Department of Internal Medicine, University of Virginia, Charlottesville, Virginia 22908, USA.
Heart Rhythm. 2011 May;8(5):721-7. doi: 10.1016/j.hrthm.2010.12.024. Epub 2010 Dec 17.
Electrocardiographic screening of intercollegiate athletes is controversial because the costs and yield are not well defined. Both the American Heart Association (AHA) and the European Society of Cardiology (ESC) have different criteria for screening, partly because the populations being screened are different.
The purpose of this study was to determine the cost and yield of a 5-year ECG screening program at a United States Division I college.
At the University of Virginia, all 1,473 competitive athletes over the course of 5 years were screened with history and physical and with ECGs using ESC guidelines with follow-up testing as dictated by clinical symptoms and ECG findings.
History and physical alone uncovered five significant cardiac abnormalities. ECGs were abnormal in 275 (19%), resulting in 359 additional tests. Additional testing confirmed eight significant cardiac abnormalities that were not found by history and physical: 1 bicuspid aortic valve, 4 rapidly conducting accessory pathways, 1 long QT patient, 1 with frequent premature ventricular contractions and low ejection fraction, and 1 with frequent premature ventricular contractions but normal ejection fraction. No cases of hypertrophic cardiomyopathy were found. Total cost of the program was US $894,870. Cost of history and physical screening alone was $343,725 or $68,745 per finding. The marginal cost of adding ECG screening, including resulting tests and procedures. was US$551,145 or US$68,893 per additional finding.
ECG screening of U.S. college athletes can uncover significant cardiac pathology not discovered by history and physical alone. Although ECG screening also results in many false positives resulting in additional tests, the overall cost per diagnosis of adding ECG screening is similar to that of history and physical screening alone.
对大学生运动员进行心电图筛查存在争议，因为其成本和收益尚未明确界定。美国心脏协会（AHA）和欧洲心脏病学会（ESC）都有不同的筛查标准，部分原因是筛查人群不同。
本研究旨在确定美国一级大学进行为期 5 年的心电图筛查计划的成本和收益。
在弗吉尼亚大学，在 5 年内对所有 1473 名竞技运动员进行了病史和体格检查，并使用 ESC 指南进行心电图检查，并根据临床症状和心电图检查结果进行后续检查。
仅病史和体格检查就发现了 5 种明显的心脏异常。心电图异常 275 例（19%），导致额外检查 359 项。进一步检查证实了 8 种未通过病史和体格检查发现的严重心脏异常：1 例二叶主动脉瓣、4 例快速传导旁路、1 例长 QT 患者、1 例频发室性早搏和低射血分数、1 例频发室性早搏但射血分数正常。未发现肥厚型心肌病。该计划的总成本为 894870 美元。仅病史和体格检查筛查的费用为 343725 美元，或每发现一个病变 68745 美元。添加心电图筛查（包括后续检查和操作）的边际成本为 551145 美元，或每增加一个额外发现物的成本为 68893 美元。
美国大学生运动员的心电图筛查可以发现仅通过病史和体格检查无法发现的严重心脏病理。尽管心电图筛查也会导致许多假阳性，导致额外检查，但添加心电图筛查的总体诊断成本与仅病史和体格检查筛查的成本相似。
