Dores Hélder, Ferreira Santos José, Dinis Paulo, Moscoso Costa Francisco, Mendes Lígia, Monge José, Freitas António, de Araújo Gonçalves Pedro, Cardim Nuno, Mendes Miguel
Departamento de Cardiologia, Hospital da Luz, Lisboa, Portugal; Departamento de Cardiologia, Hospital da Luz, Setúbal, Portugal; Serviço de Cardiologia, Hospital das Forças Armadas, Lisboa, Portugal; Serviço de Cardiologia, Hospital de Santa Cruz, Carnaxide, Portugal; NOVA Medical School, Lisboa, Portugal.
Departamento de Cardiologia, Hospital da Luz, Setúbal, Portugal.
Rev Port Cardiol. 2017 Jun;36(6):443-449. doi: 10.1016/j.repc.2016.07.013. Epub 2017 Jun 7.
Assessment of the electrocardiogram (ECG) in athletes remains controversial, with lack of standardization and difficulty in applying specific criteria in its interpretation. The purpose of this study was to assess variability in the interpretation of the ECG in athletes.
Twenty ECGs of competitive athletes were assessed by cardiologists and cardiology residents, 11 of them normal or with isolated physiological changes and nine pathological. Each ECG was classified as normal/physiological or pathological, with or without the use of specific interpretation criteria.
The study presents responses from 58 physicians, 42 (72.4%) of them cardiologists. Sixteen (27.6%) physicians reported that they regularly assessed athletes and 32 (55.2%) did not use specific ECG interpretation criteria, of which the Seattle criteria were the most commonly used (n=13). Each physician interpreted 15±2 ECGs correctly, corresponding to 74% of the total number of ECGs (variation: 45%-100%). Interpretation of pathological ECGs was correct in 68% (variation: 22%-100%) and of normal/physiological in 79% (variation: 55%-100%). There was no significant difference in interpretation between cardiologists and residents (74±10% vs. 75±10%; p=0.724) or between those who regularly assessed athletes and those who did not (77±12% vs. 73±9%; p=0.286), but there was a trend for a higher rate of correct interpretation using specific criteria (77±10% vs. 72±10%; p=0.092). The reproducibility of the study was excellent (intraclass correlation coefficient=0.972; p<0.001).
A quarter of the ECGs were not correctly assessed and variability in interpretation was high. The use of specific criteria can improve the accuracy of interpretation of athletes' ECGs, which is an important part of pre-competitive screening, but one that is underused.
对运动员心电图（ECG）的评估仍存在争议，缺乏标准化且在解读中应用特定标准存在困难。本研究的目的是评估运动员心电图解读的变异性。
心脏病专家和心脏病学住院医师对20份竞技运动员的心电图进行了评估，其中11份正常或有孤立的生理变化，9份为病理性。每份心电图被分类为正常/生理性或病理性，无论是否使用特定的解读标准。
该研究呈现了58位医生的回复，其中42位（72.4%）是心脏病专家。16位（27.6%）医生报告他们定期评估运动员，32位（55.2%）未使用特定的心电图解读标准，其中西雅图标准是最常用的（n = 13）。每位医生正确解读了15±2份心电图，占心电图总数的74%（变异范围：45% - 100%）。病理性心电图的解读正确率为68%（变异范围：22% - 100%），正常/生理性心电图的解读正确率为79%（变异范围：55% - 100%）。心脏病专家和住院医师之间（74±10%对75±10%；p = 0.724）或定期评估运动员的医生和未定期评估的医生之间（77±12%对73±9%；p = 0.286）在解读上没有显著差异，但使用特定标准时正确解读率有更高的趋势（77±10%对72±10%；p = 0.092）。该研究的可重复性极佳（组内相关系数 = 0.972；p < 0.001）。
四分之一的心电图未得到正确评估，解读的变异性很高。使用特定标准可提高运动员心电图解读的准确性，这是赛前筛查的重要部分，但目前使用不足。
