Letter to the Editor
New ‘refined’ criteria for the electrocardiographic assessment of athletes
Novos «critérios refinados» eletrocardiográficos na avaliação de atletas
Ricardo C. Rodrigues
, Gomes Serrão, Susana Gomes, Décio Pereira
Corresponding author
Serviço de Cardiologia, Hospital Dr. Nélio Mendonça, Funchal, Portugal
Read
8146
Timeswas read the article
2134
Total PDF
6012
Total HTML
Share statistics
array:26 [ "pii" => "S2174204916301969" "issn" => "21742049" "doi" => "10.1016/j.repce.2016.05.008" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "865" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2016" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Rev Port Cardiol. 2016;35:711-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3425 "formatos" => array:3 [ "EPUB" => 156 "HTML" => 2652 "PDF" => 617 ] ] "Traduccion" => array:1 [ "pt" => array:20 [ "pii" => "S0870255116301743" "issn" => "08702551" "doi" => "10.1016/j.repc.2016.05.007" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "865" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Rev Port Cardiol. 2016;35:711-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4509 "formatos" => array:3 [ "EPUB" => 213 "HTML" => 3479 "PDF" => 817 ] ] "pt" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta ao Editor</span>" "titulo" => "Novos «critérios refinados» eletrocardiográficos na avaliação de atletas" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "711" "paginaFinal" => "713" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "New ‘refined’ criteria for the electrocardiographic assessment of athletes" ] ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2463 "Ancho" => 1493 "Tamanyo" => 448452 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Derivação V3 aumentada em diferentes condições clínicas. Cima: notar a elevação do ponto J antecedendo a inversão da onda T (ambos os painéis de atletas saudáveis). Meio: notar a elevação do segmento ST (sem elevação do ponto J) antecedendo a inversão da onda T (ambos os painéis de doentes com miocardiopatia hipertrófica). Em baixo: notar a ausência de elevação do ponto J antecedendo a inversão da onda T (ambos os painéis de doentes com displasia arritmogénica do ventrículo direito). Setas indicam «ponto J». Adaptado de Calore et al.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a>.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ricardo C. Rodrigues, Gomes Serrão, Susana Gomes, Décio Pereira" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Ricardo C." "apellidos" => "Rodrigues" ] 1 => array:2 [ "nombre" => "Gomes" "apellidos" => "Serrão" ] 2 => array:2 [ "nombre" => "Susana" "apellidos" => "Gomes" ] 3 => array:2 [ "nombre" => "Décio" "apellidos" => "Pereira" ] ] ] ] ] "idiomaDefecto" => "pt" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204916301969" "doi" => "10.1016/j.repce.2016.05.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916301969?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116301743?idApp=UINPBA00004E" "url" => "/08702551/0000003500000012/v2_201701270020/S0870255116301743/v2_201701270020/pt/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S2174204916301970" "issn" => "21742049" "doi" => "10.1016/j.repce.2016.02.005" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "866" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Rev Port Cardiol. 2016;35:715-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2618 "formatos" => array:3 [ "EPUB" => 162 "HTML" => 2009 "PDF" => 447 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "How should we interpret the athlete's electrocardiogram?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "715" "paginaFinal" => "716" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Como interpretar o eletrocardiograma do atleta?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Hélder Dores, Nuno Cardim" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Hélder" "apellidos" => "Dores" ] 1 => array:2 [ "nombre" => "Nuno" "apellidos" => "Cardim" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S0870255116301755" "doi" => "10.1016/j.repc.2016.02.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116301755?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916301970?idApp=UINPBA00004E" "url" => "/21742049/0000003500000012/v2_201702040044/S2174204916301970/v2_201702040044/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2174204916302409" "issn" => "21742049" "doi" => "10.1016/j.repce.2016.11.009" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "905" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Rev Port Cardiol. 2016;35:709-10" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1745 "formatos" => array:3 [ "EPUB" => 147 "HTML" => 1260 "PDF" => 338 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>" "titulo" => "Amorphous tumor of the mitral valve" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "709" "paginaFinal" => "710" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Tumor amorfo da válvula mitral" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 748 "Ancho" => 701 "Tamanyo" => 126247 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Histology showing dystrophic calcifications and fibrosis, with no other changes and no evidence of inflammation or tumor.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Henrique Guedes, Nuno Moreno, Rui Cunha Sousa, Mário Jorge Amorim, Aurora Andrade, Paula Pinto" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Henrique" "apellidos" => "Guedes" ] 1 => array:2 [ "nombre" => "Nuno" "apellidos" => "Moreno" ] 2 => array:2 [ "nombre" => "Rui" "apellidos" => "Cunha Sousa" ] 3 => array:2 [ "nombre" => "Mário Jorge" "apellidos" => "Amorim" ] 4 => array:2 [ "nombre" => "Aurora" "apellidos" => "Andrade" ] 5 => array:2 [ "nombre" => "Paula" "apellidos" => "Pinto" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255116302724" "doi" => "10.1016/j.repc.2016.01.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116302724?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916302409?idApp=UINPBA00004E" "url" => "/21742049/0000003500000012/v2_201702040044/S2174204916302409/v2_201702040044/en/main.assets" ] "asociados" => array:1 [ 0 => array:20 [ "pii" => "S2174204916301970" "issn" => "21742049" "doi" => "10.1016/j.repce.2016.02.005" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "866" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Rev Port Cardiol. 2016;35:715-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2618 "formatos" => array:3 [ "EPUB" => 162 "HTML" => 2009 "PDF" => 447 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "How should we interpret the athlete's electrocardiogram?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "715" "paginaFinal" => "716" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Como interpretar o eletrocardiograma do atleta?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Hélder Dores, Nuno Cardim" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Hélder" "apellidos" => "Dores" ] 1 => array:2 [ "nombre" => "Nuno" "apellidos" => "Cardim" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S0870255116301755" "doi" => "10.1016/j.repc.2016.02.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116301755?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916301970?idApp=UINPBA00004E" "url" => "/21742049/0000003500000012/v2_201702040044/S2174204916301970/v2_201702040044/en/main.assets" ] ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "New ‘refined’ criteria for the electrocardiographic assessment of athletes" "tieneTextoCompleto" => true "saludo" => "To the Editor" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "711" "paginaFinal" => "713" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ricardo C. Rodrigues, Gomes Serrão, Susana Gomes, Décio Pereira" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Ricardo C." "apellidos" => "Rodrigues" "email" => array:1 [ 0 => "ricardomcr@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Gomes" "apellidos" => "Serrão" ] 2 => array:2 [ "nombre" => "Susana" "apellidos" => "Gomes" ] 3 => array:2 [ "nombre" => "Décio" "apellidos" => "Pereira" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Serviço de Cardiologia, Hospital Dr. Nélio Mendonça, Funchal, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Novos «critérios refinados» eletrocardiográficos na avaliação de atletas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1479 "Ancho" => 897 "Tamanyo" => 179883 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Close-up of lead V3 in different clinical conditions. Top: J-point elevation preceding T-wave inversion (both panels from healthy athletes); middle: ST-segment elevation (without J-point elevation) preceding T-wave inversion (both panels from patients with hypertrophic cardiomyopathy); bottom: ST-segment elevation (without J-point elevation) preceding T-wave inversion (both panels from patients with arrhythmogenic right ventricular cardiomyopathy). Arrows indicate the J-point. ARVC: arrhythmogenic right ventricular cardiomyopathy; HCM: hypertrophic cardiomyopathy. Adapted from Calore et al.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> with permission from Oxford University Press.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read the exhaustive review by Machado and Vaz Silva entitled “Benign and pathological electrocardiographic changes in athletes”<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> with great interest.</p><p id="par0010" class="elsevierStylePara elsevierViewall">As stated in the article, the Seattle criteria<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a> are among the most commonly used tools for assessing the electrocardiogram (ECG) of athletes, in order to detect and differentiate pathological alterations from those related to intense exercise. They have improved the false-positive rate while maintaining diagnostic accuracy in particular populations,<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">3–5</span></a> compared to the previous recommendations for the interpretation of the ECG in athletes published by the European Society of Cardiology (ESC), initially in 2005<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> and updated in 2010.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">However, although the Seattle criteria were the first to address the influence of race, with specific recommendations for individuals of African and Afro-Caribbean origin (who have a higher risk of sudden cardiac death<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a>), the false-positive rate remains high, especially in black athletes.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">3–5,9,10</span></a> This increases the cost of pre-participation screening,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> besides the consequences of exclusion from competitive sports in terms of the professional and emotional impact on athletes’ lives.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Sheikh et al.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> compared ECG changes between black and white athletes and proposed a set of ‘refined’ criteria which, without losing sensitivity, improved specificity, particularly in black athletes. These new criteria are predicated on the idea that isolated ECG findings of left or right atrial dilatation, left or right axis deviation, and/or right ventricular hypertrophy are of dubious value in athletes without symptoms, family history or abnormalities on physical examination (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Sheikh et al.’s study retrospectively assessed the ECGs of 5505 elite athletes (4297 white and 1208 black), most of them male. The ECGs were analyzed according to the ESC recommendations,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> the Seattle criteria,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a> and the new refined criteria.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> Abnormalities were identified in 21.5%, 9.6% and 6.6% of the total population, respectively. The reduction in ECGs classified as abnormal was more marked in black athletes (40.4% by the ESC criteria, 18.4% by the Seattle criteria and 11.5% by the refined criteria), and was also seen in white individuals, although to a lesser extent (16.2%, 7.1% and 5.3%, respectively). The reduction in abnormal ECGs compared to the Seattle criteria was thus 37.5% in black athletes and 25.4% in white athletes. The specificity of the refined criteria was 94.1% for white athletes and 84.2% for black athletes, better than the ESC criteria (73.8% and 40.3%, respectively) and the Seattle criteria (92.1% and 79.3%). This improvement in specificity was achieved without compromising sensitivity, all three sets of criteria identifying all athletes with major cardiac disorders and 98.1% of athletes with hypertrophic cardiomyopathy.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The study by Sheikh et al.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> has certain limitations: although it assessed the clinical history, physical exam and ECGs of 5505 athletes (1208 black and 4297 white), the analysis was retrospective and the criteria were based on data from elite athletes, and so it is uncertain whether the findings can be generalized to nonelite athletes. Furthermore, echocardiographic data were not available in all individuals, which may have led to underestimation of the prevalence of some minor abnormalities.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Nevertheless, these findings have been confirmed in a population of male athletes (1367 Arab, 748 black and 376 Caucasian), in which the refined criteria performed better (5.3% abnormal ECGs) than the Seattle criteria (11.6%) and the ESC criteria (22.3%), all three sets presenting 100% sensitivity.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> Black athletes continue to present a higher prevalence of abnormal ECGs compared with Arab and Caucasian athletes (10% vs. 3.6% and 2.1%, respectively), although lower than by the Seattle criteria (16.6%, 9.7% and 8.5%, respectively) and the ESC criteria (29.9%, 19.1% and 18.6%, respectively).</p><p id="par0035" class="elsevierStylePara elsevierViewall">It should also be noted that after the article by Machado and Vaz Silva<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> was accepted for publication, new data appeared suggesting that a combination of J-point elevation and T-wave inversion not extending beyond V4 differentiated between physiological adaptation and cardiomyopathy in this population.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> This study compared ECG patterns of T-wave inversion (≥1 mm) in ≥2 contiguous anterior leads (V1–V4) in 80 healthy athletes; 95 patients with hypertrophic cardiomyopathy (HCM), including 26 athletes; and 58 patients with arrhythmogenic right ventricular cardiomyopathy (ARVC), including nine athletes. A J-point elevation <1 mm in the anterior leads and T-wave inversion extending beyond V4 were independent predictors for both ARVC and HCM, while the combination of J-point elevation ≥1 mm and T-wave inversion not extending beyond V4 excluded these cardiomyopathies with 100% sensitivity and 55% specificity (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 1</a>).<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Although Machado and Vaz Silva<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> state that the exclusion of “certain ECG alterations that are still deemed abnormal even when found in isolation” could improve the false-positive rate, in view of the study by Sheikh et al.,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> it is our opinion that insufficient emphasis was given to the new refined criteria, which, although not yet incorporated into the guidelines, will in all likelihood soon be, and will help reduce false positives without compromising diagnostic sensitivity.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rodrigues RC, Serrão G, Gomes S, Pereira D. Novos «critérios refinados» eletrocardiográficos na avaliação de atletas. Rev Port Cardiol. 2016;35:711–713.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1479 "Ancho" => 897 "Tamanyo" => 179883 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Close-up of lead V3 in different clinical conditions. Top: J-point elevation preceding T-wave inversion (both panels from healthy athletes); middle: ST-segment elevation (without J-point elevation) preceding T-wave inversion (both panels from patients with hypertrophic cardiomyopathy); bottom: ST-segment elevation (without J-point elevation) preceding T-wave inversion (both panels from patients with arrhythmogenic right ventricular cardiomyopathy). Arrows indicate the J-point. ARVC: arrhythmogenic right ventricular cardiomyopathy; HCM: hypertrophic cardiomyopathy. Adapted from Calore et al.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> with permission from Oxford University Press.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Training-related normal variants (not warranting further investigation in asymptomatic athletes with no family history or abnormal physical findings) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">• Sinus bradycardia<br>• First-degree atrioventricular block<br>• Incomplete right bundle branch block<br>• Early repolarization<br>• Isolated QRS voltage criteria for left ventricular hypertrophy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Borderline variants (potentially warranting further investigation if two or more are present) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">• Left atrial enlargement<br>• Right atrial enlargement<br>• Left axis deviation<br>• Right axis deviation<br>• Right ventricular hypertrophy<br>• T-wave inversion up to V4 in black athletes (when preceded by characteristic convex ST-segment elevation) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Training-unrelated changes (warranting further investigation) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">• ST-segment depression<br>• Pathological Q-waves<br>• Ventricular pre-excitation<br>• T-wave inversion beyond V1 in white athletes and beyond V4 in black athletes<br>• Complete left bundle branch block or complete right bundle branch block<br>• QTc ≥470 ms in males and ≥480 ms in females<br>• Brugada-like early repolarization<br>• Atrial or ventricular arrhythmias<br>• ≥2 premature ventricular complexes per 10 s tracing \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1338782.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Definition of abnormal ECGs using the refined criteria.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Benign and pathological electrocardiographic changes in athletes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Machado" 1 => "M. Vaz Silva" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2015.07.007" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2015" "volumen" => "34" "paginaInicial" => "753" "paginaFinal" => "770" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26643438" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0065" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Electrocardiographic interpretation in athletes: the ‘Seattle criteria’" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.A. Drezner" 1 => "M.J. Ackerman" 2 => "J. Anderson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bjsports-2012-092067" "Revista" => array:6 [ "tituloSerie" => "Br J Sports Med" "fecha" => "2013" "volumen" => "47" "paginaInicial" => "122" "paginaFinal" => "124" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23303758" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0070" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Seattle Criteria increase the specificity of preparticipation ECG screening among elite athletes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Brosnan" 1 => "A. La Gerche" 2 => "J. Kalman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bjsports-2013-092420" "Revista" => array:6 [ "tituloSerie" => "Br J Sports Med" "fecha" => "2014" "volumen" => "48" "paginaInicial" => "1144" "paginaFinal" => "1150" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23813487" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0075" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of abnormal ECGs in male soccer players decreases with the Seattle criteria, but is still high" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H.M. Berge" 1 => "K. Gjesdal" 2 => "T.E. Andersen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/sms.12274" "Revista" => array:6 [ "tituloSerie" => "Scand J Med Sci Sports" "fecha" => "2015" "volumen" => "25" "paginaInicial" => "501" "paginaFinal" => "508" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24961617" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0080" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of three ECG criteria for athlete pre-participation screening" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D. Pickham" 1 => "S. Zarafshar" 2 => "D. Sani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jelectrocard.2014.07.019" "Revista" => array:6 [ "tituloSerie" => "J Electrocardiol" "fecha" => "2014" "volumen" => "47" "paginaInicial" => "769" "paginaFinal" => "774" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25155389" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0085" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Pelliccia" 1 => "R. Fagard" 2 => "H.H. Bjornstad" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehi325" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2005" "volumen" => "26" "paginaInicial" => "1422" "paginaFinal" => "1445" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15923204" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0090" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recommendations for interpretation of 12-lead electrocardiogram in the athlete" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D. Corrado" 1 => "A. Pelliccia" 2 => "H. Heidbuchel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehp473" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2010" "volumen" => "31" "paginaInicial" => "243" "paginaFinal" => "259" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19933514" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0095" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence, cause, and comparative frequency of sudden cardiac death in national collegiate athletic association athletes: a decade in review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "K.G. Harmon" 1 => "I.M. Asif" 2 => "J.J. Maleszewski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.115.015431" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2015" "volumen" => "132" "paginaInicial" => "10" "paginaFinal" => "19" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25977310" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0100" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of three current sets of electrocardiographic interpretation criteria for use in screening athletes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N.R. Riding" 1 => "N. Sheikh" 2 => "C. Adamuz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/heartjnl-2014-306437" "Revista" => array:6 [ "tituloSerie" => "Heart" "fecha" => "2015" "volumen" => "101" "paginaInicial" => "384" "paginaFinal" => "390" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25502812" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0105" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of electrocardiographic criteria for the detection of cardiac abnormalities in elite black and white athletes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N. Sheikh" 1 => "M. Papadakis" 2 => "S. Ghani" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.113.006179" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2014" "volumen" => "129" "paginaInicial" => "1637" "paginaFinal" => "1649" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24619464" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0110" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Electrocardiographic anterior T-wave inversion in athletes of different ethnicities: differential diagnosis between athlete's heart and cardiomyopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Calore" 1 => "A. Zorzi" 2 => "N. Sheikh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehv59" "Revista" => array:3 [ "tituloSerie" => "Eur Heart J" "fecha" => "2015" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27141094" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003500000012/v2_201702040044/S2174204916301969/v2_201702040044/en/main.assets" "Apartado" => array:4 [ "identificador" => "29282" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003500000012/v2_201702040044/S2174204916301969/v2_201702040044/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916301969?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 3 | 10 |
| 2024 October | 72 | 38 | 110 |
| 2024 September | 77 | 24 | 101 |
| 2024 August | 64 | 27 | 91 |
| 2024 July | 44 | 28 | 72 |
| 2024 June | 61 | 31 | 92 |
| 2024 May | 50 | 23 | 73 |
| 2024 April | 45 | 36 | 81 |
| 2024 March | 48 | 19 | 67 |
| 2024 February | 44 | 19 | 63 |
| 2024 January | 66 | 30 | 96 |
| 2023 December | 69 | 31 | 100 |
| 2023 November | 63 | 38 | 101 |
| 2023 October | 64 | 24 | 88 |
| 2023 September | 63 | 27 | 90 |
| 2023 August | 61 | 16 | 77 |
| 2023 July | 61 | 13 | 74 |
| 2023 June | 46 | 18 | 64 |
| 2023 May | 79 | 30 | 109 |
| 2023 April | 38 | 4 | 42 |
| 2023 March | 43 | 27 | 70 |
| 2023 February | 42 | 26 | 68 |
| 2023 January | 60 | 43 | 103 |
| 2022 December | 57 | 21 | 78 |
| 2022 November | 70 | 34 | 104 |
| 2022 October | 61 | 37 | 98 |
| 2022 September | 41 | 34 | 75 |
| 2022 August | 49 | 34 | 83 |
| 2022 July | 50 | 32 | 82 |
| 2022 June | 36 | 34 | 70 |
| 2022 May | 36 | 36 | 72 |
| 2022 April | 44 | 34 | 78 |
| 2022 March | 42 | 45 | 87 |
| 2022 February | 50 | 40 | 90 |
| 2022 January | 65 | 27 | 92 |
| 2021 December | 40 | 34 | 74 |
| 2021 November | 52 | 37 | 89 |
| 2021 October | 71 | 49 | 120 |
| 2021 September | 44 | 27 | 71 |
| 2021 August | 56 | 36 | 92 |
| 2021 July | 40 | 26 | 66 |
| 2021 June | 35 | 17 | 52 |
| 2021 May | 51 | 37 | 88 |
| 2021 April | 86 | 29 | 115 |
| 2021 March | 100 | 33 | 133 |
| 2021 February | 91 | 13 | 104 |
| 2021 January | 53 | 23 | 76 |
| 2020 December | 96 | 13 | 109 |
| 2020 November | 60 | 28 | 88 |
| 2020 October | 54 | 20 | 74 |
| 2020 September | 78 | 14 | 92 |
| 2020 August | 38 | 12 | 50 |
| 2020 July | 84 | 9 | 93 |
| 2020 June | 71 | 12 | 83 |
| 2020 May | 104 | 12 | 116 |
| 2020 April | 78 | 24 | 102 |
| 2020 March | 83 | 21 | 104 |
| 2020 February | 155 | 30 | 185 |
| 2020 January | 84 | 12 | 96 |
| 2019 December | 75 | 7 | 82 |
| 2019 November | 50 | 13 | 63 |
| 2019 October | 73 | 4 | 77 |
| 2019 September | 115 | 19 | 134 |
| 2019 August | 63 | 14 | 77 |
| 2019 July | 78 | 10 | 88 |
| 2019 June | 62 | 22 | 84 |
| 2019 May | 104 | 21 | 125 |
| 2019 April | 88 | 22 | 110 |
| 2019 March | 111 | 13 | 124 |
| 2019 February | 82 | 14 | 96 |
| 2019 January | 38 | 24 | 62 |
| 2018 December | 65 | 16 | 81 |
| 2018 November | 108 | 14 | 122 |
| 2018 October | 109 | 22 | 131 |
| 2018 September | 57 | 13 | 70 |
| 2018 August | 44 | 12 | 56 |
| 2018 July | 24 | 11 | 35 |
| 2018 June | 63 | 2 | 65 |
| 2018 May | 72 | 4 | 76 |
| 2018 April | 69 | 10 | 79 |
| 2018 March | 99 | 6 | 105 |
| 2018 February | 36 | 6 | 42 |
| 2018 January | 59 | 6 | 65 |
| 2017 December | 86 | 13 | 99 |
| 2017 November | 74 | 12 | 86 |
| 2017 October | 55 | 11 | 66 |
| 2017 September | 41 | 12 | 53 |
| 2017 August | 44 | 10 | 54 |
| 2017 July | 22 | 9 | 31 |
| 2017 June | 48 | 22 | 70 |
| 2017 May | 36 | 20 | 56 |
| 2017 April | 27 | 19 | 46 |
| 2017 March | 48 | 74 | 122 |
| 2017 February | 72 | 14 | 86 |
| 2017 January | 47 | 19 | 66 |
| 2016 December | 93 | 34 | 127 |
| 2016 November | 3 | 9 | 12 |
Show all
