ECG screening criteria for young athletes

European ECG screening criteria for young athletes need review

SEPTEMBER 13, 2010 | Sue Hughes

Stockholm, Sweden - The European ECG-based screening process for hypertrophic cardiomyopathy (HCM) in young athletes needs to be reviewed, and the criteria for further evaluation should be recalculated according to the type and intensity of the exercise performed, a new study suggests.

"Training-related changes on the ECG are different for individuals participating in different sports. We should not be using the same screening criteria for a whole range of sports. As well as the type and intensity of sport, other factors that can influence ECG changes are gender and race. Therefore, we need a whole set of different individual guidelines for each group," study author Dr José Angel Cabrera (Hospital Quiron, Madrid, Spain) told heartwire.

Cabrera explained that the European ECG screening criteria for young athletes are associated with a very high rate of false positives, meaning that many individuals are referred on unnecessarily for further tests. "The guidelines have changed recently, and the situation has improved. We used to see a rate of about 70% false positives, but this has now been reduced to about 50%. But we can improve the ECG criteria even more if we factor in type of sport, race, and gender. We can then really refine what we are looking for as a sign of structural heart disease." Several groups are working on producing such guidelines, he added./.../

ECG in College Athletes

ACC: ECG Reveals Cardiac Problems in A Third of College Athletes

By Crystal Phend, Staff Writer, MedPage Today Published: April 01, 2009 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco Earn CME/CE credit for reading medical news

ORLANDO, April 1 -- Cardiac screening for college-level athletes that included an electrocardiogram discovered abnormalities in 21% to 37% of students, according to two studies at major U.S. universities. Action Points   Note that these studies were published as abstracts and presented as posters at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal. Note that neither study included a control group for comparison of standard history- and physical exam-based preparticipation screening with and without electrocardiograms. But researchers from the two groups reached opposite conclusions about routine EKGs for athletes at the American College of Cardiology (ACC) meeting here this week. Professional athletes in the U.S. commonly get intensive cardiac screening, but its use at lower levels of competition has been debated. The European Cardiology Society supports routine electrocardiograms to reduce risk of sudden cardiac death in competitive collegiate sports. The ACC recommends only a simpler, history- and physical exam-based screening. The leader of one research group, Anthony Magalski, M.D., of St. Luke's Mid America Heart Institute in Kansas City, Mo., spoke to the value of added testing./.../

AHA/ACCF/HRS Scientific Statements on EKG

Part III: Intraventricular Conduction Disturbances:
A Scientific Statement From the American Heart AssociationElectrocardiography and Arrhythmias Committee, Council on ClinicalCardiology; the American College of Cardiology Foundation; and the HeartRhythm Society: Endorsed by the International Society for ComputerizedElectrocardiologyBorys Surawicz, Rory Childers, Barbara J. Deal, and Leonard S. Gettes
Circulation 2009;119 e235-e240
http://circ.ahajournals.org/cgi/content/extract/119/10/e235?etoc

Part IV: The ST Segment, T and U Waves, and the QTInterval:
Pentti M. Rautaharju, Borys Surawicz, and Leonard S. Gettes
Circulation 2009;119 e241-e250
http://circ.ahajournals.org/cgi/content/extract/119/10/e241?etoc

Part V: Electrocardiogram Changes Associated WithCardiac Chamber Hypertrophy:
E. William Hancock, Barbara J. Deal, David M. Mirvis, Peter Okin, PaulKligfield, and Leonard S. GettesCirculation 2009;119 e251-e261
http://circ.ahajournals.org/cgi/content/extract/119/10/e251?etoc

Part VI: Acute Ischemia/Infarction:
Galen S. Wagner, Peter Macfarlane, Hein Wellens, Mark Josephson, AntonGorgels, David M. Mirvis, Olle Pahlm, Borys Surawicz, Paul Kligfield, RoryChilders, and Leonard S. Gettes
Circulation 2009;119 e262-e270
http://circ.ahajournals.org/cgi/content/extract/119/10/e262?etoc

Outcomes in Athletes with Marked ECG Repolarization Abnormalities

Antonio Pelliccia, M.D., Fernando M. Di Paolo, M.D., Filippo M. Quattrini, M.D., Cristina Basso, M.D., Franco Culasso, Ph.D., Gloria Popoli, M.D., Rosanna De Luca, M.D., Antonio Spataro, M.D., Alessandro Biffi, M.D., Gaetano Thiene, M.D., and Barry J. Maron, M.D.
Background Young, trained athletes may have abnormal 12-lead electrocardiograms (ECGs) without evidence of structural cardiac disease. Whether such ECG patterns represent the initial expression of underlying cardiac disease with potential long-term adverse consequences remains unresolved. We assessed long-term clinical outcomes in athletes with ECGs characterized by marked repolarization abnormalities.
Methods From a database of 12,550 trained athletes, we identified 81 with diffusely distributed and deeply inverted T waves (2 mm in at least three leads) who had no apparent cardiac disease and who had undergone serial clinical, ECG, and echocardiographic studies for a mean (±SD) of 9±7 years (range, 1 to 27). Comparisons were made with 229 matched control athletes with normal ECGs from the same database.
Results Of the 81 athletes with abnormal ECGs, 5 (6%) ultimately proved to have cardiomyopathies, including one who died suddenly at the age of 24 years from clinically undetected arrhythmogenic right ventricular cardiomyopathy. Of the 80 surviving athletes, clinical and phenotypic features of hypertrophic cardiomyopathy developed in 3 after 12±5 years (at the ages of 27, 32, and 50 years), including 1 who had an aborted cardiac arrest. The fifth athlete demonstrated dilated cardiomyopathy after 9 years of follow-up. In contrast, none of the 229 athletes with normal ECGs had a cardiac event or received a diagnosis of cardiomyopathy 9±3 years after initial evaluation (P=0.001).
Conclusions Markedly abnormal ECGs in young and apparently healthy athletes may represent the initial expression of underlying cardiomyopathies that may not be evident until many years later and that may ultimately be associated with adverse outcomes. Athletes with such ECG patterns merit continued clinical surveillance.