October 3, 2026European Heart Journal
Improving the interpretation of the athlete's electrocardiogram
Key result
Excluding isolated axis deviation and atrial enlargement from abnormal ECG categories increases specificity for hypertrophic cardiomyopathy from 90% to 94% but reduces sensitivity from 91% to 89.5%.
Why the study?
Do modern ECG interpretation criteria reduce the rate of abnormal ECGs compared to older criteria in collegiate athletes?
Population
874 incoming varsity NCAA Division I athletes at the University of Nevada, Reno
Comparison
12-lead ECG interpretation using modern criteria vs 12-lead ECG interpretation using older criteria
Design
Cohort
Follow-up
5 years
Authors
Discussion
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Member takes
Implication
Applying modern ECG interpretation criteria (Seattle and Sharma Refined) in collegiate athletes significantly reduces the number of abnormal ECGs requiring further investigation to 2.8%, while maintaining the ability to detect serious cardiovascular conditions.
Key Points
- Evaluate recent evidence regarding electrocardiographic changes in athletes to refine interpretation criteria that minimize false-positive results without compromising sensitivity for detecting lethal cardiovascular disease.
- Assessed the prevalence of isolated ECG findings, including voltage criteria for right ventricular hypertrophy, axis deviation, and atrial enlargement, across healthy athletes and patients with cardiomyopathy.
- Compared diagnostic sensitivity and specificity trade-offs across European Society of Cardiology Group 1 (training-related) and Group 2 (training-unrelated) classification frameworks.
- Voltage criteria for right ventricular hypertrophy were present in 12% of athletes and 0% of patients with cardiomyopathy or pulmonary hypertension in isolation.
- Excluding isolated axis deviation and atrial enlargement increased specificity for hypertrophic cardiomyopathy from 90% to 94% but reduced sensitivity from 91% to 89.5%.
- Evaluating non-voltage ECG criteria alone after classifying isolated increased QRS voltages as normal increased specificity for hypertrophic cardiomyopathy from 52% to 92%, with sensitivity shifting from 96% to 93%.
Structured PICO
Do modern ECG interpretation criteria reduce the rate of abnormal ECGs compared to older criteria in collegiate athletes?
P
Population
Editorial discussing recent studies on the prevalence and interpretation of ECG abnormalities in athletes compared to patients with cardiomyopathy.
E
Exposure
12-lead ECG interpretation using modern criteria (2011 Stanford, 2013 Seattle, and 2014 Sharma Refined criteria)
C
Comparator
12-lead ECG interpretation using older criteria (2005 European criteria)
O
Outcome
Rate of abnormal ECGssurrogate
Applying modern ECG interpretation criteria (Seattle and Sharma Refined) in collegiate athletes significantly reduces the number of abnormal ECGs requiring further investigation to 2.8%, while maintaining the ability to detect serious cardiovascular conditions.
Limitations
- Limited power for statistical analysis due to the number of athletes at a single university, especially regarding differences by ethnicity
- Underestimated true abnormal rate for European criteria because phase 1 ECGs were not retrospectively reassessed using the 2005 European criteria
- Reported abnormal ECG rate instead of false-positive rate because 17 athletes initially misclassified as normal did not receive a confirmatory echocardiogram
Cite This Study
Corrado et al. (2013) conducted an editorial in Athlete's heart and cardiomyopathy. Revised ECG interpretation criteria vs. Standard ECG criteria was evaluated. Excluding isolated axis deviation and atrial enlargement from abnormal ECG categories increases specificity for hypertrophic cardiomyopathy from 90% to 94% but reduces sensitivity from 91% to 89.5%.