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Evans L, Hutt K. Sudden Cardiac Death in Dancers and Athletes: Time for Increased Cardiac Screening? J Dance Med Sci 2024; 28:132-138. [PMID: 37864364 DOI: 10.1177/1089313x231203052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Background: Young athletes are thought to be models of peak physical condition, capable of exceptional physical accomplishments. However approximately 64 UK athletes aged 12 to 35 will die each year from a phenomenon known as Sudden Cardiac Death (SCD). SCD can be defined as an unexpected death as a result of abrupt loss of cardiac function within an hour of symptom onset. Undiagnosed heart conditions such as arrhythmias are often found to be the cause of SCD. Advantageous physical attributes found in athletes' hearts can complicate diagnoses as hearts with inherited conditions can appear physiologically similar to hearts adapted to strenuous exercise. Growing research surrounding SCD within sporting populations aims to decrease mortality rates however there is an absence of study specifically into SCD in dance. Within sport, the topic of cardiac screening has generated widespread controversy which is fueled by a lack of empirical evidence. There is currently no international consensus of pre participation cardiac screening methods within dance or sport, potentially leaving many dancers and athletes at risk. Methods: As part of this study, existing material surrounding the topics of SCD and cardiac screening in athletes and dancers was gathered. All existing studies at the time of writing in relation to cardiac screening in athletes and dancers were collected and analysed in order to compare results and evaluate the methodological limitations.This process aimed to identify gaps in current knowledge and research to inform future study. Results: This article aimed to analyze the epidemiology of SCD within sport and dance and to make recommendations for pre-participation screening within dance institutions. The study highlights the need to increase awareness of SCD within the dance community and determine appropriate screening approaches depending on context and setting.
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Affiliation(s)
- Lola Evans
- London Contemporary Dance School, London, UK
| | - Kim Hutt
- London Studio Centre, London, UK
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Barry M, Sylla IS, Balde MD, Bangoura M, Camara I. [Place of the electrocardiogram in the visit of non-contra-indication to the practice of competitive sports between the ages of 12 and 35 : Survey of physicians who are members of the Guinean Association of Sports Physicians]. Ann Cardiol Angeiol (Paris) 2024; 73:101762. [PMID: 38733860 DOI: 10.1016/j.ancard.2024.101762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/13/2024] [Accepted: 03/29/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION An electrocardiogram (ECG), combined with a well-conducted clinical examination, is more effective than the clinical examination alone in detecting underlying cardiac pathologies in athletes. The aim of this study was to evaluate the use of ECGs by physicians who are members of the Guinean Association of Sports Physicians, during the non-contraindication visit for competitive sports between the ages of 12 and 35. METHODOLOGY We conducted a web-survey from July 15 to August 15, 2023. A survey form was created on "Google Docs" and pre-tested. It was then broadcast on all the communication networks used by these doctors. The data were secured using "Google Drive" software. Analyses were performed using SPSS version 20 software. RESULTS Of the 51 included, 74.51% said they had received at least one training session on ECG interpretation for athletes. All of them either requested or performed an ECG at least once in a while, as part of the check-up for non-contraindication to competitive sport. The ECG was systematic, according to 72.55% of doctors. Three quarters referred to a sports cardiologist in the event of an abnormal ECG, 66.67% to a cardiology resident and 58.82% to a cardiologist. In the absence of an ECG, the presence of functional signs on exertion, the notion of a family history of cardiovascular disease and the presence of at least two cardiovascular risk factors were the main reasons for seeking an opinion. CONCLUSION A resting ECG is carried out almost systematically by doctors who are members of the Guinean Association of Sports Doctors, as part of the check-up for non-contraindication to practising sport.
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Affiliation(s)
- Mamadou Barry
- Service de cardiologie hôpital National Ignace DEEN, Conakry, Guinée.
| | | | | | - Mohamed Bangoura
- Service de cardiologie hôpital National Ignace DEEN, Conakry, Guinée
| | - Ibrahima Camara
- Service de médecine général B Rhumatologie hôpital National Ignace DEEN, Conakry, Guinée
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Palermi S, Vecchiato M, Saglietto A, Niederseer D, Oxborough D, Ortega-Martorell S, Olier I, Castelletti S, Baggish A, Maffessanti F, Biffi A, D'Andrea A, Zorzi A, Cavarretta E, D'Ascenzi F. Unlocking the potential of artificial intelligence in sports cardiology: does it have a role in evaluating athlete's heart? Eur J Prev Cardiol 2024; 31:470-482. [PMID: 38198776 DOI: 10.1093/eurjpc/zwae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
The integration of artificial intelligence (AI) technologies is evolving in different fields of cardiology and in particular in sports cardiology. Artificial intelligence offers significant opportunities to enhance risk assessment, diagnosis, treatment planning, and monitoring of athletes. This article explores the application of AI in various aspects of sports cardiology, including imaging techniques, genetic testing, and wearable devices. The use of machine learning and deep neural networks enables improved analysis and interpretation of complex datasets. However, ethical and legal dilemmas must be addressed, including informed consent, algorithmic fairness, data privacy, and intellectual property issues. The integration of AI technologies should complement the expertise of physicians, allowing for a balanced approach that optimizes patient care and outcomes. Ongoing research and collaborations are vital to harness the full potential of AI in sports cardiology and advance our management of cardiovascular health in athletes.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, via Pansini 5, 80131 Naples, Italy
| | - Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Andrea Saglietto
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Citta della Salute e della Scienza' Hospital, 10129 Turin, Italy
- Department of Medical Sciences, University of Turin, 10129 Turin, Italy
| | - David Niederseer
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Sandra Ortega-Martorell
- Data Science Research Centre, Liverpool John Moores University, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Ivan Olier
- Data Science Research Centre, Liverpool John Moores University, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, Liverpool John Moores University, Liverpool, UK
| | - Silvia Castelletti
- Cardiology Department, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Alessandro Biffi
- Med-Ex, Medicine & Exercise, Medical Partner Scuderia Ferrari, 00187 Rome, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I Hospital, 84014 Nocera Inferiore, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
- Mediterranea Cardiocentro, 80122 Naples, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
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Abstract
Sudden cardiac death (SCD) pathophysiological point of view can be either mechanical or electrical. In case of mechanical SCD, the most frequent causes are pulmonary thromboembolism and cardiac tamponade due to intrapericardial rupture (aortic dissection, heart rupture). This distinction is important because cardiac arrest retains survival potential through cardiopulmonary resuscitation and defibrillators only if the rhythm is shockable. The heart diseases that can cause SCD vary according to the age of the individual. In young people, primary electrical diseases ('ion channel diseases') and cardiomyopathies (particularly hypertrophic and arrhythmogenic), both genetically determined and therefore potentially recurred in the proband's family, as well as myocarditis and coronary anomalies prevail; in adult-elderly populations, coronary atherosclerosis with its complications and degenerative valve diseases (aortic stenosis and mitral valve prolapse) predominate. In this short text, the main structural heart diseases characterized by electrical instability at risk of SCD will be recalled, with a focus on coronary, myocardial, and valvular diseases.
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Affiliation(s)
- Monica De Gaspari
- Cardiovascular Pathology, Padua Hospital, Department of Cardiology, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Stefania Rizzo
- Cardiovascular Pathology, Padua Hospital, Department of Cardiology, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Gaetano Thiene
- Cardiovascular Pathology, Padua Hospital, Department of Cardiology, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Cristina Basso
- Corresponding author. Tel: +39 049 827 2286, Fax: +39 049 821 2284,
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Maurizi N, Fumagalli C, Skalidis I, Muller O, Armentano N, Cecchi F, Marchionni N, Olivotto I. Layman electrocardiographic screening using smartphone-based multiple‑lead ECG device in school children. Int J Cardiol 2023; 373:142-144. [PMID: 36513281 DOI: 10.1016/j.ijcard.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pre-partecipation ECG screening of large populations has a significant socioeconomic impact. Technological progress now allows for high-tech-low-cost ECG screening using validated smartphone-based devices capable of guiding to the correct performance of a 12‑lead ECG by layman with no medical background. METHODS We enrolled 728 (364, 52% males) individuals, aged 12-13 years who underwent ECG screening with a smartphone 12‑lead ECG during school hours by layman volunteers. Correct electrodes placement was provided by a validated image-processing algorithm by the smartphone camera in the App. ECG interpretation was via a telecardiology platform and alterations classified following current standards. RESULTS A total of 741 ECGs were recorded, of which 13(2%) were technically not interpretable. Mean PR, QRS and QTc were: 145 ± 22, 85 ± 19 and 387 ± 57 msec. No QTc prolongation was observed. Mean QRS axis was 15°; 26 (4%) patients presented an iRBB. T-wave inversion from V1-V3 was present in 145 (21%) subjects. Twenty-one(3%) patients were referred to second level examination: deep Q-waves in inferior leads in 12(1.6%), ventricular ectopics in 5(0.7%), anterior T-waves inversions V1-V4 in 3(0.4%); extreme right axis deviation in 1(0.3%). Second line investigations did not provide any definitive diagnosis. Total project costs (material equipment and human cost) was 14.460€, 19.51€ per individual. The potential net saving with respect to current pre-participation screening cost was 19%. CONCLUSIONS Layman 12‑lead Smartphone-ECG population screening proved feasible and effective, with a rate of non-interpretable ECG of <5%. Potential cost-saving in ECG screening and recording was 19%, providing an appealing opportunity when large campaigns should be addressed also in developing countries.
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Affiliation(s)
- Niccolò Maurizi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Department of Cardiology, University Hospital of Lausanne, Switzerland.
| | - Carlo Fumagalli
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Ioannis Skalidis
- Department of Cardiology, University Hospital of Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, University Hospital of Lausanne, Switzerland
| | | | - Franco Cecchi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Niccolò Marchionni
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
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6
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Harris CS, Froelicher VF, Hadley D, Wheeler MT. Guide to the Female Student Athlete ECG: A Comprehensive Study of 3466 Young, Racially Diverse Athletes. Am J Med 2022; 135:1478-1487.e4. [PMID: 35981651 DOI: 10.1016/j.amjmed.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES The 12-lead electrocardiogram (ECG) is used in the preparticipation screening examination for athletes. Despite known differences in ECG findings by sex, only QTc prolongation is given a sex-specific threshold. We hypothesize that our large dataset-with diversity in age, race, and sport participation-can be utilized to improve ECG screening in female student athletes. METHODS Computerized 12-lead ECGs were recorded and analyzed in female athletes who underwent preparticipation screening examination between June 2010 and September 2021. The quantitative, empirical 2017 international criteria for electrocardiographic interpretation were compared with either the 99th percentile in our cohort or the percentile that corresponded to the known disease prevalence. RESULTS Of 3466 female athletes with ECGs as part of preparticipation screening examination, the 2017 international criteria classified 2.1% of athletes with at least one ECG abnormality requiring cardiological evaluation. Rates were similar across age, race/ethnicity, and sporting discipline. Using ranges based on our population, 2.7% of athletes would require additional workup. Surprisingly, ST depression up to 0.03 mV was a normal finding in this cohort. If RS voltage extremes were considered findings requiring follow-up, an additional 9.6% of the athlete population would be flagged using current definitions. This number decreases to 2.7% if using the 99th percentile in this cohort. CONCLUSION These results highlight a difference in the reported prevalence of ECG abnormalities when comparing empirically derived thresholds to statistically derived ranges. Consideration of new metrics specific to the female athlete population has the potential to further refine athlete ECG screening.
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Sawlani SP, Barkley LC. Medical Problems in the Athlete: Cardiovascular Conditions. Curr Sports Med Rep 2022; 21:169-170. [PMID: 35703741 DOI: 10.1249/jsr.0000000000000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Sabrina P Sawlani
- Division of Primary Care Sports Medicine, Department of Orthopaedic Surgery, University of California, Los Angeles, CA
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8
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Pathology of sudden death, cardiac arrhythmias, and conduction system. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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9
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Parizher G, Phelan DM, Ayers C, Goodwin R, Levine BD. A Video-Enhanced, Electronic Modality for Preparticipation Examination of Young Athletes. Curr Sports Med Rep 2021; 20:485-488. [PMID: 34524192 DOI: 10.1249/jsr.0000000000000879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT We developed a video-enhanced preparticipation evaluation symptom questionnaire (the V-PPE), intended to help screen athletes for heart disease. We now report results of a pilot quality improvement study evaluating V-PPE's performance. In a prospective before-and-after study, approximately 5700 high-school athletes were prompted to voluntarily fill out the V-PPE questionnaire. We compared symptom frequencies on standard PPE to those on V-PPE. Of 5700 athletes, 46 (0.8%), 117 (2.0%), 33 (0.6%), and 101 (1.8%) reported syncope, angina, palpitations, and dyspnea, respectively on routine screening. Four hundred and ninety-two (8.6%) voluntarily filled out the V-PPE. Athletes were more likely to report palpitations on V-PPE than PPE, but not angina, dyspnea, syncope, or at least one symptom. Symptom frequencies on electronic PPE questionnaires are lower than recent reports suggest. Embedded videos can alter screening yield. More research is necessary to evaluate the predictive value of the V-PPE for clinically relevant cardiac pathology.
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Affiliation(s)
- Gary Parizher
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Dermot M Phelan
- Sports Cardiology Center, Heart, Vascular, and Thoracic Institute, Cleveland, Clinic, Cleveland OH
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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10
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Palermi S, Serio A, Vecchiato M, Sirico F, Gambardella F, Ricci F, Iodice F, Radmilovic J, Russo V, D'Andrea A. Potential role of an athlete-focused echocardiogram in sports eligibility. World J Cardiol 2021; 13:271-297. [PMID: 34589165 PMCID: PMC8436685 DOI: 10.4330/wjc.v13.i8.271] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/27/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023] Open
Abstract
Sudden cardiac death (SCD) of an athlete is a rare but tragic event and sport activity might play a trigger role in athletes with underlying structural or electrical heart diseases. Preparticipation screenings (PPs) have been conceived for the potential to prevent SCD in young athletes by early identification of cardiac diseases. The European Society of Cardiology protocol for PPs includes history collection, physical examination and baseline electrocardiogram, while further examinations are reserved to individuals with abnormalities at first-line evaluation. Nevertheless, transthoracic echocardiography has been hypothesized to have a primary role in the PPs. This review aims to describe how to approach an athlete-focused echocardiogram, highlighting what is crucial to focus on for the different diseases (cardiomyopathies, valvulopathies, congenital heart disease, myocarditis and pericarditis) and when is needed to pay attention to overlap diagnostic zone ("grey zone") with the athlete's heart. Once properly tested, focused echocardiography by sports medicine physicians may become standard practice in larger screening practices, potentially available during first-line evaluation.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | - Alessandro Serio
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | - Marco Vecchiato
- Sport and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Padova 35128, Italy
| | - Felice Sirico
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | | | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti 66100, Italy
| | - Franco Iodice
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy
| | - Juri Radmilovic
- Unit of Cardiology and Intensive Coronary Care, "Umberto I" Hospital, Nocera Inferiore 84014, Italy
| | - Vincenzo Russo
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy
| | - Antonello D'Andrea
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy.
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Kochi AN, Vettor G, Dessanai MA, Pizzamiglio F, Tondo C. Sudden Cardiac Death in Athletes: From the Basics to the Practical Work-Up. ACTA ACUST UNITED AC 2021; 57:medicina57020168. [PMID: 33673000 PMCID: PMC7918885 DOI: 10.3390/medicina57020168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 12/14/2022]
Abstract
Sudden cardiac death in athletes is a relatively rare event, but due to the increasing number of individuals practicing high-performance sports, in absolute terms, it has become an important issue to be addressed. Since etiologies are many and the occurrence is rare, tracing the ideal preparticipation screening program is challenging. So far, as screening tools, a comprehensive clinical evaluation and a simple 12-lead electrocardiogram (ECG) seem to be the most cost-effective strategy. Recent technological advances came to significantly help as second-line investigation tools, especially the cardiac magnetic resonance, which allows for a more detailed ventricular evaluation, cardiac tissue characterization, and eliminates the poor acoustic window problem. This article aims to review all aspects related to sudden cardiac death in athletes, beginning with definitions and epidemiology, passing through etiology and clinical characteristics, then finishing with a discussion about the best ambulatory investigational approach.
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Affiliation(s)
- Adriano Nunes Kochi
- Heart Rhythm Center, Department of Clinical Electrophysiology and Cardiac Pacing at Monzino Cardiology Center, IRCCS, 20138 Milan, Italy; (A.N.K.); (G.V.); (M.A.D.); (F.P.)
- Nossa Senhora da Conceição Hospital, 91350-200 Porto Alegre, Brazil
| | - Giulia Vettor
- Heart Rhythm Center, Department of Clinical Electrophysiology and Cardiac Pacing at Monzino Cardiology Center, IRCCS, 20138 Milan, Italy; (A.N.K.); (G.V.); (M.A.D.); (F.P.)
| | - Maria Antonietta Dessanai
- Heart Rhythm Center, Department of Clinical Electrophysiology and Cardiac Pacing at Monzino Cardiology Center, IRCCS, 20138 Milan, Italy; (A.N.K.); (G.V.); (M.A.D.); (F.P.)
| | - Francesca Pizzamiglio
- Heart Rhythm Center, Department of Clinical Electrophysiology and Cardiac Pacing at Monzino Cardiology Center, IRCCS, 20138 Milan, Italy; (A.N.K.); (G.V.); (M.A.D.); (F.P.)
| | - Claudio Tondo
- Heart Rhythm Center, Department of Clinical Electrophysiology and Cardiac Pacing at Monzino Cardiology Center, IRCCS, 20138 Milan, Italy; (A.N.K.); (G.V.); (M.A.D.); (F.P.)
- Department of Biochemical, Surgical and Dentist Sciences, University of Milan, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-02-58002480
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12
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Lawrenz W. Keine ausreichende Evidenz für das EKG als obligater Bestandteil der sportmedizinischen Vorsorgeuntersuchung bei Kindern und Jugendlichen. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-00955-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Bratincsák A, Kimata C, Limm-Chan BN, Vincent KP, Williams MR, Perry JC. Electrocardiogram Standards for Children and Young Adults Using
Z
-Scores. Circ Arrhythm Electrophysiol 2020; 13:e008253. [DOI: 10.1161/circep.119.008253] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background:
Normative ECG values for children are based on relatively few subjects and are not standardized, resulting in interpersonal variability of interpretation. Recent advances in digital technology allow a more quantitative, reproducible assessment of ECG variables. Our objective was to create the foundation of normative ECG standards in the young utilizing
Z
-scores.
Methods:
One hundred two ECG variables were collected from a retrospective cohort of 27 085 study subjects with no known heart condition, ages 0 to 39 years. The cohort was divided into 16 age groups by sex. Median, interquartile range, and range were calculated for each variable adjusted to body surface area.
Results:
Normative standards were developed for all 102 ECG variables including heart rate; P, R, and T axis; R-T axis deviation; PR interval, QRS duration, QT, and QTc interval; P, Q, R, S, and T amplitudes in 12 leads; as well as QRS and T wave integrals. Incremental
Z
-score values between –2.5 and 2.5 were calculated to establish upper and lower limits of normal. Historical ECG interpretative concepts were reassessed and new concepts observed.
Conclusions:
Electronically acquired ECG values based on the largest pediatric and young adult cohort ever compiled provide the first detailed, standardized, quantitative foundation of traditional and novel ECG variables. Expression of ECG variables by
Z
-scores lends an objective and reproducible evaluation without interpreter bias that can lead to more confident establishment of ECG-disease correlations and improved automated ECG readings in high-volume cardiac screening efforts in the young.
Graphic Abstract:
A
graphic abstract
is available for this article.
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Affiliation(s)
- András Bratincsák
- Kapi’olani Medical Center for Women and Children, Hawaii Pacific Health, Honolulu, HI (A.B.)
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI (A.B., B.N.L.-C.)
| | - Chieko Kimata
- Patient Safety & Quality Services, Hawaii Pacific Health, Honolulu, HI (C.K.)
| | - Blair N. Limm-Chan
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI (A.B., B.N.L.-C.)
| | - Kevin P. Vincent
- Department of Bioengineering, University of California San Diego (K.P.V.)
| | - Matthew R. Williams
- Rady Children’s Hospital San Diego, CA (M.W., J.C.P)
- Department of Pediatrics, University of California San Diego (M.W., J.C.P)
| | - James C. Perry
- Rady Children’s Hospital San Diego, CA (M.W., J.C.P)
- Department of Pediatrics, University of California San Diego (M.W., J.C.P)
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14
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D'Ascenzi F, Anselmi F, Mondillo S, Finocchiaro G, Caselli S, Garza MSDL, Schmied C, Adami PE, Galderisi M, Adler Y, Pantazis A, Niebauer J, Heidbuchel H, Papadakis M, Dendale P. The use of cardiac imaging in the evaluation of athletes in the clinical practice: A survey by the Sports Cardiology and Exercise Section of the European Association of Preventive Cardiology and University of Siena, in collaboration with the European Association of Cardiovascular Imaging, the European Heart Rhythm Association and the ESC Working Group on Myocardial and Pericardial Diseases. Eur J Prev Cardiol 2020; 28:1071-1077. [PMID: 32529943 DOI: 10.1177/2047487320932018] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 05/14/2020] [Indexed: 12/13/2022]
Abstract
AIMS Pre-participation evaluation (PPE) is recommended to prevent sudden cardiac death in athletes. Although imaging is not advocated as a first-line screening tool, there is a growing interest in the use of echocardiography in PPE of athletes. This survey aimed to map the use of imaging in the setting of PPE and explore physician beliefs and potential barriers that may influence individual practices. METHODS An international survey of healthcare professionals was performed across ESC Member Countries. Percentages were reported based on the number of respondents per question. RESULTS In total, 603 individuals from 97 countries participated in the survey. Two-thirds (65%) of respondents use echocardiography always or often as part of PPE of competitive athletes and this practice is not influenced by the professional or amateur status of the athlete. The majority (81%) of respondents who use echocardiography as a first-line screening tool perform the first echocardiogram during adolescence or at the first clinical evaluation, and 72% repeat it at least once in the athletes' career, at 1-5 yearly intervals. In contrast, cardiac magnetic resonance is reserved as a second-line investigation of symptomatic athletes. The majority of the respondents did not report any barriers to echocardiography, while several barriers were identified for cardiac magnetic resonance. CONCLUSIONS Echocardiography is frequently used as a first-line screening tool of athletes. In the absence of scientific evidence, before such practice is recommended, large studies using echocardiography in the PPE setting are necessary.
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Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Francesca Anselmi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | | | - Stefano Caselli
- Cardiovascular Centre Zürich, Hirslanden Klinik im Park, Zürich, Switzerland
| | | | - Christian Schmied
- Department of Cardiology, University Heart Centre Zurich, University of Zurich, Switzerland
| | - Paolo Emilio Adami
- Health and Science Department, International Association of Athletics Federation - IAAF, Monaco, France
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Yehuda Adler
- College of Law and Business, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel.,Mayanei Hayeshua Medical Center, Bnei Brak, Israel
| | | | - Josef Niebauer
- Institute of Sports Medicine, Prevention and Rehabilitation and Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp, and Antwerp University, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Michael Papadakis
- Cardiology Clinical Academic Group, St George's University of London, UK
| | - Paul Dendale
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
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15
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Weiss M, Rao P, Johnson D, Billups T, Taing C, LaNoue M, Koilor C, Miller S, Langstaff R, Shipon D. Physician adherence to 'Seattle' and 'International' ECG criteria in adolescent athletes: An analysis of compliance by specialty, experience, and practice environment. J Electrocardiol 2020; 60:98-101. [PMID: 32339816 DOI: 10.1016/j.jelectrocard.2020.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/06/2020] [Accepted: 04/11/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Screening electrocardiography (ECG) for athletes is both controversial and rapidly evolving. While identifying an abnormal ECG could detect a serious cardiovascular disease, falsely interpreting a benign ECG pattern as abnormal can lead to unnecessary testing, cost, and anxiety. Though recent refinements of athlete screening ECG criteria have significantly improved its accuracy, in clinical practice physician adherence to these criteria may vary. METHODS We analyzed physician adherence to contemporary athlete ECG criteria in a large, national athlete screening registry. 1577 consecutive screening ECGs were independently re- interpreted to assess for physician adherence to Seattle Criteria or International Criteria, respective to the criteria in place when the screening was performed. We further determined the most common ECG interpretations that deviated from these criteria, and analyzed physician characteristics for independent predictors of adherence to published ECG criteria. RESULTS Though overall adherence to contemporary criteria was high, 60.4% of ECGs interpreted as abnormal did not meet athlete ECG criteria for pathology when independently re- read. The most common ECG patterns misinterpreted as abnormal were isolated left ventricular hypertrophy (LVH) and non-pathologic T-wave inversions (TWI). Multivariate regression identified three independent predictors of adherence to athlete ECG criteria: participating in a screening overseen by the organization's medical leadership, electrophysiology specialists and adult cardiologists. CONCLUSION This study highlights the need for quality control measures and continued clinician education in a controversial and rapidly evolving field. Clinician education for athlete screening ECG criteria should emphasize the recent changes in how TWI and LVH voltage criteria should be interpreted in this patient population.
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Affiliation(s)
- Max Weiss
- Thomas Jefferson University Hospital, Philadelphia, PA, United States of America.
| | - Prashant Rao
- Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Drew Johnson
- Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Taiwanna Billups
- Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Chou Taing
- Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Marianna LaNoue
- Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Chris Koilor
- Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Stanton Miller
- Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - Renee Langstaff
- Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
| | - David Shipon
- Thomas Jefferson University Hospital, Philadelphia, PA, United States of America
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16
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17
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[High performance athlete's heart: Results of a cross-sectional survey conducted in Bobo-Dioulasso, Burkina Faso]. Ann Cardiol Angeiol (Paris) 2019; 68:17-21. [PMID: 30685082 DOI: 10.1016/j.ancard.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 06/12/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE OF THE STUDY To describe the clinical, electrocardiographic and echocardiographic features of the athlete's heart. PATIENTS AND METHODS This was a cross-sectional study conducted from August 2015 to February 2016 in the city of Bobo-Dioulasso in Burkina Faso. Athletes of high level of training (at least 8hours of weekly training, for more than six months regardless of the type of sport) have benefited from: a clinical examination, an electrocardiography and a cardiac ultrasound rest to look for electrical, morphological and functional cardiac changes. RESULTS The 192 athletes with an athlete heart included had a median age of 24 years (IQI: 21-27). The median seniority in high performance sport was 6 years (IQI: 4-8) and 10hours weekly training sessions (IQI: 10-10). The consumption of tobacco, alcohol, tea/coffee, medicines and/or energy drinks was reported respectively in 4.2%, 7.3%, 99.0%, 53.4%. A history of exertional discomfort was reported by 4.7 athletes. Electrical modifications were present in 92.1%. Sinus bradycardia was the most common abnormality (75.0% of cases). The prevalence of left atrium dilatation and left ventricular dilation was 72.4 and 22.4%, respectively. That of left ventricular hypertrophy was 9.0%. CONCLUSION In the high-performance athlete, the prevalence of electrical, morphological and functional changes was high. These need to be known by practitioners to differentiate them from cardiac pathology.
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Abstract
BACKGROUND Preparticipation physical examinations (PPEs) are required for children and adolescents before sports participation to identify at-risk athletes. These evaluations can be completed in a traditional office-based setting or in a station-based format. It is unclear if one format is superior to the other in identifying at-risk athletes. METHODS We performed a retrospective chart review of children and adolescents between the ages 10 and 18 years who received their PPE in our office or in a station-based setting in a local high school between the years 2009 and 2015. RESULTS We reviewed 2934 PPEs total, 1136 in the office-based format and 1798 in the station-based setting. A similar proportion of athletes were excluded or required further evaluation before participation in the office compared with the station-based setting (4.84% vs 5.67%). No statistically significant associations were seen between site of PPE or athlete sex and rate of clearance. There was, however, a statistically significant association between PPE site and reason for exclusion (P = 0.0456) with higher rates of exclusion for vision-related issues in the station-based setting and higher rates of exclusion for musculoskeletal or cardiopulmonary reasons in the office-based setting. CONCLUSION When conducted by the same examiners, the office-based and team-based PPE excluded or referred equal number of athletes, although the reason for further evaluation does differ based on setting.
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19
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Tague L, Wiggs J, Li Q, McCarter R, Sherwin E, Weinberg J, Sable C. Comparison of Left Ventricular Hypertrophy by Electrocardiography and Echocardiography in Children Using Analytics Tool. Pediatr Cardiol 2018; 39:1378-1388. [PMID: 29774391 DOI: 10.1007/s00246-018-1907-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/08/2018] [Indexed: 12/16/2022]
Abstract
Left ventricular hypertrophy (LVH) is a common finding on pediatric electrocardiography (ECG) leading to many referrals for echocardiography (echo). This study utilizes a novel analytics tool that combines ECG and echo databases to evaluate ECG as a screening tool for LVH. SQL Server 2012 data warehouse incorporated ECG and echo databases for all patients from a single institution from 2006 to 2016. Customized queries identified patients 0-18 years old with LVH on ECG and an echo performed within 24 h. Using data visualization (Tableau) and analytic (Stata 14) software, ECG and echo findings were compared. Of 437,699 encounters, 4637 met inclusion criteria. ECG had high sensitivity (≥ 90%) but poor specificity (43%), and low positive predictive value (< 20%) for echo abnormalities. ECG performed only 11-22% better than chance (AROC = 0.50). 83% of subjects with LVH on ECG had normal left ventricle (LV) structure and size on echo. African-Americans with LVH were least likely to have an abnormal echo. There was a low correlation between V6R on ECG and echo-derived Z score of left ventricle diastolic diameter (r = 0.14) and LV mass index (r = 0.24). The data analytics client was able to mine a database of ECG and echo reports, comparing LVH by ECG and LV measurements and qualitative findings by echo, identifying an abnormal LV by echo in only 17% of cases with LVH on ECG. This novel tool is useful for rapid data mining for both clinical and research endeavors.
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Affiliation(s)
- Lauren Tague
- Division of Cardiology, Children's National Health System, Washington, DC, USA.
- Department of Cardiology, Children's National Health System, 111 Michigan Avenue NW, Suite WW3-200, Washington, DC, 20010, USA.
| | - Justin Wiggs
- Division of Cardiology, Children's National Health System, Washington, DC, USA
| | - Qianxi Li
- Philips Research North America, Cambridge, MA, USA
| | - Robert McCarter
- Division of Biostatistics and Study Methods, Children's National Health System, Washington, DC, USA
| | - Elizabeth Sherwin
- Division of Cardiology, Children's National Health System, Washington, DC, USA
| | - Jacqueline Weinberg
- Division of Cardiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Craig Sable
- Division of Cardiology, Children's National Health System, Washington, DC, USA
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Vilardell P, Brugada J, Aboal J, Loma-Osorio P, Falces C, Andrea R, Figueras-Coll M, Brugada R. Characterization of electrocardiographic findings in young students. ACTA ACUST UNITED AC 2018; 73:139-144. [PMID: 30287239 DOI: 10.1016/j.rec.2018.06.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/26/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES The resting 12-lead electrocardiogram (ECG) has been used in the evaluation of young asymptomatic individuals to detect pre-existing heart disease, but systematic ECG use is controversial and there are no data on this population in our environment. We aimed to determine the prevalence and spectrum of electrocardiographic findings in a population of secondary school students. METHODS We conducted an observational, cross-sectional study of resting ECG findings in all 13 to 14-year-old secondary school students in a region of the province of Gerona between 2009 and 2017. ECG findings were classified into 3 groups according to the modified criteria of Corrado et al.: normal ECG findings, ECG findings suggestive of adaptive changes, and pathologic findings. Students with pathologic ECG findings were referred to a tertiary hospital, and complementary tests were performed according to a pre-established protocol. RESULTS A total of 1911 ECGs were obtained, with a participation rate of 79% of all high school students. In all, 1321 students (69%) had a normal ECG, 554 (29%) showed ECG findings suggestive of adaptive changes, and 36 (2%) had pathologic ECG findings. Among the group with pathologic findings, 5 (14%) had cardiovascular disease. The prevalence of heart disease in this group of asymptomatic secondary school students was 0.3%. CONCLUSIONS One third of the students had ECG findings that were mostly suggestive of physiological adaptation. One seventh of the students with pathologic ECG findings had pre-existing heart disease, although the overall prevalence of pre-existing heart disease was low.
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Affiliation(s)
- Pau Vilardell
- Servicio de Cardiología, Hospital Universitario Josep Trueta de Girona, Girona, Spain.
| | - Josep Brugada
- Servicio de Cardiología, Instituto del Tórax, Hospital Clínic, Barcelona, Spain
| | - Jaime Aboal
- Servicio de Cardiología, Hospital Universitario Josep Trueta de Girona, Girona, Spain; Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain
| | - Pablo Loma-Osorio
- Servicio de Cardiología, Hospital Universitario Josep Trueta de Girona, Girona, Spain; Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain
| | - Carlos Falces
- Servicio de Cardiología, Instituto del Tórax, Hospital Clínic, Barcelona, Spain
| | - Rut Andrea
- Servicio de Cardiología, Instituto del Tórax, Hospital Clínic, Barcelona, Spain
| | - Marc Figueras-Coll
- Servicio de Pediatría, Hospital Universitario Josep Trueta de Girona, Girona, Spain
| | - Ramon Brugada
- Servicio de Cardiología, Hospital Universitario Josep Trueta de Girona, Girona, Spain; Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Centro de Genética Cardiovascular, Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
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21
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Angelini P, Cheong BY, Lenge De Rosen VV, Lopez A, Uribe C, Masso AH, Ali SW, Davis BR, Muthupillai R, Willerson JT. High-Risk Cardiovascular Conditions in Sports-Related Sudden Death: Prevalence in 5,169 Schoolchildren Screened via Cardiac Magnetic Resonance. Tex Heart Inst J 2018; 45:205-213. [PMID: 30374227 DOI: 10.14503/thij-18-6645] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Improving preparticipation screening of candidates for sports necessitates establishing the prevalence of high-risk cardiovascular conditions (hr-CVC) that predispose young people to sudden cardiac death (SCD). Our accurate, novel protocol chiefly involved the use of cardiac magnetic resonance (CMR) to estimate this prevalence. Middle and high school students from a general United States population were screened by means of questionnaires, resting electrocardiograms, and CMR to determine the prevalence of 3 types of hr-CVC: electrocardiographic abnormalities, cardiomyopathies, and anomalous coronary artery origin from the opposite sinus with intramural coronary course (ACAOS-IM). We examined the range of normal left ventricular size and function in the main study cohort (schoolchildren 11-14 yr old). We defined diagnostic criteria for hr-CVC and compared the cardiac measurements of these younger participants with those of older children whom we examined (age, 15-18 yr). From 5,169 completed diagnostic studies (mean participant age, 13.06 ± 1.78 yr), CMR results revealed 76 previously undiagnosed cases of hr-CVC (1.47% of the total cohort): 11 of dilated cardiomyopathy (14.5%), 3 of nonobstructive hypertrophic cardiomyopathy (3.9%), 23 ACAOS-IM cases (30.3%; 6 left-ACAOS and 17 right-ACAOS), 4 Wolff-Parkinson-White patterns (5.3%), 34 prolonged QT intervals (44.7%), and 1 Brugada pattern (1.3%). Cardiomyopathies were significantly more prevalent in the older children. Of note, we identified 959 cases (18.5%) of left ventricular noncompaction. If our estimate is accurate, only 1.47% of school-age sports participants will need focused secondary evaluations; the rest can probably be reassured about their cardiac health after one 30-minute screening study.
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22
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Maron BJ, Estes NM, Maron MS. Is It Fair to Screen Only Competitive Athletes for Sudden Death Risk, or Is It Time to Level the Playing Field? Am J Cardiol 2018; 121:1008-1010. [PMID: 29472006 DOI: 10.1016/j.amjcard.2017.12.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/19/2017] [Accepted: 12/29/2017] [Indexed: 10/18/2022]
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23
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Mekoulou Ndongo J, Assomo Ndemba PB, Temfemo A, Dzudie Tamdja A, Abanda MH, Bika Lele EC, Tchoudjin E, Guessogo WR, Gassina LG, Mandengue SH. Pre- and post-exercise electrocardiogram pattern modifications in apparently healthy school adolescents in Cameroon. Int J Adolesc Med Health 2017; 31:/j/ijamh.ahead-of-print/ijamh-2017-0071/ijamh-2017-0071.xml. [PMID: 28779570 DOI: 10.1515/ijamh-2017-0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 06/14/2017] [Indexed: 11/15/2022]
Abstract
Background Physical Education and Sport (PES) is compulsory in Cameroonian education system. Cardiac accidents and sudden cardiac deaths (SCD) have been reported during PES examinations. This study aimed to contribute in the prevention of these cardiac accidents by studying pre- and post-exercise electrocardiogram (ECG) pattern modifications in apparently healthy school adolescents. Methods One hundred school adolescents without apparent heart disease [aged 18 ± 2 years; body mass index (BMI): 21.9 ± 2.3] were included. Participants performed two intermittent sprint-endurance tests. The test consisted in walking 2000 m as warm-up, followed by sprint and endurance races. A 12-leads ECG was performed before and in 5 min after the tests. ECG patterns changes were studied with particular attention to abnormalities that could be associated with risk of SCD. Results At rest, ECG patterns variants consisted of bradycardia (30%), sinus arrhythmia (9%), posterior hemi post-block (2%), and early repolarization (3%). which disappeared after exercise in all participants. QTc (ms) and heart rate (HR) increased after exercise (p < 0.001); and RR (ms) decreased post-exercise (p < 0.001). Other changes includes the appearance of the T-waves reversed in precordial leads (V2-V4) (p < 0.001), ventricular (6%), atrial and other supraventricular premature beats (2%) in the post-exercise ECG. Left ventricular hypertrophy (2%), right auricular enlargement (2%), short PR (2%) appeared at the end of the tests. Conclusion This study suggests that an intermittent exercise can induce cardiac abnormalities able to provoke cardiac accidents and SCD in apparently healthy school adolescents.
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Affiliation(s)
- Jerson Mekoulou Ndongo
- Exercise and Sport Physiology and Medicine Unit, Faculty of Science, University of Douala, Douala, Cameroon
| | - Peguy Brice Assomo Ndemba
- Exercise and Sport Physiology and Medicine Unit, Faculty of Science, University of Douala, Douala, Cameroon
| | - Abdou Temfemo
- Exercise and Sport Physiology and Medicine Unit, Faculty of Science, University of Douala, Douala, Cameroon.,Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Anasthase Dzudie Tamdja
- Department of Non-Communicable Diseases, Clinical Research Education, Networking and Consultancy (CRENC), Douala, Cameroon.,Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
| | - Martin Hongieh Abanda
- Department of Non-Communicable Diseases, Clinical Research Education, Networking and Consultancy (CRENC), Douala, Cameroon
| | - Elysée Claude Bika Lele
- Exercise and Sport Physiology and Medicine Unit, Faculty of Science, University of Douala, Douala, Cameroon
| | - Ernest Tchoudjin
- Exercise and Sport Physiology and Medicine Unit, Faculty of Science, University of Douala, Douala, Cameroon
| | - Wiliam Richard Guessogo
- Exercise and Sport Physiology and Medicine Unit, Faculty of Science, University of Douala, Douala, Cameroon.,National Institute for Youth and Sports Yaoundé, Yaounde, Cameroon
| | - Louis-Georges Gassina
- Exercise and Sport Physiology and Medicine Unit, Faculty of Science, University of Douala, Douala, Cameroon
| | - Samuel Honoré Mandengue
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon.,Exercise and Sport Physiology and Medicine Unit, Faculty of Science, University of Douala, P.O. Box 7064, Douala, Cameroon, Phone: (+00237) 698 48 63 00
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Maillot N, Guenancia C, Yameogo NV, Gudjoncik A, Garnier F, Lorgis L, Chagué F, Cottin Y. Impact of the dynamic and static component of the sport practised for electrocardiogram analysis in screening athletes. Scand J Med Sci Sports 2017; 28:575-584. [PMID: 28730749 DOI: 10.1111/sms.12949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2017] [Indexed: 11/30/2022]
Abstract
To interpret the electrocardiogram (ECG) of athletes, the recommendations of the ESC and the Seattle criteria define type 1 peculiarities, those induced by training, and type 2, those not induced by training, to rule out cardiomyopathy. The specificity of the screening was improved by Sheikh who defined "Refined Criteria," which includes a group of intermediate peculiarities. The aim of our study was to investigate the influence of static and dynamic components on the prevalence of different types of abnormalities. The ECGs of 1030 athletes performed during preparticipation screening were interpreted using these three classifications. Our work revealed 62/16%, 69/13%, and 71/7% of type 1 peculiarities and type 2 abnormalities for the ESC, Seattle, and Refined Criteria algorithms, respectively(P<.001). For type 2 abnormalities, three independent factors were found for the ESC and Seattle criteria: age, Afro-Caribbean origin, and the dynamic component with, for the latter, an OR[95% CI] of 2.35[1.28-4.33] (P=.006) and 1.90[1.03-3.51] (P=.041), respectively. In contrast, only the Afro-Caribbean origin was associated with type 2 abnormalities using the Refined Criteria: OR[95% CI] 2.67[1.60-4.46] (P<.0001). The Refined Criteria classified more athletes in the type 1 category and fewer in the type 2 category compared with the ESC and Seattle algorithms. Contrary to previous studies, a high dynamic component was not associated with type 2 abnormalities when the Refined Criteria were used; only the Afro-Caribbean origin remained associated. Further research is necessary to better understand adaptations with regard to duration and thus improve the modern criteria for ECG screening in athletes.
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Affiliation(s)
- N Maillot
- Cardiology Department, University Hospital, Dijon, France
| | - C Guenancia
- Cardiology Department, University Hospital, Dijon, France.,LPPCM, INSERM UMR 866, Univ. Bourgogne Franche-Comté, Dijon, France
| | - N V Yameogo
- Cardiology Department, University Hospital, Dijon, France
| | - A Gudjoncik
- Cardiology Department, University Hospital, Dijon, France.,LPPCM, INSERM UMR 866, Univ. Bourgogne Franche-Comté, Dijon, France
| | - F Garnier
- Cardiology Department, University Hospital, Dijon, France
| | - L Lorgis
- Cardiology Department, University Hospital, Dijon, France.,LPPCM, INSERM UMR 866, Univ. Bourgogne Franche-Comté, Dijon, France
| | - F Chagué
- Cardiology Department, University Hospital, Dijon, France
| | - Y Cottin
- Cardiology Department, University Hospital, Dijon, France.,LPPCM, INSERM UMR 866, Univ. Bourgogne Franche-Comté, Dijon, France
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25
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Variability in interpretation of the electrocardiogram in athletes: Another limitation in pre-competitive screening. Rev Port Cardiol 2017; 36:443-449. [PMID: 28599797 DOI: 10.1016/j.repc.2016.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/17/2016] [Accepted: 07/26/2016] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Assessment of the electrocardiogram (ECG) in athletes remains controversial, with lack of standardization and difficulty in applying specific criteria in its interpretation. The purpose of this study was to assess variability in the interpretation of the ECG in athletes. METHODS Twenty ECGs of competitive athletes were assessed by cardiologists and cardiology residents, 11 of them normal or with isolated physiological changes and nine pathological. Each ECG was classified as normal/physiological or pathological, with or without the use of specific interpretation criteria. RESULTS The study presents responses from 58 physicians, 42 (72.4%) of them cardiologists. Sixteen (27.6%) physicians reported that they regularly assessed athletes and 32 (55.2%) did not use specific ECG interpretation criteria, of which the Seattle criteria were the most commonly used (n=13). Each physician interpreted 15±2 ECGs correctly, corresponding to 74% of the total number of ECGs (variation: 45%-100%). Interpretation of pathological ECGs was correct in 68% (variation: 22%-100%) and of normal/physiological in 79% (variation: 55%-100%). There was no significant difference in interpretation between cardiologists and residents (74±10% vs. 75±10%; p=0.724) or between those who regularly assessed athletes and those who did not (77±12% vs. 73±9%; p=0.286), but there was a trend for a higher rate of correct interpretation using specific criteria (77±10% vs. 72±10%; p=0.092). The reproducibility of the study was excellent (intraclass correlation coefficient=0.972; p<0.001). CONCLUSIONS A quarter of the ECGs were not correctly assessed and variability in interpretation was high. The use of specific criteria can improve the accuracy of interpretation of athletes' ECGs, which is an important part of pre-competitive screening, but one that is underused.
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Variability in interpretation of the electrocardiogram in athletes: Another limitation in pre-competitive screening. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
There are clear health benefits to exercise; even so, patients with cardiac conditions who engage in exercise and athletic competition may on rare occasion experience sudden cardiac death (SCD). This article reviews the epidemiology and common causes of SCD in specific athlete populations. There is ongoing debate about the optimal mechanism for SCD prevention, specifically regarding the inclusion of the ECG and/or cardiac imaging in routine preparticipation sports evaluation. This controversy and contemporary screening recommendations are also reviewed.
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Affiliation(s)
| | | | - Rory B Weiner
- Massachusetts General Hospital, Boston, Massachusetts
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28
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Maron BJ, Haas TS, Ahluwalia A, Murphy CJ, Garberich RF. Demographics and Epidemiology of Sudden Deaths in Young Competitive Athletes: From the United States National Registry. Am J Med 2016; 129:1170-1177. [PMID: 27039955 DOI: 10.1016/j.amjmed.2016.02.031] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 02/08/2016] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Sudden deaths in young competitive athletes are tragic events, with high public visibility. The importance of race and gender with respect to sport and the diagnosis and causes of sudden death in athletes has generated substantial interest. METHODS The US National Registry of Sudden Death in Athletes, 1980-2011, was accessed to define the epidemiology and causes of sudden deaths in competitive athletes. A total of 2406 deaths were identified in young athletes aged 19 ± 6 years engaged in 29 diverse sports. RESULTS Among the 842 athletes with autopsy-confirmed cardiovascular diagnoses, the incidence in males exceeded that in females by 6.5-fold (1:121; 691 vs 1:787,392 athlete-years; P ≤.001). Hypertrophic cardiomyopathy was the single most common cause of sudden death, occurring in 302 of 842 athletes (36%) and accounting for 39% of male sudden deaths, almost 4-fold more common than among females (11%; P ≤.001). More frequent among females were congenital coronary artery anomalies (33% vs 17% of males; P ≤.001), arrhythmogenic right ventricular cardiomyopathy (13% vs 4%; P = .002), and clinically diagnosed long QT syndrome (7% vs 1.5%; P ≤.002). The cardiovascular death rate among African Americans/other minorities exceeded whites by almost 5-fold (1:12,778 vs 1:60; 746 athlete-years; P <.001), and hypertrophic cardiomyopathy was more common among African Americans/other minorities (42%) than in whites (31%; P ≤.001). Male and female basketball players were 3-fold more likely to be African American/other minorities than white. CONCLUSIONS Within this large forensic registry of competitive athletes, cardiovascular sudden deaths due to genetic and/or congenital heart diseases were uncommon in females and more common in African Americans/other minorities than in whites. Hypertrophic cardiomyopathy is an under-appreciated cause of sudden death in male minority athletes.
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Affiliation(s)
- Barry J Maron
- Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minn.
| | - Tammy S Haas
- Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minn
| | - Aneesha Ahluwalia
- Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minn
| | - Caleb J Murphy
- Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minn
| | - Ross F Garberich
- Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minn
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Thompson AJ, Cannon BC, Wackel PL, Horner JM, Ackerman MJ, O'Leary PW, Eidem BW, Johnson JN. Electrocardiographic abnormalities in elite high school athletes: comparison to adolescent hypertrophic cardiomyopathy. Br J Sports Med 2016; 50:105-10. [PMID: 26729893 DOI: 10.1136/bjsports-2015-094880] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND In athletes, ECG changes from physiological cardiac remodelling are common but can overlap with findings from a pathological disorder. We compared ECG findings in a group of elite high school athletes to a cohort of adolescents with hypertrophic cardiomyopathy (HCM). METHODS/RESULTS We prospectively performed 15-lead ECGs and echocardiograms in 147 elite high school athletes. Student-athlete ECGs were compared in blinded fashion to ECGs of 148 adolescents with HCM of similar age and ethnicity. Standard ECG hypertrophy criteria and established expert opinion guidelines (European Society of Cardiology, ESC and Seattle criteria) were analysed. All student-athletes had normal echocardiograms. Overall, 77/147 (52%) of student-athletes met standard ECG criteria for ventricular hypertrophy compared to 126/148 (85%) adolescents with HCM (p<0.0001). There were 112/148 (76%) adolescents with HCM who had pathological Q-waves, T-wave inversion and/or ST-segment depression compared to 1/147 (1%) athletes (p<0.0001). Most patients with HCM (84%, 124/148) had ≥1 abnormal ECG finding(s) according to Seattle criteria, compared to 1% of student-athletes (2/147). Similarly, 130/148 (88%) patients with HCM met group-2 ESC criteria (abnormal), compared to 36/147 (24%) student-athletes (p<0.0001). CONCLUSIONS Over 50% of elite high school athletes with echocardiographically confirmed normal hearts satisfied standard voltage criteria for ventricular hypertrophy. Pathological Q-waves, T-wave inversion or ST-segment depression were most helpful in distinguishing adolescents with HCM from normals. Both ESC and Seattle criteria successfully stratified the student-athlete and HCM cohorts, however each had a false-negative rate >10% for the HCM cohort. The Seattle criteria demonstrated a significantly lower false-positive rate (1%) than the ESC criteria (24%).
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Affiliation(s)
- Alex J Thompson
- Department of Pediatrics, Mayo Clinic, Rochester, Minnesota, USA
| | - Bryan C Cannon
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Philip L Wackel
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Justin M Horner
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Ackerman
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Patrick W O'Leary
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin W Eidem
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan N Johnson
- Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
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Medico-legal perspectives on sudden cardiac death in young athletes. Int J Legal Med 2016; 131:393-409. [PMID: 27654714 DOI: 10.1007/s00414-016-1452-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/08/2016] [Indexed: 01/11/2023]
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Salehi S, Moradi Shahpar F, Norouzi G, Ghazalian F, Poursaid Esfehani M, Abedi Yekta AH. Prevalence of Cardiovascular Disorders Among Iranian Elite Athletes. Asian J Sports Med 2016; 7:e35826. [PMID: 27625762 PMCID: PMC5003308 DOI: 10.5812/asjsm.35826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 02/07/2016] [Accepted: 03/06/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Athletes' health is an important issue and for promoting it, pre-participation examination (PPE) is widely performed by responsible bodies around the world. OBJECTIVES This study was to determine prevalence of cardiovascular disorders among athletes participating in the Asian games and answering the question whether the electrocardiogram (ECG) is a necessary part of pre-participation examination (PPE) for prevention of sudden cardiac death. MATERIALS AND METHODS All athletes participated at Asian games came to sports medicine federation for a PPE including a comprehensive questionnaire, physical examination and ECG. In this retrospective study all profiles of 338 athletes have been studied as well as their electrocardiograms. Multiple logistic regressions as well as Firth's bias reduction were used with R statistical software and SPSS. For predicting the changes in ECG, receiver operating characteristic (ROC) curve has done. RESULTS Among 388 athletes, 80 (20.6%) were female and 308 (79.4%) male with mean age of 23.2 + 8 years. Nine athletes (2.3%) were smokers, 28 of them (7.2%) experienced chest pain and discomfort, 45 of them (13.3%) had palpitations and 28 (7.2%) had history of anemia. Study of their electrocardiograms showed that long Q-T interval was not seen for anyone, but evidence of left ventricular hypertrophy was seen in 12 (3.1%), inverted T wave in 6 (1.5%), and right bundle branch block in 45 (13.3%). CONCLUSIONS PPE provides very important information of athletes' health. This study has shown that there was not any significant relation between current examination and electrocardiogram changes but regarding the ECG changes we recommend it as a routine part of PPE.
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Affiliation(s)
- Shahin Salehi
- Imam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Farhad Moradi Shahpar
- Physical Education Department, University of Isfahan, Isfahan, IR Iran
- Iran Sports Medicine Federation, Tehran, IR Iran
| | | | - Farshad Ghazalian
- Department of Physical Education, Science and Research Branch, Islamic Azad University, Tehran, IR Iran
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Phelps HM, Sachdeva R, Mahle WT, McCracken CE, Kelleman M, McConnell M, Fischbach PS, Cardis BM, Campbell RM, Oster ME. Syncope Best Practices: A Syncope Clinical Practice Guideline to Improve Quality. CONGENIT HEART DIS 2015; 11:230-8. [DOI: 10.1111/chd.12324] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 02/05/2023]
Affiliation(s)
- Heather M. Phelps
- Sibley Heart Center Cardiology, Children's Healthcare of Atlanta; Atlanta Ga
- Department of Pediatrics; Emory University School of Medicine; Atlanta Ga USA
| | - Ritu Sachdeva
- Sibley Heart Center Cardiology, Children's Healthcare of Atlanta; Atlanta Ga
- Department of Pediatrics; Emory University School of Medicine; Atlanta Ga USA
| | - William T. Mahle
- Sibley Heart Center Cardiology, Children's Healthcare of Atlanta; Atlanta Ga
- Department of Pediatrics; Emory University School of Medicine; Atlanta Ga USA
| | | | - Michael Kelleman
- Department of Pediatrics; Emory University School of Medicine; Atlanta Ga USA
| | - Michael McConnell
- Sibley Heart Center Cardiology, Children's Healthcare of Atlanta; Atlanta Ga
- Department of Pediatrics; Emory University School of Medicine; Atlanta Ga USA
| | - Peter S. Fischbach
- Sibley Heart Center Cardiology, Children's Healthcare of Atlanta; Atlanta Ga
- Department of Pediatrics; Emory University School of Medicine; Atlanta Ga USA
| | - Brian M. Cardis
- Sibley Heart Center Cardiology, Children's Healthcare of Atlanta; Atlanta Ga
- Department of Pediatrics; Emory University School of Medicine; Atlanta Ga USA
| | - Robert M. Campbell
- Sibley Heart Center Cardiology, Children's Healthcare of Atlanta; Atlanta Ga
- Department of Pediatrics; Emory University School of Medicine; Atlanta Ga USA
| | - Matthew E. Oster
- Sibley Heart Center Cardiology, Children's Healthcare of Atlanta; Atlanta Ga
- Department of Pediatrics; Emory University School of Medicine; Atlanta Ga USA
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Chatard JC, Mujika I, Goiriena JJ, Carré F. Screening young athletes for prevention of sudden cardiac death: Practical recommendations for sports physicians. Scand J Med Sci Sports 2015; 26:362-74. [PMID: 26432052 DOI: 10.1111/sms.12502] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 12/13/2022]
Abstract
Regular intensive exercise in athletes increases the relative risk of sudden cardiac death (SCD) compared with the relatively sedentary population. Most cases of SCD are due to silent cardiovascular diseases, and pre-participation screening of athletes at risk of SCD is thus of major importance. However, medical guidelines and recommendations differ widely between countries. In Italy, the National Health System recommends pre-participation screening for all competitive athletes including personal and family history, a physical examination, and a resting 12-lead electrocardiogram (ECG). In the United States, the American College of Cardiology and the American Heart Association recommend a pre-participation screening program limited to the use of specific questionnaires and a clinical examination. The value of a 12-lead ECG is debated based on issues surrounding cost-efficiency and feasibility. The aim of this review was to focus on (i) the incidence rate of cardiac diseases in relation to SCD; (ii) the value of conducting a questionnaire and a physical examination; (iii) the value of a 12-lead resting ECG; (iv) the importance of other cardiac evaluations in the prevention of SCD; and (v) the best practice for pre-participation screening.
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Affiliation(s)
- J-C Chatard
- Laboratory of Exercise Physiology, Faculty of Medicine Jacques Lisfranc, University of Lyon-Saint-Etienne, Saint-Etienne, France
| | - I Mujika
- Department of Physiology, Faculty of Medicine and Odontology, University of the Basque Country, Leioa, Basque Country, Spain.,School of Kinesiology and Health Research Center, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - J J Goiriena
- Department of Physiology, Faculty of Medicine and Odontology, University of the Basque Country, Leioa, Basque Country, Spain
| | - F Carré
- Laboratory of Exercise Physiology, Faculty of Medicine, University of Rennes, Rennes, France
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Washington R. Electrocardiograms during Preparticipation Athletic Evaluations: Is the Selective Use a Compromise to Mass Screening? J Pediatr 2015; 167:789-90. [PMID: 26259674 DOI: 10.1016/j.jpeds.2015.07.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 07/23/2015] [Indexed: 11/16/2022]
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Burns KM, Encinosa WE, Pearson GD, Kaltman JR. Electrocardiogram in Preparticipation Athletic Evaluations among Insured Youths. J Pediatr 2015; 167:804-809.e1. [PMID: 26148663 PMCID: PMC4586399 DOI: 10.1016/j.jpeds.2015.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/15/2015] [Accepted: 06/04/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To retrospectively characterize electrocardiogram (ECG) use among preparticipation history and examinations (PPEs). STUDY DESIGN Using the 2005 to 2010 MarketScan insurance database, we identified subjects aged 5-21 years with either a PPE with an ECG or a PPE alone, excluding those with known cardiac diagnoses. We described cardiology referrals and subspecialty testing within 180 days and cardiac diagnoses within 1 year of the PPE, and the costs of testing in each group. RESULTS From 2005-2009, 503 304 PPEs occurred in 419 456 subjects, of which 8621 (2%) included an ECG. ECG use increased from 12-20 per 1000 PPEs from 2005-2009. Females, lower socioeconomic status, and rural settings were associated with fewer ECGs. Thirteen percent of PPEs with ECG and 0.5% of PPEs alone led to a cardiology referral. After PPEs with ECG, cardiac disease was identified in 18% (2% sports-limiting); after PPEs alone, cardiac disease was identified in 0.5% (0.03% sports-limiting). The PPE had a sensitivity of 44% and a specificity of 98.6% of identifying cardiac disease. The total reimbursement cost of PPEs plus testing was $80 396 464 ($160 per PPE). CONCLUSIONS These real-world data demonstrate that community providers selectively use the ECG as part of the PPE with a high rate of identification of cardiac disease. Mass ECG screening would need to be more efficient at identifying disease than this selective approach.
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Affiliation(s)
- Kristin M Burns
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD.
| | - William E Encinosa
- Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Rockville, MD
| | - Gail D Pearson
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Jonathan R Kaltman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
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Improving ECG Services at a Children's Hospital: Implementation of a Digital ECG System. Int J Pediatr 2015; 2015:697149. [PMID: 26451150 PMCID: PMC4584242 DOI: 10.1155/2015/697149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 07/10/2015] [Accepted: 08/23/2015] [Indexed: 12/02/2022] Open
Abstract
Background. The use of digital ECG software and services is becoming common. We hypothesized that the introduction of a completely digital ECG system would increase the volume of ECGs interpreted at our children's hospital. Methods. As part of a hospital wide quality improvement initiative, a digital ECG service (MUSE, GE) was implemented at the Children's Hospital at Montefiore in June 2012. The total volume of ECGs performed in the first 6 months of the digital ECG era was compared to 18 months of the predigital era. Predigital and postdigital data were compared via t-tests. Results. The mean ECGs interpreted per month were 53 ± 16 in the predigital era and 216 ± 37 in the postdigital era (p < 0.001), a fourfold increase in ECG volume after introduction of the digital system. There was no significant change in inpatient or outpatient service volume during that time. The mean billing time decreased from 21 ± 27 days in the postdigital era to 12 ± 5 days in the postdigital era (p < 0.001). Conclusion. Implementation of a digital ECG system increased the volume of ECGs officially interpreted and reported.
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37
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Zimmermann P. Cardiac Screening. Ann Intern Med 2015; 163:151. [PMID: 26192573 DOI: 10.7326/l15-5112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Hoyt WJ, Dean PN, Battle RW. The Historical Perspective of Athletic Sudden Death. Clin Sports Med 2015; 34:571-85. [PMID: 26100429 DOI: 10.1016/j.csm.2015.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Since antiquity, the athlete has been elevated to a heroic status both within small communities and at the international level. Although numerous population studies have estimated athletic sudden death to be a rare event, the consequences resonate far beyond those directly affected. Sports cardiology has evolved as a result of these tragedies, which highlighted a need for safer play and more programmatic protection of the athlete in play. In this article, athletic sudden death is analyzed from a historical and literary perspective and the development of modern initiatives to protect athletes from sudden death is reviewed.
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Affiliation(s)
- Walter J Hoyt
- Department of Pediatric Cardiology, University of Virginia, PO Box 800386, Charlottesville, VA 22908, USA.
| | - Peter N Dean
- Department of Pediatric Cardiology, University of Virginia, PO Box 800386, Charlottesville, VA 22908, USA
| | - Robert W Battle
- Department of Cardiology, University of Virginia, PO Box 800386, Charlottesville, VA 22908, USA
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Pre-participation screening for athletes and the role of advanced practice providers. J Electrocardiol 2015; 48:339-44. [PMID: 25791248 DOI: 10.1016/j.jelectrocard.2015.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Indexed: 11/21/2022]
Abstract
Pre-participation screening of athletes for underlying cardiovascular disease is recommended by the AHA/ACC. However, vigorous debate continues as to whether the ECG should be used as part of a broad-based screening program. The AHA/ACC "do not support national mandatory screening ECGs of athletes, because the logistics, manpower, financial and resource considerations make such a program inapplicable to US". In an effort to address these impediments and to increase access for communities, we explore the use of advanced practice providers (Nurse Practitioners and Physician Assistants) in providing pre-participation screening to athletes with ECG interpretation. In the current healthcare environment with limited primary care resources, advanced practice providers are an important new element in improving access to care. Pre-participation screening with ECG interpretation is currently within an advanced practice provider's scope of practice. Emerging data shows that advanced practice providers perform care that is within acceptable patient care standards, safely, and cost effectively, compared to physician counterparts. To further improve pre-participation screening, a national education and certification program on 12-lead ECG interpretation is needed. Standardized screening tools and mass screening protocols that include screening ECGs for targeted athlete populations who are at high risk for SCD are needed. These recommendations are aimed at addressing some of the barriers raised by the AHA/ACC group to pre-participation screening with ECG.
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Abstract
Preparticipation screening for unsuspected cardiovascular disease is a controversial topic in the medical and lay communities. Much attention has been directed towards young competitive athletes, particularly the proposed strategy of incorporating 12-lead electrocardiograms into the screening process, even on a national or worldwide basis. However, sudden deaths of young athletes owing to genetic or congenital heart diseases have a low incidence in the general population. Furthermore, young people not engaged in competitive sports can harbour the same conditions that cause sudden death in athletes, which has gone largely unrecognized. Notably, sudden deaths from these diseases are numerically far more common in the much larger population of nonathletes. In this Perspectives article, we propose that an ethical dilemma has emerged, raising the important public-health issue of whether young individuals should be arbitrarily excluded from potentially life-saving clinical screening evaluations because they do not engage in competitive sports programmes.
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Vetter VL. Electrocardiographic screening of all infants, children, and teenagers should be performed. Circulation 2015; 130:688-97; discussion 697. [PMID: 25135125 DOI: 10.1161/circulationaha.114.009737] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Victoria L Vetter
- From The Children's Hospital of Philadelphia, and Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA.
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42
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Olin JT, Clary MS, Deardorff EH, Johnston K, Morris MJ, Sokoya M, Staudenmayer H, Christopher KL. Inducible laryngeal obstruction during exercise: moving beyond vocal cords with new insights. PHYSICIAN SPORTSMED 2015; 43:13-21. [PMID: 25644598 DOI: 10.1080/00913847.2015.1007026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Exercise as an important part of life for the health and wellness of children and adults. Inducible laryngeal obstruction (ILO) is a consensus term used to describe a group of disorders previously called vocal cord dysfunction, paradoxical vocal fold motion, and numerous other terms. Exercise-ILO can impair one's ability to exercise, can be confused with asthma, leading to unnecessary prescription of asthma controller and rescue medication, and results in increased healthcare resource utilization including (rarely) emergency care. It is characterized by episodic shortness of breath and noisy breathing that generally occurs at high work rates. The present diagnostic gold standard for all types of ILO is laryngoscopic visualization of inappropriate glottic or supraglottic movement resulting in airway narrowing during a spontaneous event or provocation challenge. A number of different behavioral techniques, including speech therapy, biofeedback, and cognitive-behavioral psychotherapy, may be appropriate to treat individual patients. A consensus nomenclature, which will allow for better characterization of patients, coupled with new diagnostic techniques, may further define the epidemiology and etiology of ILO as well as enable objective evaluation of therapeutic modalities.
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Affiliation(s)
- James Tod Olin
- Department of Pediatrics, National Jewish Health, Pediatric Exercise Tolerance Center , Denver, CO , USA
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Lawless CE, Asplund C, Asif IM, Courson R, Emery MS, Fuisz A, Kovacs RJ, Lawrence SM, Levine BD, Link MS, Martinez MW, Matherne GP, Olshansky B, Roberts WO, Salberg L, Vetter VL, Vogel RA, Whitehead J. Protecting the Heart of the American Athlete. J Am Coll Cardiol 2014; 64:2146-71. [DOI: 10.1016/j.jacc.2014.08.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Maron BJ, Friedman RA, Kligfield P, Levine BD, Viskin S, Chaitman BR, Okin PM, Saul JP, Salberg L, Van Hare GF, Soliman EZ, Chen J, Matherne GP, Bolling SF, Mitten MJ, Caplan A, Balady GJ, Thompson PD. Assessment of the 12-Lead ECG as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12–25 Years of Age). Circulation 2014; 130:1303-34. [DOI: 10.1161/cir.0000000000000025] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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45
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Maron BJ, Friedman RA, Kligfield P, Levine BD, Viskin S, Chaitman BR, Okin PM, Saul JP, Salberg L, Van Hare GF, Soliman EZ, Chen J, Matherne GP, Bolling SF, Mitten MJ, Caplan A, Balady GJ, Thompson PD. Assessment of the 12-lead electrocardiogram as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 years of age): a scientific statement from the American Heart Association and the American College of Cardiology. J Am Coll Cardiol 2014; 64:1479-514. [PMID: 25234655 DOI: 10.1016/j.jacc.2014.05.006] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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46
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Wearable Wireless Cardiovascular Monitoring Using Textile-Based Nanosensor and Nanomaterial Systems. ELECTRONICS 2014. [DOI: 10.3390/electronics3030504] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Fudge J, Harmon KG, Owens DS, Prutkin JM, Salerno JC, Asif IM, Haruta A, Pelto H, Rao AL, Toresdahl BG, Drezner JA. Cardiovascular screening in adolescents and young adults: a prospective study comparing the Pre-participation Physical Evaluation Monograph 4th Edition and ECG. Br J Sports Med 2014; 48:1172-8. [PMID: 24948082 PMCID: PMC4374061 DOI: 10.1136/bjsports-2014-093840] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND This study compares the accuracy of cardiovascular screening in active adolescents and young adults using a standardised history, physical examination and resting 12-lead ECG. METHODS Participants were prospectively screened using a standardised questionnaire based on the Pre-participation Physical Evaluation Monograph 4th Edition (PPE-4), physical examination and ECG interpreted using modern standards. Participants with abnormal findings had focused echocardiography and further evaluation. Primary outcomes included disorders associated with sudden cardiac arrest (SCA). RESULTS From September 2010 to July 2011, 1339 participants underwent screening: age 13-24 (mean 16) years, 49% male, 68% Caucasian, 17% African-American and 1071 (80%) participating in organised sports. Abnormal history responses were reported on 916 (68%) questionnaires. After physician review, 495/916 (54%) participants with positive questionnaires were thought to have non-cardiac symptoms and/or a benign family history and did not warrant additional evaluation. Physical examination was abnormal in 124 (9.3%) participants, and 72 (5.4%) had ECG abnormalities. Echocardiograms were performed in 586 (44%) participants for abnormal history (31%), physical examination (8%) or ECG (5%). Five participants (0.4%) were identified with a disorder associated with SCA, all with ECG-detected Wolff-Parkinson-White. The false-positive rates for history, physical examination and ECG were 31.3%, 9.3% and 5%, respectively. CONCLUSIONS A standardised history and physical examination using the PPE-4 yields a high false-positive rate in a young active population with limited sensitivity to identify those at risk for SCA. ECG screening has a low false-positive rate using modern interpretation standards and improves detection of primary electrical disease at risk of SCA.
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Affiliation(s)
- Jessie Fudge
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Kimberly G Harmon
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - David S Owens
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Jordan M Prutkin
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Jack C Salerno
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Irfan M Asif
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Alison Haruta
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Hank Pelto
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Ashwin L Rao
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Brett G Toresdahl
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Jonathan A Drezner
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
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48
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Strategies for assessing the prevalence of cardiovascular sudden deaths in young competitive athletes. Int J Cardiol 2014; 173:369-72. [DOI: 10.1016/j.ijcard.2014.02.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/14/2014] [Accepted: 02/13/2014] [Indexed: 11/20/2022]
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49
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Sports and Exercise Cardiology in the United States. J Am Coll Cardiol 2014; 63:1461-72. [DOI: 10.1016/j.jacc.2013.12.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 12/17/2013] [Accepted: 12/24/2013] [Indexed: 01/02/2023]
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50
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Pérez-Riera AR, de Lucca AA, Barbosa-Barros R, Yanowitz FG, de Cano SF, Cano MN, Palandri-Chagas AC. Value of electro-vectorcardiogram in hypertrophic cardiomyopathy. Ann Noninvasive Electrocardiol 2014; 18:311-26. [PMID: 23879271 DOI: 10.1111/anec.12067] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The electrocardiogram is an important tool for the initial diagnostic suspicion of hypertrophic cardiomyopathy in any of its forms, both in symptomatic and in asymptomatic patients because it is altered in more than 90 percent of the cases. Electrocardiographic anomalies are more common in patients carriers of manifest hypertrophic cardiomyopathy and the electrocardiogram alterations are earlier and more sensitive than the increase in left ventricular wall thickness detected by the echocardiogram. Nevertheless, despite being the leading cause of sudden death among young competitive athletes there is no consensus over the need to include the method in the pre-participation screening. In apical hypertrophic cardiomyopathy the electrocardiographic hallmarks are the giant negative T waves in anterior precordial leads. In the vectorcardiogram, the QRS loop is located predominantly in the left anterior quadrant and T loop in the opposite right posterior quadrant, which justifies the deeply negative T waves recorded. The method allows estimating the left ventricular mass because it relates to the maximal spatial vector voltage of the left ventricle in the QRS loop. The recording on electrocardiogram or Holter monitoring of nonsustained monomorphic ventricular tachycardia in patients with syncope, recurrent syncope in young patient, hypotension induced by strain, bradyarrhythmia, or concealed conduction are markers of poor prognosis. The presence of rare sustained ventricular tachycardia is observed in mid-septal obstructive HCM with apical aneurysm. The presence of complete right bundle branch block pattern is frequent after the percutaneous treatment and complete left bundle branch block is the rule after myectomy.
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