Dunn Tim, Abdelfattah Ramy, Aggarwal Sonya, Pickham David, Hadley David, Froelicher Victor
Stanford University Medical School, Stanford University, Stanford, CA.
Stanford University Medical School, Stanford University, Stanford, CA.
J Electrocardiol. 2015 May-Jun;48(3):395-8. doi: 10.1016/j.jelectrocard.2015.02.009. Epub 2015 Mar 4.
Screening athletes with ECGs is aimed at identifying "at-risk" individuals who may have a cardiac condition predisposing them to sudden cardiac death. The Seattle criteria highlight QRS duration greater than 140 ms and ST segment depression in two or more leads greater than 50 μV as two abnormal ECG patterns associated with sudden cardiac death.
High school, college, and professional athletes underwent 12 lead ECGs as part of routine pre-participation physicals. Prevalence of prolonged QRS duration was measured using cut-points of 120, 125, 130, and 140 ms. ST segment depression was measured in all leads except leads III, aVR, and V1 with cut-points of 25 μV and 50 μV.
Between June 2010 and November 2013, 1595 participants including 297 (167 male, mean age 16.2) high school athletes, 1016 (541 male, mean age 18.8) college athletes, and 282 (mean age 26.6) male professional athletes underwent screening with an ECG. Only 3 athletes (0.2%) had a QRS duration greater than 125 ms. ST segment depression in two or more leads greater than 50 μV was uncommon (0.8%), while the prevalence of ST segment depression in two or more leads increased to 4.5% with a cut-point of 25 μV.
Changing the QRS duration cut-point to 125 ms would increase the sensitivity of the screening ECG, without a significant increase in false-positives. However, changing the ST segment depression cut-point to 25 μV would lead to a significant increase in false-positives and would therefore not be justified.
对运动员进行心电图筛查旨在识别可能患有易导致心源性猝死的心脏疾病的“高危”个体。西雅图标准强调QRS波时限大于140毫秒以及两个或更多导联的ST段压低大于50微伏是与心源性猝死相关的两种异常心电图模式。
高中、大学和职业运动员接受12导联心电图检查作为常规赛前体检的一部分。使用120、125、130和140毫秒的切点测量QRS波时限延长的患病率。除III、aVR和V1导联外，在所有导联测量ST段压低，切点为25微伏和50微伏。
在2010年6月至2013年11月期间，1595名参与者接受了心电图筛查，其中包括297名（167名男性，平均年龄16.2岁）高中运动员、1016名（541名男性，平均年龄18.8岁）大学运动员和282名（平均年龄26.6岁）男性职业运动员。只有3名运动员（0.2%）的QRS波时限大于125毫秒。两个或更多导联的ST段压低大于50微伏并不常见（0.8%），而当切点为25微伏时，两个或更多导联的ST段压低患病率增至4.5%。
将QRS波时限切点改为125毫秒会提高筛查心电图的敏感性，而假阳性率不会显著增加。然而，将ST段压低切点改为25微伏会导致假阳性率显著增加，因此不合理。
