Abstract 10805: Does the 12-lead ECG Have Limitations in Detecting Hypertrophic Cardiomyopathy in the Pre-Participation Screening of Athletes?
Background. Pre-participation screening of athletes with 12-lead electrocardiograms (ECGs) has been recommended for detection of asymptomatic cardiovascular disease, particularly hypertrophic cardiomyopathy (HCM). However, while false positive rates of 10-20% have been recognized for HCM, the false negative rates are unkown.
Objective: We assessed the accuracy of recommended ECG screening criteria for suspected heart disease in trained athletes (based on recent European Society of Cardiology [ESC] recommendations), in a large cohort of patients with HCM studied by cardiovascular magnetic resonance (CMR), an imaging technique that allows for precise assessment of left ventricular hypertrophy (LVH).
Design and Setting. CMR and 12-lead ECGs were obtained in 343 HCM patients (41±17 years; 71% male). ECGs were analyzed according to recent ESC recommendations for distinguishing normal from pathologic ECG patterns in athletes. Non-pathologic ECGs were either within normal limits or demonstrated changes regarded consistent with physiologic alterations of athletic training.
Results. Among 343 HCM patients, 308 (90%) demonstrated ≥1 pathologic ECG abnormality, including Romhilt-Estes criteria for LVH in 197 (57%), ST-T wave changes in 181 (53%), and abnormal Q waves in 129 (38%). The remaining 35 patients (10%) had normal ECGs or non-pathologic variants and therefore defined a subgroup of HCM patients in whom screening ECGs would have failed to raise suspicion of heart disease (i.e., false negatives). Of those HCM patients with false negative ECGs, maximal LV wall thickness was 19 ± 3 mm (range, 13 to 26) and LV outflow tract obstruction (≥30 mmHg) was present in 7 (20%); 15 (43%) were <40 years of age. Patients with or without pathologic ECGs did not differ with respect to age, gender, or presence of obstruction, however, maximal LV wall thickness was lower in HCM patients without pathologic ECG abnormalities (19 ± 3 mm vs 22 ± 5mm; p<0.01).
Conclusions. We identified an important proportion of patients with HCM (10%) in whom suspicion of disease would not likely have been raised by screening ECG testing. This high false negative rate represents a limitation with respect to 12-lead ECG screening in large athletic populations.
- © 2011 by American Heart Association, Inc.