With the recent moves by the Chiefs front office our draft picture has become as murky as it has ever been. A revitalized interest in defensive linemen has increased the interest in Star Lotulelei as a possible draft pick at #1. There have been several what-if posts with some good opinions, but they all have the same caveat: If his heart is okay. I though I would try to pool together what little we know about Star and his condition and make some speculations based on the data. I am going to try to clearly delineate what is fact from speculation, and give links when possible.
First, some background. The NFL did not routinely do this kind of in-depth analysis of player's cardiac health until recently. The death of Gaines Adams in the 2009 season from a sudden cardiac arrest prompted an industry-wide discussion as to whether more extensive testing of NFL players was recommended. I haven't been able to find out if they started doing these more extensive tests during the 2010 draft combine, but Indiana University began routinely performing an extensive battery of cardiac evaluations, including two types of echocardiograms as part of the combine starting in 2011. The tests IU has been running are a part of a 3 year study which is in its final year. For more on that, there is an article in the IU online news letter INScope. Important to note is that the tests at the combine are overseen by a Cardiac Specialist, Dr. Richard Kovacs. It's unlikely he directly evaluated every case, but it's reasonable to think he involved himself in Star's case when the abnormality was found. Still seeing all those prospects in just 4 days, it would be hard to get to involved in any one case just from a time standpoint.
Next, we already know that Star Lotulelei was one of over 350 prospects went through the tests and was determined to have low cardiac ejection fraction. For those who don't know, this is a measure of cardiac efficiency, and is simply a fraction of the amount of blood the heart squeezes out on each pump divided by the amount of blood the heart had in it before it pumped. The "normal" numbers vary, but low ends of where this should be is 50-55%. Significant depression of ejection fraction in the 30-40% range. The oft reported number for Lotulelei has been 44%. What I also haven't been able to find is the number of athletes at the combine who have had this type of finding. Maybe this is the first case it has happened in, or maybe it's just the first time it happened to a player of this caliber.
Other than this number (44%), I haven't found any reports of any symptoms he might have been having or other abnormal test findings that would give any insight to a deeper problem. ESPN, along with other sources reported, Star lost 10 pounds in the 3 days preceding the combine, and speculates this could have had something to do with the abnormal. The Utah team doctor, orthopedist David Petron, MD did not give any specifics about Star because of privacy concerns, but in a Salt Lake Tribune article he gave some possible causes which would not be reason to question Lotulelei's long-term health. He suggested there was cause to doubt the significance of the test, which is certainly true. There is some level of subjectivity to these tests, and two cardiologists might look at the same Echo and come up with slightly different conclusions.
It's important to remember that this is not how medicine usually gets practiced. We usually go from a symptom to a test or a screening test to a more extensive test. An echocardiogram has never been extensively studied as a screening tool as it is being right now in the draft combine. No guidelines currently exist for the evaluation or treatment of an asymptomatic patient with an incidental finding of low ejection fraction above 40%. But, there are some in the medical community who think ejection fraction should be assessed as a risk factor for cardiac disease (from Ohio State for example). It could easily be that many people, even athletes have a low ejection fraction and this doesn't increase their risk for anything and doesn't jeopardize their lives or athletic career. It could also be that this screen picked up evidence of a much deeper problem that could prevent Star from even having a career and may have saved his life. A couple of those potential problems are:
Cardiomyopathy: in lay-terms heart muscle problem. It comes in many different forms, but the one that get's the most attention is Hypertrophic Cardiomyopathy, a leading cause for sudden death in young athletes. Another type would be Dilated Cardiomyopathy, where the heart wall is overly stretched and can't squeeze as effectively. Both types can occur without any symptoms, and are potentially fatal. Obesity can play a role in both types.
Myocarditis/Endocarditis: both are inflammatory heart conditions usually caused by infection, and all could potentially exist without symptoms. They are usually temporary conditions, but could also lead to long-term problems (like Dilated Cardiomyopathy).
"Silent" heart attack: like it sounds, a heart attack with few-to-no symptoms that results in areas of heart tissue death. Less living tissue means less squeezing,.
I am not saying any of those are necessarily the cause, but they could be. It also wasn't intended to be a full differential diagnosis. Another proposed cause was dehydration. I admit I was high on this one as a possible especially given the reported weight-loss, but the more I think about it, the less likely I think it is. The reason why: Dehydration lowers a person's blood volume. Lower volume means less resistance in the blood vessels. The heart then doesn't have to squeeze as hard to push out the blood. Severe dehydration would actually increase ejection fraction. This is why we give diuretics in most cases of moderate-to-severe heart failure.
I am not meaning to suggest that the worst case scenarios are what is happening or even likely. Again, we are going off of no symptoms and a clinical finding that has not been studied as an effective screen. If anyone on AP is a cardiologist, maybe he or she could clarify some of these points. I really hope for his sake that this is nothing at all. Whether there really is a risk, no one knows. If Star is cleared to work out at his pro day, that should answer a lot of questions. I would expect even if he does check out, that this could affect his draft stock.