Lawless Christine E, Best Thomas M
Division of Cardiovascular Medicine and Sports Medicine, Ohio State University Medical Center, Columbus, OH, USA.
Med Sci Sports Exerc. 2008 May;40(5):787-98. doi: 10.1249/MSS.0b013e318164dd18.
Electrocardiography (ECG) has been proposed as a method to enhance the ability of the preparticipation examination (PPE) to detect underlying cardiac conditions that can lead to sudden cardiac death (SCD) in young athletes.
We conducted a Medline review of the published medical literature, using the key terms of cardiovascular screening of athletes, ECG in athletes, SCD in athletes, and ECG in specific cardiac disease states: hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, dilated cardiomyopathy, myocarditis, long QT syndrome, Brugada syndrome, coronary artery anomalies, myocardial bridging, aortic stenosis, mitral valve prolapse, and Marfan syndrome. ECG seems to increase the sensitivity of the PPE from 2.5-6% to 50-95%. Overall sensitivity appears to be about 50%; false-positive rates can be as high as 40%, and there is at least a 4-5% false-negative rate. In Europe, ECG-based screening programs have been associated with a decline in the SCD rate in young athletes, but similar programs are currently not recommended in the United States for many reasons: lack of randomized trial data; cost of screening; lack of a clear standard for ECG interpretation in the athlete; the likelihood that asymptomatic athletes with underlying lethal conditions might differ significantly from symptomatic individuals with the same conditions; and concern that ECG screening might actually increase the death rate, via treatment-related procedural complications.
Although some authorities advocate the use of ECG screening of young athletes, further studies are required to define what constitutes a normal ECG in athletes, and to determine whether ECG-based screening protocols truly are superior, not only in finding disease, but also saving lives. For those who either choose ECG-based screening or interpret ECG in athletes, we propose a simple interpretation scheme and decision tree.
心电图（ECG）已被提议作为一种方法，以提高参与运动前检查（PPE）检测可能导致年轻运动员心源性猝死（SCD）的潜在心脏疾病的能力。
我们对已发表的医学文献进行了Medline检索，使用的关键词包括运动员心血管筛查、运动员心电图、运动员心源性猝死以及特定心脏疾病状态下的心电图：肥厚型心肌病、致心律失常性右室心肌病、扩张型心肌病、心肌炎、长QT综合征、Brugada综合征、冠状动脉异常、心肌桥、主动脉瓣狭窄、二尖瓣脱垂和马凡综合征。心电图似乎能将PPE的敏感性从2.5%-6%提高到50%-95%。总体敏感性似乎约为50%；假阳性率可高达40%，且至少有4%-5%的假阴性率。在欧洲，基于心电图的筛查项目与年轻运动员心源性猝死率的下降有关，但目前在美国不建议开展类似项目，原因有很多：缺乏随机试验数据；筛查成本；缺乏运动员心电图解读的明确标准；有潜在致命疾病的无症状运动员可能与有相同疾病的有症状个体存在显著差异；以及担心心电图筛查可能因治疗相关的程序性并发症而实际上增加死亡率。
尽管一些权威机构主张对年轻运动员进行心电图筛查，但仍需要进一步研究来确定运动员正常心电图的构成，并确定基于心电图的筛查方案是否真的更优越，不仅在于发现疾病，还在于挽救生命。对于那些选择基于心电图的筛查或解读运动员心电图的人，我们提出了一个简单的解读方案和决策树。
