Abstract 4129: Addition of the Electrocardiogram to the Pre-participation Examination of College Athletes
Background: While the use of standardized, cardiovascular system-focused history and physical examination are recommended for the pre-participation examination (PPE) of young athletes, the addition of the 12-lead electrocardiogram (ECG) has been controversial. Since the impact of ECG screening on college athletes has rarely been reported, we analyzed the findings of adding the ECG to the PPE of Stanford student-athletes in 2007.
Methods: For the past 15 years, the Stanford Sports Medicine program has mandated a web-based PPE questionnaire and physical exam by Stanford physicians for participation in intercollegiate athletics. During the 2007 PPE, computerized ECGs were recorded on all athletes and entered into a database. ECGs were overread by a senior cardiologist (VF) and digital measurements taken.
Results: Six-hundred fifty three recordings were obtained (54% male, 7% African-American, mean age 20 years) representing 19 sports. While 52% of the women had completely normal ECGs, only 20% of the men did so. Voltage criteria for LVH were found in 50% of ECGs; however only 4% had a Romhilt-Estes score of 2 or greater. Atrial and Q wave abnormalities and ST depression were each present in 3%. Early repolarization occurred in 38% and was twice as common in men as women, while T wave inversion in V2 and V3 occurred in 7% and was twice as common in women. Incomplete RBBB occurred in 13% while RBBB occurred in 8 men (2%). Sixty-five athletes (10%) were judged to have distinctly abnormal ECG findings suggestive of arrhythmogenic right ventricular dysplasia, hypertrophic cardiomyopathy (HCM) and/or biventricular hypertrophy. These athletes will be submitted to further testing.
Conclusions: With volunteer help, mass ECG screening is readily achievable within the collegiate setting. Our rate of secondary testing suggests the need for an evaluation of cost effectiveness. Applying digital pattern recognition algorithms to large cohorts of athletes and patients with HCM will facilitate a more nuanced approach to the pre-participation ECG and reduce costs.