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Comparison of three current sets of electrocardiographic interpretation criteria for use in screening athletes.

Riding, NR; Sheikh, N; Adamuz, C; Watt, V; Farooq, A; Whyte, GP; George, KP; Drezner, JA; Sharma, S; Wilson, MG (2015) Comparison of three current sets of electrocardiographic interpretation criteria for use in screening athletes. Heart, 101 (5). pp. 384-390. ISSN 1468-201X
SGUL Authors: Sharma, Sanjay

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BACKGROUND: An increasing number of sporting bodies report unacceptably high levels of false-positive ECGs when undertaking pre-participation cardiac screening. To address this issue, modified ECG interpretation criteria have become available for use within athletes. OBJECTIVE: This study assessed the accuracy of the new 2014 'Refined Criteria' against the 2013 Seattle Criteria and the 2010 European Society of Cardiology (ESC) recommendations in a cohort of Arabic, black and Caucasian athletes. METHODS: 2491 male athletes (1367 Arabic, 748 black and 376 Caucasian) undertook pre-participation screening including a 12-lead ECG, with further investigation(s) upon indication. RESULTS: Ten athletes (0.4%) were identified with cardiac pathology; seven with hypertrophic cardiomyopathy (HCM; five black and two Arabic) and three Arabs with Wolff-Parkinson-White syndrome (WPW). All three ECG criteria were 100% sensitive identifying all cases of HCM and WPW. The 2014 Refined Criteria reduced (p<0.0001) the prevalence of an abnormal ECG to 5.3% vs 11.6% (Seattle Criteria) and 22.3% (2010 ESC recommendations). The 2014 Refined Criteria significantly (p<0.0001) improved specificity (94.0%) across all ethnicities compared with the Seattle Criteria (87.5%) and ESC recommendations (76.6%). Black athletes continue to present a higher prevalence (p<0.0001) of abnormal ECGs compared with Arabic and Caucasian athletes (10% vs 3.6% and 2.1%). CONCLUSIONS: The 2014 Refined Criteria for athlete ECG interpretation outperformed both the 2013 Seattle Criteria and the 2010 ESC recommendations by significantly reducing the number of false-positive ECGs in Arabic, black and Caucasian athletes while maintaining 100% sensitivity for serious cardiac pathologies.

Item Type: Article
Additional Information: This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Keywords: Athletes, Continental Population Groups, Death, Sudden, Cardiac, Electrocardiography, Heart Defects, Congenital, Heart Diseases, Humans, Male, Mass Screening, Practice Guidelines as Topic, Sensitivity and Specificity, Young Adult, Humans, Heart Defects, Congenital, Heart Diseases, Death, Sudden, Cardiac, Electrocardiography, Mass Screening, Sensitivity and Specificity, Continental Population Groups, Male, Practice Guidelines as Topic, Young Adult, Athletes, 1102 Cardiovascular Medicine And Haematology, Cardiovascular System & Hematology
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Heart
ISSN: 1468-201X
Language: eng
12 February 2015Published
11 December 2014Published Online
30 October 2014Accepted
Publisher License: Creative Commons: Attribution-Noncommercial 4.0
PubMed ID: 25502812
Web of Science ID: WOS:000349683900012
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