NEW YORK (Reuters Health) - Exercise 12-lead electrocardiography (ECG) is useful in identifying cardiac abnormalities in individuals who are seeking to participate in competitive sports, new research shows. Whether disqualification of these athletes helps prevent cardiovascular events will require further study.
The study is the "first to investigate, in a large population of sports participants, a complete cardiovascular preparticipation screening that included both baseline and exercise electrocardiograms," lead author Dr. Francesco Sofi from the University of Florence, Italy, told Reuters Health.
As reported in the October 17th Online First issue of the British Medical Journal, Dr. Sofi's team analyzed data from 30,065 prospective athletes to assess the clinical usefulness of preparticipation cardiovascular screening.
Resting ECG identified 6% of subjects as having cardiac abnormalities, while exercise ECG identified 4.9%. More than 80% of the abnormalities seen with resting ECG involved relatively benign ECG changes.
The authors report that 1227 athletes with normal findings on resting ECG showed abnormalities on exercise ECG.
All told, 196 subjects (0.6%) were considered ineligible for participation in competitive sports, including 159 who were disqualified for cardiac reasons. Nearly 80% of the latter group had important cardiac abnormalities that were only seen on exercise ECG.
On regression analysis, age over 30 years was identified as a significant predictor of disqualification due to cardiac abnormalities on exercise testing.
In an accompanying clinical review, Dr. Sanjay Sharma, from King's College Hospital, London, and colleagues discuss the epidemiology, objectives, methods, psychological impact, and costs of preparticipation screening for cardiac abnormalities in young athletes.
The authors conclude that "preparticipation screening using health questionnaires and physical examination only has poor sensitivity whereas elaborate screening programs are cost prohibitive." This leaves 12-lead ECG testing, which is useful in preventing sudden cardiac death from channelopathies and cardiomyopathies, but not due to coronary disease, they note.
Unfortunately, "implementation of preparticipation screening is currently hampered by the lack of resources and infrastructure and cannot be regarded as cost effective in most countries," Dr. Sharma's team concludes.
BMJ Online First 2008.
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