Department of Medicine, Queen's University, Kingston, Ontario, Canada.
Division of Cardiology and Sports Cardiology BC, University of British Columbia, Vancouver, British Columbia, Canada.
J Electrocardiol. 2023 Nov-Dec;81:36-40. doi: 10.1016/j.jelectrocard.2023.07.007. Epub 2023 Jul 22.
Electrocardiogram (ECG) testing in pre-participation screening (PPS) remains controversial due to its cost, resource dependency, and the potential for inaccurate interpretations. At most centres, ECGs are conducted internally by providers trained in athletic ECG interpretation. Outsourcing ECG requisitions to an athlete's primary care network (PCN) may reduce institutional demands. This study compared PCN-conducted athletic ECG interpretation to expert sports cardiology interpretation.
This was a retrospective, single-centre chart-review study of all athletes who underwent cardiovascular PPS between 2017 and 2021. All athletes submitted an ECG with their screening package, which was conducted and interpreted within their PCN. All ECGs were reinterpreted by a sports cardiologist using the International Criteria (IC) for electrocardiographic interpretation in athletes. Overall, positive, and negative percent agreement were used to compare PCN-conducted ECG interpretation with IC interpretation.
A total of 740 athletes submitted a screening package with a valid ECG (mean age: 18.5 years, 39.6% female). PCN-conducted ECGs were interpreted by 181 unique physicians. Among 41 (5.5%) PCN-conducted ECGs that were initially interpreted as abnormal, only 5 (0.7%) were classified as abnormal according to the IC. All PCN-conducted ECGs reported as normal were also classified as normal according to the IC. The overall agreement between PCN-conducted and IC ECG interpretation was 95.1% (positive percent agreement: 100%, negative percent agreement: 95.1%).
Normal PCN-conducted athletic ECGs are interpreted with high agreement to the IC. Majority of PCN-conducted ECGs interpreted as abnormal are indeed normal as per the IC. These findings suggest that a PPS workflow model that outsources ECG requisitions to a PCN may be a reliable approach to PPS, all while reducing screening-related institutional costs and resource requirements.
由于心电图（ECG）测试的成本、资源依赖性以及可能存在不准确的解释，在参赛前筛查（PPS）中仍存在争议。在大多数中心，ECG 由接受过运动心电图解读培训的提供者进行内部检测。将心电图申请外包给运动员的初级保健网络（PCN）可能会降低机构需求。本研究比较了 PCN 进行的运动心电图解读与专家运动心脏病学解读。
这是一项回顾性的单中心图表回顾研究，涉及所有 2017 年至 2021 年间接受心血管 PPS 的运动员。所有运动员在其筛查包中提交了一份心电图，该心电图在他们的 PCN 中进行并解释。所有心电图均由一名运动心脏病专家使用运动员心电图解读的国际标准（IC）重新解读。总体、阳性和阴性百分比一致性用于比较 PCN 进行的心电图解读与 IC 解读。
共有 740 名运动员提交了一份包含有效心电图的筛查包（平均年龄：18.5 岁，女性占 39.6%）。PCN 进行的心电图由 181 名独特的医生进行解读。在最初被解读为异常的 41 份（5.5%）PCN 进行的心电图中，只有 5 份（0.7%）根据 IC 被归类为异常。所有被 PCN 报告为正常的心电图也根据 IC 被归类为正常。PCN 进行的和 IC 心电图解读之间的总体一致性为 95.1%（阳性百分比一致性：100%，阴性百分比一致性：95.1%）。
根据 IC，正常的 PCN 进行的运动心电图解读具有高度一致性。根据 IC，大多数被 PCN 解读为异常的心电图实际上是正常的。这些发现表明，将心电图申请外包给 PCN 的 PPS 工作流程模型可能是一种可靠的 PPS 方法，同时降低了与筛查相关的机构成本和资源需求。
