Editorial comment
Use of the electrocardiogram in pre-participation screening of athletes: For or against?
A utilização do eletrocardiograma na avaliação pré-competitiva dos atletas: pró ou contra?
Armando L. Bordalo e Sá
UTIC Arsénio Cordeiro, Serviço de Cardiologia, Hospital de Santa Maria, CHLN, Lisboa, Portugal
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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "451" "paginaFinal" => "452" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Armando L. Bordalo e Sá" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Armando L." "apellidos" => "Bordalo e Sá" "email" => array:1 [ 0 => "armando.bordalo@sapo.pt" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "UTIC Arsénio Cordeiro, Serviço de Cardiologia, Hospital de Santa Maria, CHLN, Lisboa, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "A utilização do eletrocardiograma na avaliação pré-competitiva dos atletas: pró ou contra?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The use of the 12-lead electrocardiogram (ECG) in the pre-participation screening of athletes is still not universally accepted. In 2014 the American Heart Association decided for the third time not to support mandatory national athlete screening throughout the US, particularly with routine use of ECGs.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Among the reasons for this repeated decision are the low incidence of events and the substantial number of false-negative and false-positive results (in the range of 5% to 20% depending on the specific ECG criteria used). Other reasons include the influence of observer variability and the impact of ethnicity/race on the interpretation of ECGs, which have a significant effect on the definition of a ‘normal’ ECG.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In Europe, the European Society of Cardiology (ESC) first published guidelines on the interpretation of the ECG in athletes in 2005,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> which were updated in 2010,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> and which distinguish common training-related findings from rarer non-training-related changes. The 2010 criteria improved specificity from 83% to 89.5% and reduced false positives from 16.9% to 10% while preserving sensitivity. The Seattle criteria, published in 2013, introduced stricter and less ambiguous thresholds, especially those related to T-wave inversion, ST-segment depression and pathological Q waves.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> Advances in knowledge have led to certain alterations (including left or right axis deviation, left or right atrial dilatation, right ventricular hypertrophy, and T-wave inversion accompanied by ST-segment elevation in V1-V4 in black athletes) now being classified as borderline, i.e. in isolation they are probably not pathological, but the presence of two or more of these findings may warrant additional investigation. Application of the ‘refined criteria’ has further reduced the false-positive rate to 4.9%.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> If prospective studies confirm that the use of these criteria not only reduces the number of ECGs considered abnormal, but also continues to detect all genuine abnormalities and thereby reduces the incidence of sudden deaths in athletes, interpretation of the ECG in athletes will be more unequivocal – and hence less variable.</p><p id="par0015" class="elsevierStylePara elsevierViewall">These questions are the subject of the interesting article by Dores et al. published in this issue of the <span class="elsevierStyleItalic">Journal</span>.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Variability in the interpretation of athletes’ ECGs has only recently attracted the attention of investigators,<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7,8</span></a> and the present study analyzes one of the largest numbers of experts (58 physicians, 72% of them cardiologists). Curiously, the proportion of correctly interpreted ECGs was no greater among cardiologists than among cardiology residents, nor in those who regularly assessed athletes than in those who did not. Only the use of specific criteria showed a tendency to improve the rate of correct interpretation, which highlights the usefulness of these criteria for reducing variability in reading ECGs for screening of athletes.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In view of data from Italy, which show that including the ECG in pre-participation screening of athletes has reduced the incidence of sudden death in sports by 90% over a period of 26 years by identifying athletes with potentially fatal heart disease, it is difficult to accept the American decision not to include the ECG, even given the psychological impact of being required to undergo additional exams, and even though including the ECG cannot completely avoid the unnecessary exclusion of some athletes from competitive sport or prevent all sudden deaths in sport.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">9,10</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Bordalo e Sá AL. A utilização do eletrocardiograma na avaliação pré-competitiva dos atletas: pró ou contra? Rev Port Cardiol. 2017;36:451–452.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 2: preparticipation screening for cardiovascular disease in competitive athletes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B.J. Maron" 1 => "B.D. Levine" 2 => "R.L. Washington" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIR.0000000000000238" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2015" "volumen" => "132" "paginaInicial" => "e267" "paginaFinal" => "e272" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26527714" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiovascular pre-participation screening of young competitive athletes for prevention of sudden death: proposal for a common European protocol. Consensus Statement of the Study Group of Sport 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 => "D. Corrado" 1 => "A. Pelliccia" 2 => "H.H. Bjornstad" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehi108" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2005" "volumen" => "26" "paginaInicial" => "516" "paginaFinal" => "524" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15689345" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "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:7 [ "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" ] ] "itemHostRev" => array:3 [ "pii" => "S0022534713042225" "estado" => "S300" "issn" => "00225347" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "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" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "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" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Variabilidade na interpretação do eletrocardiograma do atleta: mais uma limitação na avaliação pré-competitiva" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Dores" 1 => "J.F. Santos" 2 => "P. Dinis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2016.07.013" "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2017" "volumen" => "36" "paginaInicial" => "443" "paginaFinal" => "449" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28599797" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Variability in interpretation of the electrocardiogram in young athletes: an unrecognized obstacle for electrocardiogram-based screening protocols" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B. Berte" 1 => "M. Duytschaever" 2 => "J. Elices" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/europace/euu385" "Revista" => array:7 [ "tituloSerie" => "Europace" "fecha" => "2015" "volumen" => "17" "paginaInicial" => "1435" "paginaFinal" => "1440" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25662983" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S002253471405037X" "estado" => "S300" "issn" => "00225347" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Modest agreement in ECG interpretation limits the application of ECG screening in young athletes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Brosnan" 1 => "A. La Gerche" 2 => "S. Kumar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.hrthm.2014.09.060" "Revista" => array:6 [ "tituloSerie" => "Heart Rhythm" "fecha" => "2015" "volumen" => "12" "paginaInicial" => "130" "paginaFinal" => "136" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25285648" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Using the 12-lead electrocardiogram in the care of athletic patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.J. Yeo" 1 => "S. Sharma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ccl.2016.06.004" "Revista" => array:6 [ "tituloSerie" => "Cardiol Clin" "fecha" => "2016" "volumen" => "34" "paginaInicial" => "543" "paginaFinal" => "555" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27692223" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interpretation of the electrocardiogram in athletes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K. Prakash" 1 => "S. Sharma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cjca.2015.10.026" "Revista" => array:7 [ "tituloSerie" => "Can J Cardiol" "fecha" => "2016" "volumen" => "32" "paginaInicial" => "438" "paginaFinal" => "451" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26860775" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0022534712044850" "estado" => "S300" "issn" => "00225347" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003600000006/v1_201707020042/S2174204917301290/v1_201707020042/en/main.assets" "Apartado" => array:4 [ "identificador" => "9917" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003600000006/v1_201707020042/S2174204917301290/v1_201707020042/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917301290?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 5 | 11 |
| 2024 October | 33 | 27 | 60 |
| 2024 September | 32 | 23 | 55 |
| 2024 August | 67 | 21 | 88 |
| 2024 July | 63 | 25 | 88 |
| 2024 June | 36 | 24 | 60 |
| 2024 May | 28 | 18 | 46 |
| 2024 April | 33 | 24 | 57 |
| 2024 March | 24 | 18 | 42 |
| 2024 February | 25 | 25 | 50 |
| 2024 January | 21 | 19 | 40 |
| 2023 December | 25 | 30 | 55 |
| 2023 November | 24 | 19 | 43 |
| 2023 October | 17 | 13 | 30 |
| 2023 September | 25 | 20 | 45 |
| 2023 August | 27 | 15 | 42 |
| 2023 July | 17 | 7 | 24 |
| 2023 June | 26 | 20 | 46 |
| 2023 May | 29 | 27 | 56 |
| 2023 April | 21 | 2 | 23 |
| 2023 March | 39 | 23 | 62 |
| 2023 February | 28 | 14 | 42 |
| 2023 January | 25 | 27 | 52 |
| 2022 December | 30 | 28 | 58 |
| 2022 November | 34 | 25 | 59 |
| 2022 October | 47 | 15 | 62 |
| 2022 September | 28 | 32 | 60 |
| 2022 August | 24 | 39 | 63 |
| 2022 July | 32 | 32 | 64 |
| 2022 June | 26 | 27 | 53 |
| 2022 May | 20 | 31 | 51 |
| 2022 April | 25 | 29 | 54 |
| 2022 March | 27 | 36 | 63 |
| 2022 February | 35 | 29 | 64 |
| 2022 January | 24 | 17 | 41 |
| 2021 December | 23 | 27 | 50 |
| 2021 November | 32 | 39 | 71 |
| 2021 October | 40 | 38 | 78 |
| 2021 September | 18 | 20 | 38 |
| 2021 August | 28 | 28 | 56 |
| 2021 July | 19 | 19 | 38 |
| 2021 June | 17 | 14 | 31 |
| 2021 May | 31 | 32 | 63 |
| 2021 April | 37 | 20 | 57 |
| 2021 March | 53 | 18 | 71 |
| 2021 February | 57 | 18 | 75 |
| 2021 January | 29 | 7 | 36 |
| 2020 December | 39 | 6 | 45 |
| 2020 November | 39 | 12 | 51 |
| 2020 October | 33 | 16 | 49 |
| 2020 September | 52 | 9 | 61 |
| 2020 August | 23 | 6 | 29 |
| 2020 July | 31 | 9 | 40 |
| 2020 June | 36 | 3 | 39 |
| 2020 May | 25 | 9 | 34 |
| 2020 April | 20 | 14 | 34 |
| 2020 March | 35 | 12 | 47 |
| 2020 February | 83 | 26 | 109 |
| 2020 January | 26 | 7 | 33 |
| 2019 December | 31 | 4 | 35 |
| 2019 November | 29 | 6 | 35 |
| 2019 October | 30 | 6 | 36 |
| 2019 September | 30 | 6 | 36 |
| 2019 August | 29 | 6 | 35 |
| 2019 July | 31 | 16 | 47 |
| 2019 June | 23 | 9 | 32 |
| 2019 May | 37 | 11 | 48 |
| 2019 April | 22 | 21 | 43 |
| 2019 March | 76 | 10 | 86 |
| 2019 February | 80 | 10 | 90 |
| 2019 January | 82 | 6 | 88 |
| 2018 December | 125 | 11 | 136 |
| 2018 November | 107 | 11 | 118 |
| 2018 October | 162 | 5 | 167 |
| 2018 September | 51 | 16 | 67 |
| 2018 August | 49 | 7 | 56 |
| 2018 July | 51 | 7 | 58 |
| 2018 June | 60 | 8 | 68 |
| 2018 May | 64 | 7 | 71 |
| 2018 April | 69 | 20 | 89 |
| 2018 March | 112 | 14 | 126 |
| 2018 February | 46 | 5 | 51 |
| 2018 January | 50 | 11 | 61 |
| 2017 December | 96 | 14 | 110 |
| 2017 November | 71 | 16 | 87 |
| 2017 October | 40 | 14 | 54 |
| 2017 September | 42 | 23 | 65 |
| 2017 August | 65 | 17 | 82 |
| 2017 July | 95 | 41 | 136 |
| 2017 June | 15 | 5 | 20 |
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