Key result
The new ESC criteria for ECG interpretation in athletes reduced positive screenings to 12% compared to 21% with the old criteria, but missed two out of four new cardiovascular diagnoses.
Why the study?
Do the new ESC criteria for ECG interpretation reduce false positives without increasing false negatives compared to old criteria in athletes undergoing pre-participation screening?
Cohort (n=561)
Do the new ESC criteria for ECG interpretation reduce false positives without increasing false negatives compared to old criteria in athletes undergoing pre-participation screening?
Absolute Event Rate: 12% vs 21%
While the new ESC criteria for ECG interpretation in athletes reduce false-positive screenings, they may increase false-negatives by missing relevant cardiovascular diagnoses.
Questionnaire and new ESC ECG criteria cut false positives but risk missed diagnoses; leaves open optimal PPS balance pending prospective validation.
BACKGROUND: In recent years various proposals and subsequent changes have been made to improve pre-participation screening (PPS) methods. This study examines the Lausanne questionnaire and the old and new ESC criteria for a positive electrocardiogram (ECG) in athletes. DESIGN: Retrospective cohort study. METHODS: All consecutive students undergoing a PPS between January and July 2011 were included. The screening consisted of the Lausanne questionnaire, a physical examination, and a 12-lead ECG. RESULTS: A total of 561 students were screened. A total of 310 students (55%) answered positively to one or more of the Lausanne questions and 49 (9%) of these abnormalities were assessed as medically relevant. Physical examination was abnormal in nine (1.6%) students. In total, 120 (21%) ECGs were found positive following the old criteria. According to the new criteria, 68 (12%) ECGs were found positive. Four (already known) congenital cardiac disorders and four new diagnoses were found. When using the new ECG criteria, two out of four new cardiovascular diagnoses would have been missed. CONCLUSIONS: The use of the Lausanne questionnaire provides many irrelevant findings causing unnecessary positive screening outcomes. With the new ESC criteria for a positive 12-lead ECG in athletes, the number of false-positive screenings greatly decrease: however, at the cost of an increase in the number of false-negatives. To reach a conclusive judgment on the cost:benefit ratio of PPS, it is necessary to have a validated discriminating questionnaire, specific medical knowledge of PPS and clear definitions of a normal and abnormal 12-lead ECG in athletes.
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Snoek et al. (2013) conducted a cohort in Pre-participation screening in athletes (n=561). New ESC criteria for ECG interpretation vs. Old ESC criteria was evaluated on Positive ECG screening. The new ESC criteria for ECG interpretation in athletes reduced positive screenings to 12% compared to 21% with the old criteria, but missed two out of four new cardiovascular diagnoses.
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