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Panhuyzen-Goedkoop NM, Verbeek ALM, Goedkoop RJ, Malekzadeh A, Wilde AAM, Peters RJG, Jørstad HT. Quality of athlete screening for high-risk cardiovascular conditions-A systematic review. Scand J Med Sci Sports 2023; 33:2094-2109. [PMID: 37449413 DOI: 10.1111/sms.14446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 04/21/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Sudden cardiac death (SCD) is the leading medical cause of death in athletes. To prevent SCD, screening for high-risk cardiovascular conditions (HRCC) is recommended. Screening strategies are based on a limited number of studies and expert consensus. However, evidence and efficacy of athlete HRCC screening is unclear. OBJECTIVE To determine methodological quality and quality of evidence of athlete screening, and screening efficacy to detect HRCC in a systematic review. METHODS We performed a systematic search of Medline, Embase, Scopus and Cochrane Library up to June 2021. We included articles containing original data of athlete cardiovascular screening, providing details of screening strategies, test results and HRCC detection. We assessed methodological quality of the included articles by QUADAS-2, quality of evidence of athlete HRCC screening by GRADE, and athlete HRCC screening efficacy by SWiM. RESULTS Of 2720 citations, we included 33 articles (1991-2018), comprising 82 417 athletes (26.7% elite, 73.4% competitive, 21.7% women, 75.2% aged ≤35). Methodological quality was 'very low' (33 articles), caused by absence of data blinding and inappropriate statistical analysis. Quality of evidence was 'very low' (33 articles), due to observational designs and population heterogeneity. Screening efficacy could not be reliably established. The prevalence of HRCC was 0.43% with false positive rate (FPR) 13.0%. CONCLUSIONS Methodological quality and quality of evidence on athlete screening are suboptimal. Efficacy could not be reliably established. The prevalence of screen detected HRCC was very low and FPR high. Given the limitations of the evidence, individual recommendations need to be prudent.
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Affiliation(s)
- Nicole M Panhuyzen-Goedkoop
- Department of Cardiology, Amsterdam University Medical Centers, Heart Centre, Amsterdam, The Netherlands
- Sports Medical Centre Papendal, Arnhem, The Netherlands
| | - André L M Verbeek
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Arjan Malekzadeh
- University Library, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam University Medical Centers, Heart Centre, Amsterdam, The Netherlands
| | - Ron J G Peters
- Department of Cardiology, Amsterdam University Medical Centers, Heart Centre, Amsterdam, The Netherlands
| | - Harald T Jørstad
- Department of Cardiology, Amsterdam University Medical Centers, Heart Centre, Amsterdam, The Netherlands
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2
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Sharma S, Drezner JA, Baggish A, Papadakis M, Wilson MG, Prutkin JM, La Gerche A, Ackerman MJ, Borjesson M, Salerno JC, Asif IM, Owens DS, Chung EH, Emery MS, Froelicher VF, Heidbuchel H, Adamuz C, Asplund CA, Cohen G, Harmon KG, Marek JC, Molossi S, Niebauer J, Pelto HF, Perez MV, Riding NR, Saarel T, Schmied CM, Shipon DM, Stein R, Vetter VL, Pelliccia A, Corrado D. International recommendations for electrocardiographic interpretation in athletes. Eur Heart J 2019; 39:1466-1480. [PMID: 28329355 DOI: 10.1093/eurheartj/ehw631] [Citation(s) in RCA: 200] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 12/08/2016] [Indexed: 12/14/2022] Open
Abstract
Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural, or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly over the last decade; pushed by a growing body of scientific data that both tests proposed criteria sets and establishes new evidence to guide refinements. On 26-27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington, to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD.
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Affiliation(s)
- Sanjay Sharma
- Cardiology Clinical Academic Group, St George's, University of London, UK
| | - Jonathan A Drezner
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Aaron Baggish
- Division of Cardiology, Massachusettes General Hospital, MA, USA
| | - Michael Papadakis
- Cardiology Clinical Academic Group, St George's, University of London, UK
| | - Mathew G Wilson
- Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Qatar
| | - Jordan M Prutkin
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Andre La Gerche
- Department of Cardiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Michael J Ackerman
- Department of Cardiovascular Diseases, Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, MN, USA
| | - Mats Borjesson
- Department of Neuroscience and Physiology, Sahlgrenska University Hospital/Ostra Sahlgrenska Academy, Goteborg, Sweden
| | - Jack C Salerno
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Irfan M Asif
- Department of Family Medicine, University of South Carolina, Greenville, SC, USA
| | - David S Owens
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Eugene H Chung
- Division of Cardiology, University of North Carolina School of Medicine, NC, USA
| | - Michael S Emery
- Center of Cardiovascular Care in Athletics, Indiana University School of Medicine, IN, USA
| | | | - Hein Heidbuchel
- Department of Cardiology, Arrhythmology Hasselt University, Hasselt, Belgium.,Department of Cardiology, Antwerp, Belgium
| | - Carmen Adamuz
- Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Qatar
| | | | - Gordon Cohen
- Division of Pediatric Cardiothoracic Surgery, University of California San Francisco School of Medicine, CA, USA
| | - Kimberly G Harmon
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | | | - Silvana Molossi
- Division of Pediatric Cardiology, Baylor College of Medicine, TX, USA
| | - Josef Niebauer
- University Institute of Sports Medicine, Paracelsus Medical University, Austria
| | - Hank F Pelto
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Marco V Perez
- Center for Inherited Cardiovascular Disease, Stanford University, CA, USA
| | - Nathan R Riding
- Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Qatar
| | - Tess Saarel
- Pediatric Cardiology, Cleveland Clinic, OH, USA
| | | | - David M Shipon
- Heart Center of Philadelphia, Jefferson University Hospitals, PA, USA
| | - Ricardo Stein
- Department of Cardiology, Hospital de Clinicas de Porte Allegre, Brazil
| | | | | | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Italy
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3
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Sharma S, Drezner JA, Baggish A, Papadakis M, Wilson MG, Prutkin JM, La Gerche A, Ackerman MJ, Borjesson M, Salerno JC, Asif IM, Owens DS, Chung EH, Emery MS, Froelicher VF, Heidbuchel H, Adamuz C, Asplund CA, Cohen G, Harmon KG, Marek JC, Molossi S, Niebauer J, Pelto HF, Perez MV, Riding NR, Saarel T, Schmied CM, Shipon DM, Stein R, Vetter VL, Pelliccia A, Corrado D. International Recommendations for Electrocardiographic Interpretation in Athletes. J Am Coll Cardiol 2017; 69:1057-1075. [PMID: 28231933 DOI: 10.1016/j.jacc.2017.01.015] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural, or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly over the last decade; pushed by a growing body of scientific data that both tests proposed criteria sets and establishes new evidence to guide refinements. On February 26-27, 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington, to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD.
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Affiliation(s)
- Sanjay Sharma
- Cardiology Clinical and Academic Group, St George's University of London, United Kingdom.
| | - Jonathan A Drezner
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Aaron Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael Papadakis
- Cardiology Clinical and Academic Group, St George's University of London, United Kingdom
| | - Mathew G Wilson
- Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Qatar
| | - Jordan M Prutkin
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Andre La Gerche
- Department of Cardiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Michael J Ackerman
- Department of Cardiovascular Diseases, Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Mats Borjesson
- Department of Neuroscience and Physiology, Sahlgrenska University Hospital/Ostra Sahlgrenska Academy, Goteborg, Sweden
| | - Jack C Salerno
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Irfan M Asif
- Department of Family Medicine, University of South Carolina, Greenville, South Carolina
| | - David S Owens
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Eugene H Chung
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Michael S Emery
- Center of Cardiovascular Care in Athletics, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Hein Heidbuchel
- Department of Cardiology, Arrhythmology Hasselt University, Belgium; Department of Cardiology, Antwerp, Belgium
| | - Carmen Adamuz
- Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Qatar
| | | | - Gordon Cohen
- Division of Pediatric Cardiothoracic Surgery, University of California San Francisco School of Medicine, San Francisco, California
| | - Kimberly G Harmon
- Department of Family Medicine, University of Washington, Seattle, Washington
| | | | - Silvana Molossi
- Division of Pediatric Cardiology, Baylor College of Medicine, Houston, Texas
| | - Josef Niebauer
- University Institute of Sports Medicine, Paracelsus Medical University, Austria
| | - Hank F Pelto
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Marco V Perez
- Center for Inherited Cardiovascular Disease, Stanford University, Stanford, California
| | - Nathan R Riding
- Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Qatar
| | - Tess Saarel
- Pediatric Cardiology, Cleveland Clinic, Cleveland, Ohio
| | | | - David M Shipon
- Heart Center of Philadelphia, Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Ricardo Stein
- Department of Cardiology, Hospital de Clinicas de Porte Allegre, Brazil
| | | | | | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Italy
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4
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Drezner JA, Sharma S, Baggish A, Papadakis M, Wilson MG, Prutkin JM, Gerche AL, Ackerman MJ, Borjesson M, Salerno JC, Asif IM, Owens DS, Chung EH, Emery MS, Froelicher VF, Heidbuchel H, Adamuz C, Asplund CA, Cohen G, Harmon KG, Marek JC, Molossi S, Niebauer J, Pelto HF, Perez MV, Riding NR, Saarel T, Schmied CM, Shipon DM, Stein R, Vetter VL, Pelliccia A, Corrado D. International criteria for electrocardiographic interpretation in athletes: Consensus statement. Br J Sports Med 2017; 51:704-731. [PMID: 28258178 DOI: 10.1136/bjsports-2016-097331] [Citation(s) in RCA: 226] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 01/16/2023]
Abstract
Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly, advanced by a growing body of scientific data and investigations that both examine proposed criteria sets and establish new evidence to guide refinements. On 26-27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington (USA), to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD.
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Affiliation(s)
- Jonathan A Drezner
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St. George's, University of London, London, UK
| | - Aaron Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, US
| | - Michael Papadakis
- Cardiology Clinical Academic Group, St. George's, University of London, London, UK
| | - Mathew G Wilson
- Department of Sports Medicine, ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Jordan M Prutkin
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Andre La Gerche
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Michael J Ackerman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Department of Paediatric, Mayo Clinic, Rochester, Minnesota, USA.,Department of Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Molecular Pharmacology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Mats Borjesson
- Department of Neuroscience, Sahlgrenska University Hospital/Ostra Sahlgrenska Academy, Goteborg, Sweden.,Department of Physiology, Sahlgrenska University Hospital/Ostra Sahlgrenska Academy, Goteborg, Sweden
| | - Jack C Salerno
- Department of Pediatrics, University of Washington, Seattle, Washington, US
| | - Irfan M Asif
- Department of Family Medicine, University of South Carolina, Greenville, USA
| | - David S Owens
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Eugene H Chung
- Division of Cardiology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, USA
| | - Michael S Emery
- Center of Cardiovascular Care in Athletics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | | | - Carmen Adamuz
- Department of Sports Medicine, ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | - Gordon Cohen
- Division of Paediatric Surgery, University of California, San Francisco School of Medicine, San Francisco, California, USA.,Division of Cardiothoracic Surgery, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Kimberly G Harmon
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | | | - Silvana Molossi
- Division of Pediatric, Baylor College of Medicine, Houston, Texas, USA.,Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Josef Niebauer
- University Institute of Sports Medicine, Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Hank F Pelto
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Marco V Perez
- Center for Inherited Cardiovascular Disease, Stanford University, Stanford, California, USA
| | - Nathan R Riding
- Department of Sports Medicine, ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Tess Saarel
- Department of Pediatrics, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - David M Shipon
- Heart Centre of Philadelphia, Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Ricardo Stein
- Department of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Victoria L Vetter
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Domenico Corrado
- Department of Cardiac Science, University of Padua Medical School, Padua, Italy.,Department of Thoracic Sciences, University of Padua Medical School, Padua, Italy.,Department of Vascular Sciences, University of Padua Medical School, Padua, Italy
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5
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Abstract
This article summarizes the role of the 12-lead electrocardiogram (ECG) for the clinical care of athletes, with particular reference to the influence of age, gender, ethnicity, and type of sport on the appearance of the ECG, and its role in differentiating physiologic exercise-related changes from pathologic conditions implicated in sudden cardiac death (SCD). The article also explores the potential role of the ECG in detecting athletes at risk of SCD. In addition, the article reviews the evolution of ECG interpretation criteria and emphasizes the limitations of the ECG as well as the potential for future research.
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Affiliation(s)
- Tee Joo Yeo
- Cardiac Department, National University Heart Centre, 1E Kent Ridge Road, Singapore 678267, Singapore
| | - Sanjay Sharma
- Cardiovascular & Cell Sciences Research Institute, St George's University of London, St George's University NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK.
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