Massachusetts General Hospital, Boston, 02114, USA.
Ann Intern Med. 2010 Mar 2;152(5):269-75. doi: 10.7326/0003-4819-152-5-201003020-00004.
Although cardiovascular screening is recommended for athletes before participating in sports, the role of 12-lead electrocardiography (ECG) remains uncertain. To date, no prospective data that compare screening with and without ECG have been available.
To compare the performance of preparticipation screening limited to medical history and physical examination with a strategy that integrates these with ECG.
Cross-sectional comparison of screening strategies.
University Health Services, Harvard University, Cambridge, Massachusetts.
510 collegiate athletes who received cardiovascular screening before athletic participation.
Each participant had routine history and examination-limited screening and ECG. They received transthoracic echocardiography (TTE) to detect or exclude cardiac findings with relevance to sports participation. The performance of screening with history and examination only was compared with that of screening that integrated history, examination, and ECG.
Cardiac abnormalities with relevance to sports participation risk were observed on TTE in 11 of 510 participants (prevalence, 2.2%). Screening with history and examination alone detected abnormalities in 5 of these 11 athletes (sensitivity, 45.5% [95% CI, 16.8% to 76.2%]; specificity, 94.4% [CI, 92.0% to 96.2%]). Electrocardiography detected 5 additional participants with cardiac abnormalities (for a total of 10 of 11 participants), thereby improving the overall sensitivity of screening to 90.9% (CI, 58.7% to 99.8%). However, including ECG reduced the specificity of screening to 82.7% (CI, 79.1% to 86.0%) and was associated with a false-positive rate of 16.9% (vs. 5.5% for screening with history and examination only).
Definitive conclusions regarding the effect of ECG inclusion on sudden death rates cannot be made.
Adding ECG to medical history and physical examination improves the overall sensitivity of preparticipation cardiovascular screening in athletes. However, this strategy is associated with an increased rate of false-positive results when current ECG interpretation criteria are used.
None.
尽管建议运动员在参加运动前进行心血管筛查，但 12 导联心电图（ECG）的作用仍不确定。迄今为止，尚无比较筛查有无 ECG 的前瞻性数据。
比较仅基于病史和体检的参赛前筛查与整合这些因素与 ECG 的筛查策略的表现。
筛查策略的横断面比较。
马萨诸塞州剑桥市哈佛大学的大学健康服务。
510 名接受运动前心血管筛查的大学生运动员。
每位参与者都进行了常规的病史和体检受限筛查和 ECG。他们接受了经胸超声心动图（TTE）以检测或排除与运动相关的心脏发现。仅通过病史和体检进行筛查的表现与整合病史、体检和 ECG 的筛查进行了比较。
在 510 名参与者中，有 11 名（患病率 2.2%）参与者的 TTE 显示与运动相关的心脏异常。仅通过病史和体检进行筛查检测到其中 5 名运动员的异常（敏感性为 45.5%[95%CI，16.8%至 76.2%]；特异性为 94.4%[CI，92.0%至 96.2%]）。心电图检测到另外 5 名有心脏异常的参与者（总共 11 名参与者中的 10 名），从而将筛查的总敏感性提高到 90.9%（CI，58.7%至 99.8%）。然而，包括 ECG 会降低筛查的特异性至 82.7%（CI，79.1%至 86.0%），并伴有 16.9%的假阳性率（而仅通过病史和体检进行筛查的假阳性率为 5.5%）。
无法确定包括 ECG 对猝死率的影响的确定结论。
将 ECG 添加到病史和体检中可提高运动员参赛前心血管筛查的整体敏感性。然而，当使用当前的 ECG 解释标准时，这种策略与假阳性结果的发生率增加有关。
无。
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