Department of Cardiology, St Vincent's Hospital, Melbourne, Australia Department of Medicine St Vincent's, University of Melbourne, Melbourne, Australia.
Melbourne Heart Centre, Royal Melbourne Hospital, Melbourne, Australia.
Br J Sports Med. 2014 Aug;48(15):1144-50. doi: 10.1136/bjsports-2013-092420. Epub 2013 Jun 27.
In 2010, the European Society of Cardiology (ESC) released recommendations for the interpretation of the 12-lead ECG in athletes, dividing changes into group 1 (training related) and group 2 (training unrelated). Recently, the 'Seattle Criteria', a series of revisions to these recommendations, was published, with the aim of improving the specificity of ECG screening in athletes.
First, to assess the prevalence of ECG abnormalities in a cohort of elite Australian athletes using the 2010 ESC recommendations and determine how often group 2 ECG changes correlate with the evidence of significant cardiac pathology on further investigation. Second, to assess the impact of the 'Seattle Criteria' in reducing the number of athletes with ECG abnormalities in whom further cardiac testing is unremarkable ('false positives').
1197 elite athletes underwent cardiovascular screening between 2011 and 2012, of whom 1078 aged 16-35 years volunteered and were eligible to participate.
186 (17.3%) had an abnormal ECG according to ESC recommendations and a further 30 (2.8)% had unclassified changes. Three athletes (0.3%) were found to have a cardiac abnormality on further investigation. Using the Seattle Criteria, the number of athletes classified as abnormal fell to 48 (4.5%, p<0.0001) and the three with an underlying cardiac abnormality were still identified. The improved specificity was due to reclassification of 71 athletes (6.6%) with an equivocal QTc interval, 42 (3.9%) with T wave inversion isolated to V1-2 and 22 (2%) with either isolated right axis deviation or right ventricular hypertrophy on voltage criteria.
The 'Seattle Criteria' reduced the false-positive rate of ECG screening from 17% to 4.2%, while still identifying the 0.3% of athletes with a cardiac abnormality.
2010 年，欧洲心脏病学会（ESC）发布了有关运动员 12 导联心电图解读的建议，将变化分为 1 组（与训练相关）和 2 组（与训练无关）。最近，对这些建议进行了一系列修订的“西雅图标准”发布，旨在提高心电图筛查在运动员中的特异性。
首先，使用 2010 年 ESC 建议评估一组澳大利亚精英运动员的心电图异常发生率，并确定 2 组心电图变化与进一步调查中显著心脏病理学证据相关的频率。其次，评估“西雅图标准”在减少心电图异常且进一步心脏检查无异常的运动员数量（“假阳性”）方面的影响。
2011 年至 2012 年，对 1197 名精英运动员进行了心血管筛查，其中 1078 名年龄在 16-35 岁的运动员自愿且符合参与条件。
根据 ESC 建议，186 名（17.3%）运动员心电图异常，另有 30 名（2.8%）运动员心电图异常无法分类。进一步调查发现 3 名运动员（0.3%）有心脏异常。使用西雅图标准，分类为异常的运动员人数减少至 48 名（4.5%，p<0.0001），且仍识别出 3 名有潜在心脏异常的运动员。特异性的提高归因于重新分类了 71 名（6.6%）有可疑 QTc 间期的运动员、42 名（3.9%）V1-2 导联孤立性 T 波倒置的运动员和 22 名（2%）孤立性右轴偏离或右心室肥厚的运动员。
“西雅图标准”将心电图筛查的假阳性率从 17%降低至 4.2%，同时仍能识别出 0.3%有心脏异常的运动员。
