Abstract 877: Electrocardiography versus Echocardiography in High-volume, Community-based Screening for Potentially Life-threatening Cardiac Pathologies in Athletes: Implications for Optimal Screening Strategies
Background: Sudden death in the young is devastating to the community and screening for life threatening cardiac pathologies is becoming popular. However, screening strategies differ widely. There are conflicting data and differences of opinion in the medical community as to the relative value of electrocardiography (EKG) and echocardiography (ECHO) for screening.
Methods: We implemented a standardized protocol with a detailed medical questionnaire, heart auscultation, 12 lead EKG, blood pressure measurement and a limited ECHO in 216 consecutive high school athletes participating in the Maryland State Track and Field Championship meet. ECHOs were performed by certified sonographers trained on the protocol consisting of limited standard views, and color flow Doppler of all valves. ECHO and EKGs were supervised and interpreted by board certified echocardiographers and cardiac electrophysiologists.
Results: Complete data were available in 134 athletes, mean age was 18±5yrs for boys (92/69%) and 17±4yrs for girls (42/31%). All participants were asymptomatic and did not have previous history of cardiac disease. Abnormal findings were found in 36 (27%) athletes of which 22 (61%) had EKG only, 9 (25%) had ECHO only and 5 (13%) had both EKG and ECHO abnormality. The concordance between EKG and echocardiography abnormality was low (kappa=0.12;p=NS). Twenty-two athletes with EKG abnormalities did not have ECHO abnormality and 9 athletes with normal EKG had abnormal ECHOs. No significant valvular abnormalities or cardiac pathologies were discovered and no athlete needed immediate medical attention.
Conclusions: In a high-volume, community-based screenings for heart disease, there is low concordance between EKG and echocardiographic abnormalities. Notably, a fair proportion (9%) of subjects with normal EKG had echocardiographic abnormalities. Screening strategies that implement EKG alone may not capture the full spectrum of cardiac abnormalities in athletes. Since the long-term consequences of these abnormal findings is unclear, using both EKG and ECHO for screening is more likely to detect the prevalent abnormalities and may be a more prudent approach.