ECG efficient in screening for heart abnormalities in high school athletes

SAN FRANCISCO — ECG screening that uses modern interpretation criteria was better at detecting disorders associated with sudden cardiac death and produced fewer false positives than abnormal history or physical examination findings, according to new study results.

“An integrated screening protocol using history, physical examination and ECG should be recommended for pre-participation screening in young athletes,” Jordan M. Prutkin, MD, FHRS, and colleagues wrote in an abstract presented at the Heart Rhythm Society Annual Scientific Sessions.

Prutkin, from the University of Washington School of Medicine, and colleagues conducted a prospective study of 4,812 athletes (aged 13 to 19 years; 54% boys; 65% white) at 23 schools in the Seattle area from October 2010 to June 2013.

Jordan M. Prutkin

The athletes underwent a screening protocol that included a heart-heath questionnaire and physical examination based on American Heart Association recommendations, as well as a resting 12-lead ECG interpreted using athlete-specific criteria, and a limited echocardiogram if indicated.

The researchers found significant abnormalities in 23 athletes (0.5%), including nine with Wolff-Parkinson-White pattern, four with coronary artery anomalies, three with dilated aortic root/aneurysm, three with long QT syndrome, two with hypertrophic cardiomyopathy, one with ventricular arrhythmia and one with short QT syndrome.

Abnormal history or physical examination findings led to the diagnosis in 61% of disorders, and an abnormal ECG led to the diagnosis in 70% of the disorders. In 30% of cases, detection of a disorder occurred by ECG but not by the AHA protocol, the researchers found.

In addition, ECG had a false-positive rate of 3.6% vs. 22.3% for abnormal history and 14.9% for physical examination; and ECG had a positive predictive value of 8.6% vs. 1% for both abnormal history and physical examination.

“The debate has been about whether there are sufficient data to recommend an ECG to screen athletes, but there are little data that look at the utility of a history of physical,” Prutkin told Cardiology Today. “Our data suggest that an ECG interpreted using athlete-specific criteria can pick up many disorders that might lead to sudden cardiac arrest but may not be found by a history and physical, with only a smaller number of false positives.” – by Erik Swain

For more information:

Prutkin JM. Abstract PO01-194. Presented at: Heart Rhythm Society Annual Scientific Sessions; May 7-10, 2014; San Francisco.

Disclosure: Prutkin reports no relevant financial disclosures.