Hyde Nicola, Prutkin Jordan M, Drezner Jonathan A
Department of Family Medicine, Sports Medicine Section, University of Washington, United States of America.
Department of Medicine, Division of Cardiology, University of Washington, United States of America.
J Electrocardiol. 2019 Sep-Oct;56:81-84. doi: 10.1016/j.jelectrocard.2019.07.001. Epub 2019 Jul 9.
Accurate electrocardiogram (ECG) interpretation in competitive athletes requires the distinction of physiological adaptations from findings suggestive of a pathological condition. The purpose of this study was to compare the performance of the Seattle Criteria to the International Criteria in a large dataset of NCAA athletes screened with an ECG.
ECGs from 5258 NCAA athletes who underwent prior ECG screening were re-examined by two experts in the field of sports cardiology and by ECG interpretation software by Cardea (© 2018 Cardiac Insight Inc.) using the Seattle and International Criteria. Each ECG was classified as normal or abnormal and the specific ECG abnormalities noted. Chi-squared analysis was used for statistical comparisons.
The total number of ECGs flagged as abnormal by expert over-read decreased from 158 (3.0%) using the Seattle Criteria to 83 (1.6%) using the International Criteria (p<0.0001). Likewise, the total number of abnormal ECGs using ECG interpretation software by Cardea decreased from 278 (5.3%) using Seattle Criteria programming compared to 134 (2.5%) using International Criteria programming (p<0.0001). The most common ECG abnormality by expert over-read using the International Criteria was T wave inversion 40 (48%). The newer definition of pathological Q waves reduced the number of ECGs flagged as abnormal from pathologic Q waves from 69 (Seattle) to 11 (International) (84% reduction; p<0.0001). Expert over-read using both criteria and both Cardea interpretation programs identified all 13 athletes with cardiac pathology associated with sudden cardiac death. Cardea software using the International Criteria had a higher false-positive rate (2.3%) than expert over-read (1.3%) (p=0.0001).
Use of the International Criteria for ECG interpretation significantly reduces the total abnormal and false-positive ECG rates compared to the Seattle Criteria without compromising sensitivity. Cardea interpretation software performs well and may be a useful tool to assist clinicians.
在竞技运动员中准确解读心电图（ECG）需要区分生理适应性变化与提示病理状况的表现。本研究的目的是在一个使用ECG筛查的大型美国全国大学体育协会（NCAA）运动员数据集中，比较西雅图标准与国际标准的性能。
由运动心脏病学领域的两位专家以及使用Cardea（©2018心脏洞察公司）的ECG解读软件，根据西雅图标准和国际标准，对5258名之前接受过ECG筛查的NCAA运动员的ECG进行重新检查。将每份ECG分类为正常或异常，并记录具体的ECG异常情况。采用卡方分析进行统计比较。
专家复查标记为异常的ECG总数，从使用西雅图标准时的158份（3.0%）降至使用国际标准时的83份（1.6%）（p<0.0001）。同样，使用Cardea的ECG解读软件时，使用西雅图标准编程的异常ECG总数为278份（5.3%），而使用国际标准编程时为134份（2.5%）（p<0.0001）。使用国际标准经专家复查最常见的ECG异常是T波倒置，共40例（48%）。病理性Q波的新定义使标记为病理性Q波异常的ECG数量从69份（西雅图标准）降至11份（国际标准）（减少84%；p<0.0001）。使用两种标准以及两种Cardea解读程序的专家复查都识别出了所有13名患有与心源性猝死相关的心脏疾病的运动员。使用国际标准的Cardea软件假阳性率（2.3%）高于专家复查（1.3%）（p=0.0001）。
与西雅图标准相比，使用国际标准解读ECG可显著降低总的异常ECG率和假阳性率，且不影响敏感性。Cardea解读软件表现良好，可能是协助临床医生的有用工具。
