Brosnan Maria, La Gerche Andre, Kumar Saurabh, Lo Wilson, Kalman Jonathan, Prior David
Department of Cardiology, St. Vincent's Hospital, Fitzroy, Australia; St. Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia.
Department of Cardiology, St. Vincent's Hospital, Fitzroy, Australia; St. Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia.
Heart Rhythm. 2015 Jan;12(1):130-6. doi: 10.1016/j.hrthm.2014.09.060. Epub 2014 Oct 5.
Athlete ECG screening has been recommended by several international sporting bodies; however, a number of controversies remain regarding the accuracy of ECG screening. An important component that has not been assessed is the reproducibility of ECG interpretation.
The purpose of this study was to assess the variability of ECG interpretation among experienced physicians when screening a large number of athletes.
A sports cardiologist, a sports medicine physician, and an electrophysiologist analyzed 440 consecutive screening ECGs from asymptomatic athletes and were asked to classify the ECGs according to the 2010 European Society of Cardiology criteria as normal (or demonstrating training related ECG changes) or abnormal. When an abnormal ECG was identified, they were asked to outline what follow-up investigations they would recommend.
The reported prevalence of abnormal ECGs ranged from 13.4% to 17.5%. Agreement on which ECGs were abnormal ranged from poor (κ = 0.297) to moderate (κ = 0.543) between observers. Suggested follow-up investigations were varied, and follow-up costs ranged from an additional A$30-A$129 per screening episode. Neither of the 2 subjects (0.45%) in the cohort with significant pathology diagnosed as a result of screening were identified correctly by all 3 physicians.
Even when experienced physicians interpret athletes' ECGs according to current standards, there is significant interobserver variability that results in false-positive and false-negative results, thus reducing the effectiveness and increasing the social and economic cost of screening.
多个国际体育组织已建议对运动员进行心电图筛查；然而，关于心电图筛查的准确性仍存在一些争议。一个尚未评估的重要因素是心电图解读的可重复性。
本研究的目的是评估经验丰富的医生在筛查大量运动员时心电图解读的变异性。
一名运动心脏病专家、一名运动医学医生和一名电生理学家分析了440例无症状运动员的连续筛查心电图，并要求他们根据2010年欧洲心脏病学会标准将心电图分类为正常（或显示与训练相关的心电图变化）或异常。当识别出异常心电图时，要求他们概述建议的后续检查。
报告的异常心电图患病率在13.4%至17.5%之间。观察者之间对哪些心电图异常的一致性从差（κ = 0.297）到中等（κ = 0.543）不等。建议的后续检查各不相同，每次筛查的后续成本在30澳元至129澳元之间。在筛查中诊断出有重大病理结果的队列中的2名受试者（0.45%）均未被所有3名医生正确识别。
即使经验丰富的医生按照现行标准解读运动员的心电图，观察者之间仍存在显著的变异性，这会导致假阳性和假阴性结果，从而降低筛查的有效性并增加筛查的社会和经济成本。
