Recent study evokes memories of sudden cardiac death in basketball players

The makers of the ESPN documentary “Guru of Go” created one of the most powerful film sequences I’ve ever seen.

They chopped up clips of Loyola Marymount University basketball star Hank Gathers’ last moments alive with interviews and reactions from his head coach, family members and teammates. In one stretch, the documentarians jumped from close-up to close-up with all the interviewees silently shaking their heads and holding back tears as they remembered Gathers, who died on the court at age 23.

These were deft filmmaking touches, but they were almost unnecessary. The raw footage of the game itself would have been powerful enough.

Seconds before Gathers collapsed, the 6-foot-7, 210-pound forward skied for a monstrous dunk. The juxtaposition of that image of youthful power and athleticism with the subsequent picture of Gathers lying on the court, body failing him, was heartbreaking.

Gathers had previously been diagnosed with exercise-induced arrhythmia and prescribed medication, and was found to have hypertrophic cardiomyopathy upon autopsy.

I was reminded of this documentary—and other stories like it—as I wrote an article for Cardiovascular Business about how NBA players are more likely than other athlete groups to have abnormal electrocardiographic (ECG) findings.

In the study published in JAMA Cardiology, 15.6 percent of 519 NBA players were found to have abnormal ECG results, even using international criteria modified for athletes. Abnormal T-wave inversions (TWI) were present in 6.2 percent of the athletes and associated with smaller left ventricular cavity size and increased left ventricular relative wall thickness (RWT).

Sanjay Sharma, MD, FRCP, said the study was the first to evaluate the athlete-specific ECG criteria in a predominantly black cohort.

“The association of concentric left ventricular remodeling or hypertrophy with inferior and/or lateral TWI raises the question of whether left ventricular hypertrophy induced by sports in black athletes might be a harbinger for serious arrhythmias, as is the case in black patients with hypertensive heart disease,” Sharma wrote in a related editorial. “Until further data are available, it would be prudent to routinely investigate black athletes with inferior and/or lateral TWI for cardiomyopathy.”

Sudden cardiac death in basketball players is more common than you might suspect. Much of high school was a blur to me, but I distinctly remember my junior varsity coach and senior-year calculus teacher becoming emotional as he told me and my teammates about his brother dying after collapsing during a pickup game at one of our rival schools. My coach’s brother was a standout high school player and set to enter his senior season in college when he died at 21.

Another example from my personal experience: from February 2014 until May 2017, I was a sportswriter at the Evansville Courier & Press in southwestern Indiana. While I was there, a colleague wrote a five-year anniversary story about the death of Jeron Lewis, a star basketball player at nearby University of Southern Indiana.

Like Gathers, he collapsed during a game. And like Gathers, his enlarged heart played a role.

I realize not everyone is as plugged into the basketball world as an ex-player, ex-sportswriter and forever hoops junkie. Maybe you don’t have anecdotal experience with these tragedies, but statistics Sharma presented in his editorial are striking: 1 in 3,126 Division I men’s basketball players dies of sudden cardiac death in the presence of exercise per year. Prevalence shrinks to 1 in 43,770 per year for NCAA student-athletes as a whole.

There are 351 Division I men’s basketball teams, most with an allotment of 13 scholarship players. That equals 4,563 scholarship players across the country, making it likely that sudden cardiac death occurs in one of these individuals every year. And that estimation doesn’t factor in athletes at junior colleges or lower levels of NCAA competition—although some research suggests that the most elite athletes (like those in Division I or the NBA) who have trained longer and more intensely are at the greatest risk for exercise-related cardiac remodeling.

Given that sudden cardiac death will likely strike at least one college basketball player each year in this country, more care needs to be taken in investigating arrhythmias in this population. Too many apparently healthy—often supremely conditioned—athletes have already died too soon.