Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, Massachusetts, USA.
Am J Cardiol. 2012 Oct 1;110(7):1027-32. doi: 10.1016/j.amjcard.2012.05.035. Epub 2012 Jul 16.
Preparticipation screening of athletes with 12-lead electrocardiography has been promoted for the detection of asymptomatic cardiovascular disease, particularly hypertrophic cardiomyopathy (HC). Although false-positive electrocardiographic (ECG) results for HC are well recognized in athlete screening, expected false-negative rates are unknown. The aim of this study was to characterize the rate of false-negative ECG findings in a cohort of young asymptomatic patients with phenotypically expressed HC, defined by cardiovascular magnetic resonance, using the 2010 European Society of Cardiology recommended ECG criteria for the identification of suspected heart disease in trained athletes. Cardiac magnetic resonance studies and 12-lead electrocardiography were performed in 114 consecutive asymptomatic patients with HC aged ≤35 years (mean age 22 ± 8 years; 77% male patients). Electrocardiograms were analyzed to distinguish pathologic ECG patterns from alterations considered nonpathologic and physiologic consequences of athletic training. Among the 114 patients with HC, 103 (90%) demonstrated ≥1 pathologic ECG abnormality, while the remaining 11 patients (10%) had normal or nonpathologic ECG patterns and therefore defined a subgroup in whom ECG screening would not be expected to raise suspicion of heart disease (i.e., false-negative results). In this false-negative ECG results group, maximal left ventricular wall thickness was 17 ± 2 mm (range 15 to 21), compared to patients with pathologic ECG patterns, in whom maximal left ventricular wall thickness was 22 ± 5 mm (p = 0.003). In conclusion, a substantial minority of young asymptomatic patients with HC with phenotypically expressed left ventricular hypertrophy have nonpathologic ECG findings on the basis of the 2010 European Society of Cardiology guidelines. In principle, this high false-negative rate of 10% represents an important limitation in applying 12-lead electrocardiography to large, apparently healthy athletic populations for the detection of HC.
运动员的 12 导联心电图检查（Preparticipation screening of athletes with 12-lead electrocardiography）被用于筛查无症状性心血管疾病，尤其是肥厚型心肌病（Hypertrophic cardiomyopathy，HC）。虽然在运动员筛查中，人们已经充分认识到心电图（Electrocardiogram，ECG）对 HC 存在假阳性结果，但假阴性率尚未可知。本研究旨在描述使用 2010 年欧洲心脏病学会（European Society of Cardiology，ESC）推荐的 ECG 标准对有症状的、经心血管磁共振成像（Cardiovascular magnetic resonance，CMR）确诊的、表型表达的 HC 年轻无症状患者进行筛查时，假阴性心电图结果的发生率。共纳入 114 例年龄≤35 岁（平均年龄 22±8 岁，77%为男性）、无症状、有肥厚型心肌病的患者，对其进行 CMR 研究和 12 导联心电图检查。分析心电图以区分病理性心电图模式与被认为是非病理性的和运动训练的生理性结果。在 114 例 HC 患者中，103 例（90%）患者至少有 1 项病理性心电图异常，而其余 11 例（10%）患者心电图表现为正常或非病理性，因此定义为心电图检查不会怀疑患有心脏病的亚组（即假阴性结果）。在假阴性心电图结果组中，左心室壁最大厚度为 17±2mm（范围 15~21mm），而病理性心电图组左心室壁最大厚度为 22±5mm（p=0.003）。综上，在基于 2010 年 ESC 指南的情况下，年轻、无症状、有肥厚型心肌病且左心室肥厚有表型表达的患者中，相当一部分患者的心电图表现为非病理性。原则上，这一高达 10%的假阴性率在很大程度上限制了 12 导联心电图在大型、看似健康的运动员人群中用于检测 HC 的应用。
