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Albiński M, Saubade M, Menafoglio A, Meyer P, Capelli B, Perrin T, Trachsel L, Hagemeyer D, Casagrande D, Wilhelm M, Benaim C, Pirrello T, Albrecht S, Schmied C, Mivelaz Y, Tercier S, Baggish A, Gabus V. Diagnostic yield and cost analysis of electrocardiographic screening in Swiss paediatric athletes. J Sci Med Sport 2021; 25:281-286. [PMID: 34895837 DOI: 10.1016/j.jsams.2021.11.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Athletes performing sports on high level are at increased risk for sudden cardiac death. This includes paediatric athletes, even though data on screening strategies in this age group remain scarce. This study aimed to assess electrocardiogram interpretation criteria in paediatric athletes and to evaluate the cost of screening. METHODS National, multicentre, retrospective, observational study on 891 athletes of paediatric age (<18 years) evaluated by history, physical examination and 12-lead electrocardiogram. The primary outcome measure was abnormal electrocardiogram findings according to the International Recommendations for Electrographic Interpretation in Athletes. The secondary outcome measure was cost of screening. RESULTS 19 athletes (2.1%) presented abnormal electrocardiogram findings requiring further investigations, mainly abnormal T-wave inversion. These 19 athletes were predominantly males, performing endurance sports with a mean volume of 10 weekly hours for a mean duration of 6 years of training. Further investigations did not identify any relevant pathology. All athletes were cleared for competition with regular follow-up. Total costs of the screening were 108,860 USD (122 USD per athlete). CONCLUSIONS Our study using the International Recommendations for Electrographic Interpretation in Athletes identified a low count of abnormal findings in paediatric athletes, yet raising substantially the cost of screening. Hence, the utility of electrocardiogram-inclusive screening of paediatric athletes remains to be elucidated by longitudinal data.
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Affiliation(s)
- M Albiński
- Division of Paediatrics, Lausanne University Hospital, Switzerland.
| | - M Saubade
- Centre of Sports Medicine, Division of Physical and Rehabilitation Medicine, Lausanne University Hospital, Switzerland; Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland; SportAdo Centre, Department of Woman-Mother-Child, Lausanne University Hospital, Switzerland
| | - A Menafoglio
- Department of Cardiology, San Giovanni Hospital Bellinzona, Switzerland
| | - P Meyer
- Service of Cardiology, University Hospital Geneva, Switzerland
| | - B Capelli
- Department of Cardiology, Cardiocentro Ticino, Switzerland
| | - T Perrin
- Department of Cardiology, Inselspital, University Hospital Bern, Bern University, Switzerland
| | - L Trachsel
- Department of Cardiology, Inselspital, University Hospital Bern, Bern University, Switzerland
| | - D Hagemeyer
- Department of Cardiology, Inselspital, University Hospital Bern, Bern University, Switzerland
| | - D Casagrande
- Department of Cardiology, Inselspital, University Hospital Bern, Bern University, Switzerland
| | - M Wilhelm
- Department of Cardiology, Inselspital, University Hospital Bern, Bern University, Switzerland
| | - C Benaim
- Centre of Sports Medicine, Division of Physical and Rehabilitation Medicine, Lausanne University Hospital, Switzerland
| | - T Pirrello
- Swiss Federal Institute of Sports, Switzerland
| | - S Albrecht
- Swiss Federal Institute of Sports, Switzerland
| | - C Schmied
- Department of Cardiology, University Heart Centre Zurich, University of Zurich, Switzerland
| | - Y Mivelaz
- Paediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital, Switzerland
| | - S Tercier
- SportAdo Centre, Department of Woman-Mother-Child, Lausanne University Hospital, Switzerland
| | - A Baggish
- Division of Cardiology, Massachusetts General Hospital, United States of America
| | - V Gabus
- Department of Cardiology, Lausanne University Hospital, Switzerland
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Halasz G, Cattaneo M, Romano S, Biasini V, Villa M, Cassina T, Capelli B. Master athletes'ECG and the diagnostic accuracy of contemporary ECG interpretation criteria. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Over the last years, several efforts have been made to refine the ECG criteria for interpretation of young (16–35 years) competitive athlete's ECG in order to improve specificity maintaining good sensitivity. However, few data exist about the efficacy of such interpretation criteria in master athletes (over 35 years). We aimed to assess the diagnostic performance of screening based on 2017 International ECG recommendation (2017-International), 2010 European Society of Cardiology recommendation (2010-ESC) and Seattle criteria in a cohort of master athletes competing at regional and national level.
Methods
506 Caucasian master athletes (mean ages 47.9±8.7, 85,6% male, 65% endurance athletes) underwent standardized medical history, physical examination, resting and exercise ECG during their pre-participation screening. ECGs were retrospectively interpreted based on 2010-ESC, Seattle-criteria and 2017-International. For the purpose of the study we included also a transthoracic echocardiography as reference, to calculate the sensibility and specificity, area under the ROC curve (AUC) was estimated as measure of discriminative ability of each ECG criteria. Athletes with abnormalities underwent further examinations according to the European Guidelines.
Results
Twelve athletes (2,3%) were diagnosed with a condition potentially related to SCD (1 hypertrophic cardiomyopathy, 1 Type1 Brugada Syndrome, 4 Chronic Coronary Syndromes, 2 Dilated Cardiomyopathy, 3 Aortic Dilation, 1 Moderate aortic stenosis) during the pre-participation screening. International criteria failed to identify two athletes with DCM and left axis deviation on ECG while no athletes with complete right bundle branch block showed serious structural abnormalities. The most common ECG abnormalities were left axis deviation (7,1%), left atrial enlargement (4,2%) and T wave inversion (3%). 29 athletes (5,7%) exhibited a long QT interval according to 2010-ESC and 1 athlete according to International and Seattle criteria. The false positive ECG rate was 15% for 2017-International based screening, 21,9% for Seattle based screening and 30,40% for 2010-ESC based screening while the diagnostic accuracy for pathologies at risk of SCD was 0,73 (95% CI 0,69–0,77) for 2017 International based screening; 0,81 (95% CI 0,77–0,84) for Seattle Criteria based screening and 0,77 (95% CI 0,73–0,80) for 2010-ESC based screening.
Conclusion
In master athletes the 2017-International ECG criteria showed inferior accuracy compared to the Seattle criteria and 2010-ESC, the least showing a higher false positive rate mostly due to lower cut-off for long QT. Furthermore complete right bundle branch block may be considered a normal finding also in master asymptomatic athletes.
Accuracy of ECG criteria
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- G Halasz
- Cardiocentro Ticino, Lugano, Switzerland
| | - M Cattaneo
- Cardiocentro Ticino, Lugano, Switzerland
| | - S Romano
- University of L'Aquila, L'Aquila, Italy
| | - V Biasini
- University of L'Aquila, L'Aquila, Italy
| | - M Villa
- Cardiocentro Ticino, Lugano, Switzerland
| | - T Cassina
- Cardiocentro Ticino, Lugano, Switzerland
| | - B Capelli
- Cardiocentro Ticino, Lugano, Switzerland
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Perren A, Cerutti B, Lepori M, Senn V, Capelli B, Duchini F, Domenighetti G. Influence of Steroids on Procalcitonin and C-reactive Protein in Patients with COPD and Community-acquired Pneumonia. Infection 2008; 36:163-6. [DOI: 10.1007/s15010-007-7206-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Accepted: 09/19/2007] [Indexed: 01/09/2023]
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