1 Sports Medicine Section Department of Family Medicine University of Washington Seattle WA.
2 Department of Sports Medicine Hospital of Special Surgery New York NY.
J Am Heart Assoc. 2019 Jul 16;8(14):e012235. doi: 10.1161/JAHA.119.012235. Epub 2019 Jul 9.
Background Preparticipation cardiovascular screening in athletes is fully endorsed by major medical societies, yet the most effective screening protocol remains debated. We prospectively compared the performance of the American Heart Association ( AHA ) 14-point screening evaluation and a resting ECG for cardiovascular screening of high school athletes. Methods and Results Competitive athletes participating in organized high school or premier/select level sports underwent cardiovascular screening using the AHA 14-point history and physical examination, and an ECG interpreted with the Seattle Criteria. A limited echocardiogram was performed for all screening abnormalities. The primary outcome measure was identification of a cardiovascular disorder associated with sudden cardiac death. From October 2014 to June 2017, 3620 high school athletes (median age, 16 years; range 13-19; 46.2% female; 78.6% white, 8.0% black) were screened. One or more positive responses to the AHA 14-point questionnaire were present in 814 (22.5%) athletes. The most common history responses included chest pain (8.1%), family history of inheritable conditions (7.3%), and shortness of breath (6.4%). Abnormal physical examination was present in 356 (9.8%) athletes, and 103 (2.8%) athletes had an abnormal ECG . Sixteen (0.4%) athletes had conditions associated with sudden cardiac death. The sensitivity (18.8%), specificity (68.0%), and positive predictive value (0.3%) of the AHA 14-point evaluation was substantially lower than the sensitivity (87.5%), specificity (97.5%), and positive predictive value (13.6%) of ECG . Conclusions The AHA 14-point evaluation performs poorly compared with ECG for cardiovascular screening of high school athletes. The use of consensus-derived history questionnaires as the primary tool for cardiovascular screening in athletes should be reevaluated.
运动员参加赛前心血管筛查得到了主要医学协会的全面支持，但最有效的筛查方案仍存在争议。我们前瞻性地比较了美国心脏协会（AHA）14 点筛查评估和静息心电图在高中运动员心血管筛查中的表现。
参加有组织的高中或顶级/精选水平运动的竞技运动员接受了 AHA 14 点病史和体格检查以及西雅图标准解释的心电图心血管筛查。对所有筛查异常均进行了有限的超声心动图检查。主要结局指标是确定与心源性猝死相关的心血管疾病。从 2014 年 10 月至 2017 年 6 月，共对 3620 名高中运动员（中位数年龄为 16 岁，范围为 13-19 岁；46.2%为女性；78.6%为白人，8.0%为黑人）进行了筛查。AHA 14 点问卷有一个或多个阳性反应的运动员有 814 名（22.5%）。最常见的病史反应包括胸痛（8.1%）、遗传性疾病家族史（7.3%）和呼吸急促（6.4%）。体格检查异常的运动员有 356 名（9.8%），心电图异常的运动员有 103 名（2.8%）。有 16 名（0.4%）运动员患有与心源性猝死相关的疾病。AHA 14 点评估的敏感性（18.8%）、特异性（68.0%）和阳性预测值（0.3%）明显低于心电图的敏感性（87.5%）、特异性（97.5%）和阳性预测值（13.6%）。
与心电图相比，AHA 14 点评估在高中运动员心血管筛查中的表现较差。应重新评估使用共识得出的病史问卷作为运动员心血管筛查的主要工具。
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