array:26 [
  "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"
  "copyrightAnyo" => "2016"
  "documento" => "simple-article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "cor"
  "cita" => "Rev Port Cardiol. 2016;35:715-6"
  "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
    ]
  ]
  "Traduccion" => array:1 [
    "pt" => array:20 [
      "pii" => "S0870255116301755"
      "issn" => "08702551"
      "doi" => "10.1016/j.repc.2016.02.004"
      "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" => 3212
        "formatos" => array:3 [
          "EPUB" => 196
          "HTML" => 2406
          "PDF" => 610
        ]
      ]
      "pt" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Carta ao Editor</span>"
        "titulo" => "Como interpretar o eletrocardiograma do atleta&#63;"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "715"
            "paginaFinal" => "716"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "How should we interpret the athlete&#39;s electrocardiogram&#63;"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "H&#233;lder Dores, Nuno Cardim"
            "autores" => array:2 [
              0 => array:2 [
                "nombre" => "H&#233;lder"
                "apellidos" => "Dores"
              ]
              1 => array:2 [
                "nombre" => "Nuno"
                "apellidos" => "Cardim"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2174204916301970"
          "doi" => "10.1016/j.repce.2016.02.005"
          "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/S2174204916301970?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116301755?idApp=UINPBA00004E"
      "url" => "/08702551/0000003500000012/v2_201701270020/S0870255116301755/v2_201701270020/pt/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2174204916302343"
    "issn" => "21742049"
    "doi" => "10.1016/j.repce.2016.11.003"
    "estado" => "S300"
    "fechaPublicacion" => "2016-12-01"
    "aid" => "894"
    "documento" => "simple-article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "crp"
    "cita" => "Rev Port Cardiol. 2016;35:717-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1607
      "formatos" => array:3 [
        "EPUB" => 134
        "HTML" => 1161
        "PDF" => 312
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Artigo Recomendado do M&#234;s</span>"
      "titulo" => "Coment&#225;rio a&#58; &#171;<span class="elsevierStyleItalic">The SPRINT Research Group&#46; A Randomized Trial of Intensive versus Standard Blood&#8208;Pressure Control</span>&#187;"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "717"
          "paginaFinal" => "718"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Comment on&#58; &#8220;The SPRINT Research Group&#46; A Randomized Trial of Intensive versus Standard Blood&#8208;Pressure Control&#8221;"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ant&#243;nio Vaz Carneiro"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "Ant&#243;nio"
              "apellidos" => "Vaz Carneiro"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S0870255116302220"
        "doi" => "10.1016/j.repc.2016.09.006"
        "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/S0870255116302220?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916302343?idApp=UINPBA00004E"
    "url" => "/21742049/0000003500000012/v2_201702040044/S2174204916302343/v2_201702040044/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "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"
    "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
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
      "titulo" => "New &#8216;refined&#8217; criteria for the electrocardiographic assessment of athletes"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "711"
          "paginaFinal" => "713"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Novos &#171;crit&#233;rios refinados&#187; eletrocardiogr&#225;ficos na avalia&#231;&#227;o de atletas"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "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&#46; Top&#58; J-point elevation preceding T-wave inversion &#40;both panels from healthy athletes&#41;&#59; middle&#58; ST-segment elevation &#40;without J-point elevation&#41; preceding T-wave inversion &#40;both panels from patients with hypertrophic cardiomyopathy&#41;&#59; bottom&#58; ST-segment elevation &#40;without J-point elevation&#41; preceding T-wave inversion &#40;both panels from patients with arrhythmogenic right ventricular cardiomyopathy&#41;&#46; Arrows indicate the J-point&#46; ARVC&#58; arrhythmogenic right ventricular cardiomyopathy&#59; HCM&#58; hypertrophic cardiomyopathy&#46; Adapted from Calore et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> with permission from Oxford University Press&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ricardo C&#46; Rodrigues, Gomes Serr&#227;o, Susana Gomes, D&#233;cio Pereira"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Ricardo C&#46;"
              "apellidos" => "Rodrigues"
            ]
            1 => array:2 [
              "nombre" => "Gomes"
              "apellidos" => "Serr&#227;o"
            ]
            2 => array:2 [
              "nombre" => "Susana"
              "apellidos" => "Gomes"
            ]
            3 => array:2 [
              "nombre" => "D&#233;cio"
              "apellidos" => "Pereira"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S0870255116301743"
        "doi" => "10.1016/j.repc.2016.05.007"
        "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/S0870255116301743?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916301969?idApp=UINPBA00004E"
    "url" => "/21742049/0000003500000012/v2_201702040044/S2174204916301969/v2_201702040044/en/main.assets"
  ]
  "asociados" => array:1 [
    0 => array:20 [
      "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"
      "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
        ]
      ]
      "en" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
        "titulo" => "New &#8216;refined&#8217; criteria for the electrocardiographic assessment of athletes"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "711"
            "paginaFinal" => "713"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "Novos &#171;crit&#233;rios refinados&#187; eletrocardiogr&#225;ficos na avalia&#231;&#227;o de atletas"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "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&#46; Top&#58; J-point elevation preceding T-wave inversion &#40;both panels from healthy athletes&#41;&#59; middle&#58; ST-segment elevation &#40;without J-point elevation&#41; preceding T-wave inversion &#40;both panels from patients with hypertrophic cardiomyopathy&#41;&#59; bottom&#58; ST-segment elevation &#40;without J-point elevation&#41; preceding T-wave inversion &#40;both panels from patients with arrhythmogenic right ventricular cardiomyopathy&#41;&#46; Arrows indicate the J-point&#46; ARVC&#58; arrhythmogenic right ventricular cardiomyopathy&#59; HCM&#58; hypertrophic cardiomyopathy&#46; Adapted from Calore et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> with permission from Oxford University Press&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Ricardo C&#46; Rodrigues, Gomes Serr&#227;o, Susana Gomes, D&#233;cio Pereira"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Ricardo C&#46;"
                "apellidos" => "Rodrigues"
              ]
              1 => array:2 [
                "nombre" => "Gomes"
                "apellidos" => "Serr&#227;o"
              ]
              2 => array:2 [
                "nombre" => "Susana"
                "apellidos" => "Gomes"
              ]
              3 => array:2 [
                "nombre" => "D&#233;cio"
                "apellidos" => "Pereira"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "pt" => array:9 [
          "pii" => "S0870255116301743"
          "doi" => "10.1016/j.repc.2016.05.007"
          "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/S0870255116301743?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916301969?idApp=UINPBA00004E"
      "url" => "/21742049/0000003500000012/v2_201702040044/S2174204916301969/v2_201702040044/en/main.assets"
    ]
  ]
  "en" => array:14 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "How should we interpret the athlete&#39;s electrocardiogram&#63;"
    "tieneTextoCompleto" => true
    "saludo" => "To the editor&#58;"
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "715"
        "paginaFinal" => "716"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "H&#233;lder Dores, Nuno Cardim"
        "autores" => array:2 [
          0 => array:4 [
            "nombre" => "H&#233;lder"
            "apellidos" => "Dores"
            "email" => array:1 [
              0 => "heldores&#64;hotmail&#46;com"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Nuno"
            "apellidos" => "Cardim"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Hospital das For&#231;as Armadas&#44; Lisboa&#44; Portugal"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Centro de Cardiologia Desportiva e Miocardiopatias &#40;CCDM&#41;&#44; Hospital da Luz&#44; Lisboa&#44; Portugal"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "NOVA Medical School&#47;Faculdade de Ci&#234;ncias M&#233;dicas &#8211; Universidade Nova de Lisboa&#44; Lisboa&#44; Portugal"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "Como interpretar o eletrocardiograma do atleta&#63;"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">It was with considerable interest that we read the recent article by Machado and Silva<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> entitled &#8220;Benign and pathological electrocardiographic changes in athletes&#8221;&#44; a comprehensive and pertinent review&#46; Interpretation of the athlete&#39;s echocardiogram &#40;ECG&#41; remains the subject of debate&#44; but beyond the ongoing &#8216;transatlantic&#8217; discussion on whether the ECG should be included in pre-participation screening&#44; the basic question remains&#58; how should we interpret the athlete&#39;s ECG&#63;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">As Machado and Silva point out&#44; the European Society of Cardiology &#40;ESC&#41; criteria are associated with a high false-positive rate&#44; and so there is a need for more restrictive criteria&#46; Among these are the Seattle criteria&#44; which the article states are the latest recommendations for the interpretation of the ECG in athletes&#46; We would like to put forward certain points that in our opinion will add to the discussion&#46;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#40;1&#41;</span><p id="par0015" class="elsevierStylePara elsevierViewall">The Seattle criteria are a valuable aid to interpreting the athlete&#39;s ECG&#44; but it should be borne in mind that they are only a consensus document based on expert opinion&#44; and are not evidence-based&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#40;2&#41;</span><p id="par0020" class="elsevierStylePara elsevierViewall">After the publication of the Seattle criteria&#44; Sheikh et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> proposed the &#8216;refined&#8217; criteria&#46; Although these are mentioned in the article by Machado and Vaz Silva&#44; they should&#44; in our opinion&#44; have received greater attention&#44; for three reasons&#46; Firstly&#44; they are based on the analysis of a large sample of elite athletes&#44; and their accuracy was validated in a population of athletes with hypertrophic cardiomyopathy&#46; Secondly&#44; they assume&#44; on the basis of previously published research&#44; that some isolated ECG findings are probably physiological &#40;such as axis deviation or atrial dilatation&#41;&#46; Thirdly&#44; they reduce the number of false positives&#44; even compared to the Seattle criteria&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#8211;5</span></a> In our experience at the Hospital das For&#231;as Armadas and Hospital da Luz&#44; use of the &#8216;refined&#8217; criteria instead of the ESC criteria has reduced the false-positive rate by two-thirds&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#40;3&#41;</span><p id="par0025" class="elsevierStylePara elsevierViewall">As pointed out in the article&#44; even when more specific criteria are applied&#44; variability in interpretation of the ECG remains high&#46; In a study of Portuguese cardiologists&#44; soon to be published&#44; this was around 25&#37;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#40;4&#41;</span><p id="par0030" class="elsevierStylePara elsevierViewall">Another reason for the difficulty in standardizing interpretation of the athlete&#39;s ECG is that the same alteration may be defined differently in different criteria&#46; Thus&#44; pathological Q waves are defined as &#62;4 mm deep in any lead except III and aVR in the ESC criteria&#44; &#62;3 mm deep or &#62;40 ms duration in &#8805;2 contiguous leads except III and aVR in the Seattle criteria&#44; and &#8805;40 ms in duration or &#8805;25&#37; of the height of the ensuing R wave in the &#8216;refined&#8217; criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p></li></ul></p><p id="par0035" class="elsevierStylePara elsevierViewall">This long-standing debate makes it essential to develop specific structures for the assessment of athletes and for sports cardiology in general&#46; This will make it easier to standardize procedures and to develop multicenter projects that could reduce the &#8216;gray zone&#8217; that still prevails around this subject&#44; which would have a significant impact at various levels&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</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" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Dores H&#44; Cardim N&#46; Como interpretar o eletrocardiograma do atleta&#63; Rev Port Cardiol&#46; 2016&#59;35&#58;715&#8211;716&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:5 [
            0 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Altera&#231;&#245;es eletrocardiogr&#225;ficas benignas e patol&#243;gicas em atletas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Machado"
                            1 => "M&#46; 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" => "bib0035"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The hearts of competitive athletes&#58; an up-to-date overview of exercise-induced cardiac adaptations"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "H&#46; Dores"
                            1 => "A&#46; Freitas"
                            2 => "A&#46; Malhotra"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.repc.2014.07.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Port Cardiol"
                        "fecha" => "2015"
                        "volumen" => "34"
                        "paginaInicial" => "51"
                        "paginaFinal" => "64"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25575633"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "3"
              "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&#46; Sheikh"
                            1 => "M&#46; Papadakis"
                            2 => "S&#46; 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"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "4"
              "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&#46;R&#46; Riding"
                            1 => "N&#46; Sheikh"
                            2 => "C&#46; Adamuz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Heart"
                        "fecha" => "2014"
                        "paginaInicial" => "1"
                        "paginaFinal" => "7"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Should axis deviation or atrial enlargement be categorised as abnormal in young athletes&#63; The athlete&#39;s electrocardiogram&#58; time for re-appraisal of markers of pathology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "S&#46; Gati"
                            1 => "N&#46; Sheikh"
                            2 => "S&#46; Ghani"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/eurheartj/eht390"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Heart J"
                        "fecha" => "2013"
                        "volumen" => "34"
                        "paginaInicial" => "3641"
                        "paginaFinal" => "3648"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24057078"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21742049/0000003500000012/v2_201702040044/S2174204916301970/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/S2174204916301970/v2_201702040044/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916301970?idApp=UINPBA00004E"
]
Share
Journal Information
Vol. 35. Issue 12.
Pages 715-716 (December 2016)
Vol. 35. Issue 12.
Pages 715-716 (December 2016)
Letter to the Editor
Open Access
How should we interpret the athlete's electrocardiogram?
Como interpretar o eletrocardiograma do atleta?
Visits
5807
Hélder Doresa,b,
Corresponding author
heldores@hotmail.com

Corresponding author.
, Nuno Cardimb,c
a Hospital das Forças Armadas, Lisboa, Portugal
b Centro de Cardiologia Desportiva e Miocardiopatias (CCDM), Hospital da Luz, Lisboa, Portugal
c NOVA Medical School/Faculdade de Ciências Médicas – Universidade Nova de Lisboa, Lisboa, Portugal
Related content
Rev Port Cardiol. 2016;35:711-310.1016/j.repce.2016.05.008
Ricardo C. Rodrigues, Gomes Serrão, Susana Gomes, Décio Pereira
This item has received

Under a Creative Commons license
Article information
Full Text
Bibliography
Download PDF
Statistics
Full Text
To the editor:

It was with considerable interest that we read the recent article by Machado and Silva1 entitled “Benign and pathological electrocardiographic changes in athletes”, a comprehensive and pertinent review. Interpretation of the athlete's echocardiogram (ECG) remains the subject of debate, but beyond the ongoing ‘transatlantic’ discussion on whether the ECG should be included in pre-participation screening, the basic question remains: how should we interpret the athlete's ECG?2

As Machado and Silva point out, the European Society of Cardiology (ESC) criteria are associated with a high false-positive rate, and so there is a need for more restrictive criteria. Among these are the Seattle criteria, which the article states are the latest recommendations for the interpretation of the ECG in athletes. We would like to put forward certain points that in our opinion will add to the discussion.

  • (1)

    The Seattle criteria are a valuable aid to interpreting the athlete's ECG, but it should be borne in mind that they are only a consensus document based on expert opinion, and are not evidence-based.

  • (2)

    After the publication of the Seattle criteria, Sheikh et al.3 proposed the ‘refined’ criteria. Although these are mentioned in the article by Machado and Vaz Silva, they should, in our opinion, have received greater attention, for three reasons. Firstly, they are based on the analysis of a large sample of elite athletes, and their accuracy was validated in a population of athletes with hypertrophic cardiomyopathy. Secondly, they assume, on the basis of previously published research, that some isolated ECG findings are probably physiological (such as axis deviation or atrial dilatation). Thirdly, they reduce the number of false positives, even compared to the Seattle criteria.3–5 In our experience at the Hospital das Forças Armadas and Hospital da Luz, use of the ‘refined’ criteria instead of the ESC criteria has reduced the false-positive rate by two-thirds.

  • (3)

    As pointed out in the article, even when more specific criteria are applied, variability in interpretation of the ECG remains high. In a study of Portuguese cardiologists, soon to be published, this was around 25%.

  • (4)

    Another reason for the difficulty in standardizing interpretation of the athlete's ECG is that the same alteration may be defined differently in different criteria. Thus, pathological Q waves are defined as >4 mm deep in any lead except III and aVR in the ESC criteria, >3 mm deep or >40 ms duration in ≥2 contiguous leads except III and aVR in the Seattle criteria, and ≥40 ms in duration or ≥25% of the height of the ensuing R wave in the ‘refined’ criteria.4

This long-standing debate makes it essential to develop specific structures for the assessment of athletes and for sports cardiology in general. This will make it easier to standardize procedures and to develop multicenter projects that could reduce the ‘gray zone’ that still prevails around this subject, which would have a significant impact at various levels.

Conflicts of interest

The authors have no conflicts of interest to declare.

References
[1]
M. Machado, M. Vaz Silva.
Alterações eletrocardiográficas benignas e patológicas em atletas.
Rev Port Cardiol, 34 (2015), pp. 753-770
[2]
H. Dores, A. Freitas, A. Malhotra, et al.
The hearts of competitive athletes: an up-to-date overview of exercise-induced cardiac adaptations.
Rev Port Cardiol, 34 (2015), pp. 51-64
[3]
N. Sheikh, M. Papadakis, S. Ghani, et al.
Comparison of electrocardiographic criteria for the detection of cardiac abnormalities in elite black and white athletes.
Circulation, 129 (2014), pp. 1637-1649
[4]
N.R. Riding, N. Sheikh, C. Adamuz, et al.
Comparison of three current sets of electrocardiographic interpretation criteria for use in screening athletes.
Heart, (2014), pp. 1-7
[5]
S. Gati, N. Sheikh, S. Ghani, et al.
Should axis deviation or atrial enlargement be categorised as abnormal in young athletes? The athlete's electrocardiogram: time for re-appraisal of markers of pathology.
Eur Heart J, 34 (2013), pp. 3641-3648

Please cite this article as: Dores H, Cardim N. Como interpretar o eletrocardiograma do atleta? Rev Port Cardiol. 2016;35:715–716.

Copyright © 2016. Sociedade Portuguesa de Cardiologia
Download PDF
Idiomas
Revista Portuguesa de Cardiologia (English edition)
Article options
Tools
en pt

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

By checking that you are a health professional, you are stating that you are aware and accept that the Portuguese Journal of Cardiology (RPC) is the Data Controller that processes the personal information of users of its website, with its registered office at Campo Grande, n.º 28, 13.º, 1700-093 Lisbon, telephone 217 970 685 and 217 817 630, fax 217 931 095, and email revista@spc.pt. I declare for all purposes that the information provided herein is accurate and correct.