disease and be at risk for sudden death. The American Heart Association recommendation is to do a 12-point screening examination that includes a history and physical examination to screen for potential disease, but athletes can pass that and still die suddenly. Dr. Corrado at Boston Children’s Hospital came up with the idea to study the ESCAPE Project [Early Screening for Cardiovascular Abnormalities With Pre-participation Focused Echocardiography]. Specific diseases can go undetected by the history and physical that may be discovered by echocardiography.

How is this new protocol different?

We’re using a handheld ultrasound and having a sports medicine physician do the examination instead of a trained technician. It’s a quick bedside check with the athlete to see if the heart wall thickness is okay, if there’s an abnormality called hypertrophic cardiomyopathy—which is the leading cause of sudden death in athletes—and if the aorta is dilated. It’s definitely in its experimental stage. We’re not recommending this [protocol] as an evaluation tool yet.

What were the results of your study?

We found a very good correlation between the brief ultrasound that the sports medicine physician did and a thorough ultrasound that a highly experienced [technician] performed. In another study, 59 athletes were screened using this technique. There were some abnormalities found on three athletes with their history and three athletes with their ECG. Further testing found no cardiac abnormality, as predicted by the brief echo screen.

What are your next steps?

Future research will involve doing this on a larger scale with a larger number of athletes. One of the problems of doing research in this area is that the incidence of problems is extremely low. The incidence of sudden death in athletes ranges from 1 to 100,000 to 1 to 300,000. It’s going to take a very large screening study to determine if this protocol is useful or not.

Any final thoughts?

Anyone who plans to participate in competitive sports or intense exercise should be evaluated before they engage in such programs to make sure that there’s no evidence of any underlying heart disease. For younger athletes under 40, we have to think about congenital heart diseases. For older athletes, we worry about coronary artery disease, which causes heart attacks. Older athletes definitely need to be screened, especially if they have risk factors such as high blood pressure, diabetes, smoking, high cholesterol, or family history of heart disease at a young age.

 

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