Comparison of ECG Criteria for the Detection of Cardiac Abnormalities in Elite Black and White Athletes
Background—Recent efforts have focused on improving specificity of the European Society of Cardiology (ESC) criteria for ECG interpretation in athletes. These criteria are derived predominantly from white athletes (WAs) and do not account for the effect of Afro-Caribbean ethnicity or novel research questioning the relevance of several isolated ECG patterns. We assessed the impact of the ESC criteria, newly published Seattle criteria and a group of proposed refined criteria in a large cohort of black athletes (BAs) and WAs.
Methods and Results—Between 2000-2012, 1208 BAs were evaluated with history, examination, 12-lead ECG and further investigations as appropriate. Electrocardiograms were retrospectively analysed according to the ESC recommendations, Seattle criteria, and proposed refined criteria which exclude several specific ECG patterns when present in isolation. All 3 criteria were also applied to 4297 WAs and 103 young athletes with hypertrophic cardiomyopathy (HCM). The ESC recommendations raised suspicion of a cardiac abnormality in 40.4% of BAs and 16.2% of WAs. The Seattle criteria reduced abnormal ECGs to 18.4% in BAs and 7.1% in WAs. The refined criteria further reduced abnormal ECGs to 11.5% in BAs and 5.3% in WAs. All 3 criteria identified 98.1% of athletes with HCM. Compared to ESC recommendations, the refined criteria improved specificity from 40.3% to 84.2% in BAs and from 73.8% to 94.1% in WAs without compromising the sensitivity of the ECG in detecting pathology.
Conclusions—Refinement of current ECG screening criteria has the potential to significantly reduce the burden of false-positive ECGs in athletes, particularly BAs.
- Received September 9, 2013.
- Revision received January 23, 2014.
- Accepted January 28, 2014.