Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy.
Department of Cardiac, Thoracic and Vascular Sciences, Biostatistics, Epidemiology and Public Health Unit, University of Padova, Padova, Italy.
Scand J Med Sci Sports. 2019 Sep;29(9):1375-1382. doi: 10.1111/sms.13457. Epub 2019 May 29.
Although both European (EACPR) and American (ACSM) Scientific Societies have devised cardiovascular protocols for the assessment of "middle-aged/older" individuals who are about to participate in sports or physical exercise, there are no data regarding the guidelines' sensitivity of these measures. The aim of this study was to compare the outcomes of different international screening protocols.
This observational cross-sectional study evaluated 525 subjects (80% males; median age 50 [35-85] years) seeking medical certification before participating in sports or regular exercise. The screening protocol consisted in completing a personal history profile, a physical examination, a resting ECG, a maximal exercise test, and, when required, additional instrumental evaluations. The effectiveness of the current EACPR as well as the former and new ACSM guidelines was thereby analyzed.
The full screening protocol uncovered 100 previously undetected cardiovascular conditions (main pathologies detected: 21 coronary artery disease (CAD), 14 arterial hypertension, 38 complex arrhythmias). When the European guideline was used, 49% of these conditions went undetected, including 10 CAD. When the former American guideline was used, 29% (6 CAD) went undetected; when the recently updated edition was used, 50% including 11 CAD went undetected.
The former ACSM guideline demonstrated a higher diagnostic sensitivity than the newer version and the EACPR guideline. Current screening protocols might be adapted for subjects performing high-intensity exercise due to their higher risk for cardiovascular and exercise-associated adverse events. The use of an incremental ECG-monitored maximal exercise test seems to improve these screening outcomes.
尽管欧洲（EACPR）和美国（ACSM）科学协会都制定了心血管评估方案，用于评估即将参加运动或体育锻炼的“中年/老年”个体，但这些方案的敏感性数据尚不清楚。本研究旨在比较不同国际筛查方案的结果。
本观察性横断面研究评估了 525 名受试者（80%为男性；中位数年龄 50[35-85]岁），他们在参加运动或常规锻炼前寻求医学认证。筛查方案包括填写个人病史档案、体格检查、静息心电图、最大运动测试，以及在需要时进行额外的仪器评估。分析了现行 EACPR 以及旧版和新版 ACSM 指南的有效性。
完整的筛查方案发现了 100 种先前未被发现的心血管疾病（主要检测到的病理：21 例冠状动脉疾病（CAD），14 例动脉高血压，38 例复杂心律失常）。当使用欧洲指南时，这些疾病中有 49%未被发现，包括 10 例 CAD。当使用旧版美国指南时，29%（6 例 CAD）未被发现；当使用最近更新的版本时，50%（包括 11 例 CAD）未被发现。
旧版 ACSM 指南的诊断敏感性高于新版和 EACPR 指南。由于其心血管和与运动相关的不良事件风险较高，当前的筛查方案可能需要针对进行高强度运动的受试者进行调整。使用递增式心电图监测最大运动测试似乎可以改善这些筛查结果。
