Optimising screening of intermediate to high-risk asymptomatic sportsmen with exercise electrocardiogram

Aims The importance of exercise electrocardiogram (ECG) is still controversial in the prevention of cardiovascular events among sportsmen. The aim of this study was to assess the relevance of exercise ECG as a screening tool for cardiovascular events when any cardiovascular disease (CVD) risk factors are present. Methods The study included leisure time asymptomatic sportsmen evaluated from 2011 to 2016 in a university hospital. Major adverse cardiovascular events (MACE) and atrial fibrillation were collected at 3 years. Results Of the cohort of 2457 sportsmen (mean age 50.2 ± 9.4 years), 50 (2%) had a high risk SCORE2. A total of 256 exercise ECGs (10%) were defined as positive, most of them due to silent myocardial ischemia (SMI) (n = 196; 8%). These 196 SMI cases led to 33 coronary angiograms (1%), which revealed 23 significant coronary stenoses requiring revascularization. In multivariate logistic regression analysis, having at least 2 CVD risk factors was independently associated with (1) positive exercise ECG [OR=1.80 (CI 95%: 1.29-2.52), p=0.0006], with (2) suspected SMI [OR=2.57 (CI 95%: 1.10-6.02), p=0.0304], with (3) confirmed SMI [OR=8.20 (CI 95%: 3.46-19.46), p<0.0001] and with (4) cardiovascular events (MACE or atrial fibrillation) [OR=6.95 (CI 95%: 3.49-13.81), p<0.0001] at 3 years. Conclusions The study supports the European recommendations for the use of exercise ECG in evaluation of asymptomatic leisure time sportsmen. Having at least 2 CVD risk factors was the best predictors for presence of coronary artery stenosis that may increase the risk for adverse events.