Key result
Pathological Q-waves, T-wave inversion, or ST-segment depression were present in 1% of elite high school athletes compared to 76% of adolescents with hypertrophic cardiomyopathy (p<0.0001).
Why the study?
Do the Seattle and ESC ECG criteria accurately distinguish physiological cardiac remodeling in elite high school athletes from pathological changes in adolescents with hypertrophic cardiomyopathy?
Observational (n=295)
Blinded
Do the Seattle and ESC ECG criteria accurately distinguish physiological cardiac remodeling in elite high school athletes from pathological changes in adolescents with hypertrophic cardiomyopathy?
The Seattle criteria are superior to the ESC criteria for evaluating adolescent athletes, as they significantly reduce false-positive ECG findings while maintaining similar sensitivity for detecting hypertrophic cardiomyopathy.
Answers are grounded in this paper and cite their sources.
Supports ECG criteria distinguishing athlete remodeling from HCM in adolescents; leaves open prospective validation before practice change.
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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Thompson et al. (2016) conducted an observational in Hypertrophic cardiomyopathy (n=295). Elite high school athlete status vs. Adolescents with hypertrophic cardiomyopathy was evaluated on Pathological Q-waves, T-wave inversion and/or ST-segment depression (p=<0.0001). Pathological Q-waves, T-wave inversion, or ST-segment depression were present in 1% of elite high school athletes compared to 76% of adolescents with hypertrophic cardiomyopathy (p<0.0001).
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