Perrin Tilman, Trachsel Lukas Daniel, Schneiter Simon, Menafoglio Andrea, Albrecht Silvia, Pirrello Tony, Eser Prisca, Roten Laurent, Gojanovic Boris, Wilhelm Matthias
Department of Cardiology and Interdisciplinary Centre for Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
Clinic for Cardiology, Ospedale San Giovanni, Bellinzona, Switzerland.
Swiss Med Wkly. 2016 Dec 19;146:w14376. doi: 10.4414/smw.2016.14376. eCollection 2016.
Sudden cardiac arrest in athletes is a rare but dramatic event. The value of a routine electrocardiogram (ECG) during preparticipation screening (PPS) remains controversial, partly because of the relatively high number of false positive findings. Our study aimed to evaluate the prevalence of abnormal ECGs in consecutive Swiss elite athletes, overall and with regard to different sports classes, using modern screening criteria.
We analysed the 12-lead resting ECGs of high-level elite athletes (age ≥14 years) recorded at the Swiss Olympic Medical Centre Magglingen between 2013 and 2016 during routine PPS. The overall prevalence of abnormal ECGs was evaluated and compared in accordance with the original and revised Seattle criteria. Sports disciplines were categorised according to their static (estimated percentage of maximal voluntary contraction, I-III) and dynamic (estimated percentage of maximal oxygen uptake, A-C) components, and the prevalence of abnormal ECGs compared between sports classes by Fisher's exact test (with alpha set at 0.05).
ECGs from 287 consecutive athletes were analysed (64.1% male; 99.7% Caucasian; median age 20.4 ± 4.9 years; median weekly training volume 17.7 ± 7.1 hours). Based on original Seattle criteria, eight (2.8%) ECGs were classified as abnormal: three T-wave inversion (TWI), one Q-wave duration >40 ms, two QRS left axis deviation, two Q-wave amplitude >3 mm. The use of the revised Seattle criteria reduced the number of abnormal ECGs to four (1.4%): three TWI, one Q-wave duration >40 ms. Further cardiological work-up revealed an underlying structural heart disease in only one of these four athletes (inferolateral TWI on ECG), consisting of very localised mid-wall fibrosis suggestive of former myocarditis. There was a significant difference in occurrence of abnormal ECGs between the different sports categories (p = 0.018). All four abnormal ECGs according to the revised Seattle criteria occurred in the high dynamic sport classes (IIC and IIIC); three out of the four were found in the high dynamic high static class (IIIC).
In our cohort of high-level elite athletes, the prevalence of abnormal ECGs according to modern screening criteria was very low. All athletes with an abnormal ECG performed high dynamic sports. Less than one percent of our athletes had a new relevant cardiac diagnosis.
运动员心脏骤停是一种罕见但严重的事件。参与前筛查（PPS）期间常规心电图（ECG）的价值仍存在争议，部分原因是假阳性结果相对较多。我们的研究旨在使用现代筛查标准评估连续的瑞士精英运动员中总体及不同运动类别中心电图异常的患病率。
我们分析了2013年至2016年期间在瑞士奥林匹克医学中心马格林根进行常规PPS时记录的高水平精英运动员（年龄≥14岁）的12导联静息心电图。根据原始和修订的西雅图标准评估并比较心电图异常的总体患病率。运动项目根据其静态（最大自主收缩估计百分比，I - III）和动态（最大摄氧量估计百分比，A - C）成分进行分类，并通过Fisher精确检验（α设定为0.05）比较不同运动类别之间心电图异常的患病率。
分析了连续287名运动员的心电图（男性占64.1%；白种人占99.7%；年龄中位数20.4±4.9岁；每周训练量中位数17.7±7.1小时）。根据原始西雅图标准，8份（2.8%）心电图被分类为异常：3份T波倒置（TWI），1份Q波时限>40毫秒，2份QRS电轴左偏，2份Q波振幅>3毫米。使用修订的西雅图标准后，异常心电图数量减少至4份（1.4%）：3份TWI，1份Q波时限>40毫秒。进一步的心脏检查仅在这4名运动员中的1名（心电图显示下外侧TWI）发现了潜在的结构性心脏病，表现为非常局限的中层心肌纤维化，提示既往心肌炎。不同运动类别之间心电图异常的发生率存在显著差异（p = 0.018）。根据修订的西雅图标准，所有4份异常心电图均出现在高动态运动类别（IIC和IIIC）中；4份中有3份出现在高动态高静态类别（IIIC）中。
在我们的高水平精英运动员队列中，根据现代筛查标准，心电图异常的患病率非常低。所有心电图异常的运动员都从事高动态运动。我们的运动员中不到1%有新的相关心脏诊断。
