Department of Pediatrics, Mayo Clinic, Rochester, Minnesota, USA.
Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA.
Br J Sports Med. 2016 Jan;50(2):105-10. doi: 10.1136/bjsports-2015-094880.
In athletes, ECG changes from physiological cardiac remodelling are common but can overlap with findings from a pathological disorder. We compared ECG findings in a group of elite high school athletes to a cohort of adolescents with hypertrophic cardiomyopathy (HCM).
METHODS/RESULTS: We prospectively performed 15-lead ECGs and echocardiograms in 147 elite high school athletes. Student-athlete ECGs were compared in blinded fashion to ECGs of 148 adolescents with HCM of similar age and ethnicity. Standard ECG hypertrophy criteria and established expert opinion guidelines (European Society of Cardiology, ESC and Seattle criteria) were analysed. All student-athletes had normal echocardiograms. Overall, 77/147 (52%) of student-athletes met standard ECG criteria for ventricular hypertrophy compared to 126/148 (85%) adolescents with HCM (p<0.0001). There were 112/148 (76%) adolescents with HCM who had pathological Q-waves, T-wave inversion and/or ST-segment depression compared to 1/147 (1%) athletes (p<0.0001). Most patients with HCM (84%, 124/148) had ≥1 abnormal ECG finding(s) according to Seattle criteria, compared to 1% of student-athletes (2/147). Similarly, 130/148 (88%) patients with HCM met group-2 ESC criteria (abnormal), compared to 36/147 (24%) student-athletes (p<0.0001).
Over 50% of elite high school athletes with echocardiographically confirmed normal hearts satisfied standard voltage criteria for ventricular hypertrophy. Pathological Q-waves, T-wave inversion or ST-segment depression were most helpful in distinguishing adolescents with HCM from normals. Both ESC and Seattle criteria successfully stratified the student-athlete and HCM cohorts, however each had a false-negative rate >10% for the HCM cohort. The Seattle criteria demonstrated a significantly lower false-positive rate (1%) than the ESC criteria (24%).
在运动员中，心电图的变化源于生理性心脏重塑，较为常见，但可能与病理性疾病的发现相重叠。我们比较了一组精英高中生运动员和肥厚型心肌病（HCM）青少年患者的心电图结果。
方法/结果：我们前瞻性地对 147 名精英高中生运动员进行了 15 导联心电图和超声心动图检查。以盲法比较了运动员的心电图和年龄、种族相匹配的 148 例 HCM 青少年的心电图。分析了标准心电图肥厚标准和既定专家意见指南（欧洲心脏病学会，ESC 和西雅图标准）。所有学生运动员的超声心动图均正常。总体而言，与 148 例 HCM 青少年（85%）相比，147 名运动员中有 77/147（52%）符合标准心电图心室肥厚标准（p<0.0001）。与 147 名运动员（1%）相比，148 例 HCM 青少年中有 112/148（76%）有病理性 Q 波、T 波倒置和/或 ST 段压低（p<0.0001）。根据西雅图标准，大多数 HCM 患者（84%，124/148）有≥1 项异常心电图发现，而运动员仅有 1%（2/147）（p<0.0001）。同样，130/148（88%）HCM 患者符合 ESC 组 2 标准（异常），而运动员仅有 36/147（24%）（p<0.0001）。
超过 50%的超声心动图证实心脏正常的精英高中生运动员符合心室肥厚的标准电压标准。病理性 Q 波、T 波倒置或 ST 段压低最有助于将 HCM 青少年与正常人区分开来。ESC 和西雅图标准均成功地对运动员和 HCM 队列进行了分层，但每个标准对 HCM 队列的假阴性率均>10%。西雅图标准的假阳性率（1%）明显低于 ESC 标准（24%）。
