Table 2:
Characteristics of studies evaluating the use of ECG in Athletes preparticipation evaluation
| Reference | Study Design | Study Setting/Measures | Conclusion |
|---|---|---|---|
| Maron et al [29] | Cross sectional | 501 Athletes from University of Maryland Hx, PE, and ECG compared to echo for evidence of CVD |
Specificity 27%, false positive 15% Poor sensitivity, no cases of lethal CVD found. ECG did not increase sensitivity of Hx/PE |
| Corrado et al [30] | (1) Cohort (2) Cross sectional |
Trend of SCD in athletes and nonathletic population (12–35yrs) in the Veneto region of Italy (period 1979–2004) Cardiovascular causes of sports disqualification in 42,386 athletes (period 1982–2004) |
Decreased annual SCD by 89% 8.9% required further test (following ECG) 2% were disqualified |
| Fuller et al [31] | Cohort | 5615 high school student athletes. Compared ECG to Hx, PE (by cardiologists and blinded) echo and stress test done as indicated |
Specificity 97.8% for Hx/PE, 97.4% for ECG; ECG sensitivity 70%, false +ve rate 2.6% ECG has similar specificity to Hx/PE yet more effective as screening tool for CVD |
| Pelliccia et al [32] | Cross sectional | 1005 elite Italian athletes from 38 sports. ECG patterns compared with echo (both interpreted blindly) |
Sensitivity 51%, specificity 61%, PPV 7%, NPV 96% (for ECG detection) False positives caused by athletes heart limits ECG usefulness in PPE |
| Basso et al [33] | Retrospective case review | 2 large registries of SCD in young athletes in USA and Italy. ECG, stress test, echo for detecting AOCA |
27 cases of AOCA, age 9–32y, all had normal ECG, echo, stress test. Standard PPE limited in ability to detect |
| AOCA | |||
| Baggish et al [34] | Cross sectional | 510 collegiate athletes H/o, PE, with and without ECG |
ECG improved sensitivity from 45.5% to 90,9%; NPV from 98.7% to 99.8%; False+ve 16.9% |
| Hevia et al [35] | Cross sectional | 1220 Spanish athletes from different sports disciplines H/o, PE, ECG and further tests |
3.7% required additional tests 2 diagnosed (1 echo, 1 MRI) |
| Magalski et al [36] | Cohort | 964 competitive collegiate athletes H/o, PE, ECG and Echo |
ECG improved sensitivity from 44.4% to 88.9%; NPV from 99.3% to 99.9% |
| Bessem et al [37] | Cross sectional | 825 athletes cardiac screening using the Lausanne recommendation (H/o, PE, ECG) University centre of sports medicine in Groningen, Netherland |
6.3% had additional test based on ECG ECG had 11% false positive rate Number needed to screen was 1:143 |
| Sofi et al [38] | Cross sectional | 30,065 participants in competitive sports at Institute of sports medicine in Florence, Italy H/o, PE, resting and stress ECG |
Abnormal finding: Resting ECG 6% Stress ECG 4.9% 0.6% ineligible for competitive sports |
| Tanaka et al [39] | Prospective, cross sectional | 37,804 students with 6 years follow up part of national cardiac screening program in Kagoshima, Japan (included athletes and non-athletes) H/x, PE, ECG, and echo ifneeded |
3 SCD, one screened and diagnosed with HCM, 2 normal ECG findings Estimate cost of $8,800 per year of life saved |
| Marek et al [40] | Retrospective, cohort Study | High school ECG screening program (YH4L) in Chicago, USA, 32,561 High school student H/o, PE, ECG |
2.5% had ECG abnormality requiring further test |
| Steinvil et al [41] | Retrospective, cohort study | Systematic search of 2 newspapers in Israel to determine number of SCD in competitive athletes. Israeli national mandatory PPE includes resting and stress ECG |
2.6 events per 100,000 person-years ECG had no apparent influence on incidence of sudden death in athletes |
| Wilson et al [42] | Cross sectional | 1074 nationaland international junior athletes and 1646 physical active schoolchildren H/o, PE and ECG (expert sports cardiologist) |
4 WPW 3 Long QT 1 ARVC 1 Right ventricular outflow tract ventricular tachycardia Further tests in 4% |
| Pelliccia et al [43] | Cross sectional | 4450 athletes of Italian national teams, eligible initially on ECG screening underwent echocardiography |
No HCM Myocarditis(n=4) Mitral Valve Prolapse(n=3) Aortic regurgitation(n=2) ARVC(n=1) |
| Le et al [44] | Cross sectional | 653 athletes from 24 sports at Stanford sports medicine program H/o, PE and ECG |
10 % had abnormal ECG for further test |
H/o: History, PE: Physical examination, ECG: electrocardiography, ARVC: arrythmogenic right ventricular cardiomyopathy, HCM: Hypertrophic cardiomyopathy, AOCA: Anomalous Origin of Coronary Artery, WPW: Wolf Parkinson White syndrome, SCD: Sudden cardiac death, CVD: cardiovascular disease, NPV: negative predictive value, PPV: Positive predictive value