Cardiology Department, G. Da Saliceto Hospital, Piacenza, Italy; Sport and Exercise Medicine, Cardiocentro Ticino, Lugano, Switzerland.
Cardiovascular Intensive Care Unit, Cardiocentro Ticino, Lugano, Switzerland.
Int J Cardiol. 2021 Jul 15;335:40-46. doi: 10.1016/j.ijcard.2021.04.019. Epub 2021 Apr 12.
Electrocardiographic (ECG) pre-participation screening(PPS) can prevent sudden cardiac death(SCD) but the Interpretation of the athlete's ECG is based on specific criteria addressed for adult athletes while few data exist about the pediatric athlete's ECG. We aimed to assess the features of pediatric athletes' ECG and compared the diagnostic performance of 2017 International ECG recommendation, 2010 European Society of Cardiology recommendation and 2013-Seattle criteria in detecting clinical conditions at risk of SCD.
886 consecutive pediatric athletes (mean age 11.7 ± 2.5 years; 7-16-years) were enrolled and prospectively evaluated with medical history, physical examination, resting and exercise ECG and transthoracic echocardiography during their PPS.
The most common physiological ECG patterns in pediatric athletes were isolated left ventricular hypertrophy criteria (26.9%), juvenile T-wave pattern (22%) and early repolarization pattern (13.2%). The most frequent borderline abnormalities were left axis deviation (1.8%) and right axis deviation (0.9%) while T-wave inversion (0.8%) especially located in inferior leads (0.7%) was the most prevalent abnormal findings. Seven athletes (0.79%) were diagnosed with a condition related to SCD. Compared to Seattle and ESC, the International improved ECG specificity (International = 98% ESC = 64% Seattle = 95%) with lower sensitivity (ESC and Seattle 86%vs International 57%). The false-positive rate decreases from 36% of ESC to 2.2% of International but the latter showed a higher false-negative rate(0.34%).
Pediatric athletes like the adult counterpart exhibit a high prevalence of ECG abnormalities mostly representing training-related ECG adaptation. The International criteria showed a lower false-positive rate but at the cost of loss of sensitivity.
心电图（ECG）赛前筛查（PPS）可以预防心源性猝死（SCD），但运动员心电图的解读是基于针对成年运动员的特定标准，而关于儿科运动员心电图的数据较少。我们旨在评估儿科运动员心电图的特征，并比较 2017 年国际 ECG 推荐、2010 年欧洲心脏病学会推荐和 2013 年西雅图标准在检测 SCD 风险临床情况方面的诊断性能。
886 例连续的儿科运动员（平均年龄 11.7 ± 2.5 岁；7-16 岁）在 PPS 期间接受了病史、体格检查、静息和运动心电图以及经胸超声心动图的前瞻性评估。
儿科运动员最常见的生理性心电图模式是孤立性左心室肥厚标准（26.9%）、青少年 T 波模式（22%）和早期复极模式（13.2%）。最常见的边界异常是左轴偏离（1.8%）和右轴偏离（0.9%），而 T 波倒置（0.8%）特别是在下导（0.7%）最为常见。7 名运动员（0.79%）被诊断为与 SCD 相关的疾病。与西雅图和 ESC 相比，国际标准提高了 ECG 的特异性（国际=98%，ESC=64%，西雅图=95%），但敏感性降低（ESC 和西雅图为 86%，国际为 57%）。ESC 的假阳性率从 36%降至国际标准的 2.2%，但后者的假阴性率（0.34%）较高。
儿科运动员与成年运动员一样，心电图异常的发生率很高，主要代表与训练相关的心电图适应性。国际标准的假阳性率较低，但敏感性降低。
