062 Re-appraisal of ECG interpretation in young athletes: should axis deviation and voltage criterion for atrial enlargement be categorised as abnormal in athletes? The British experience

AimTo investigate the accuracy of the recently published international recommendations for ECG interpretation in young athletes in a large cohort of white and black adolescent soccer players.Methods11 168 soccer players (mean age 16.4±1.2 years) were evaluated with a health questionnaire, ECG and echocardiogram; 10 581 (95%) of the players were male and 10 163 (91%) were white. ECGs were retrospectively analysed according to (1) the 2010 European Society of Cardiology (ESC) recommendations, (2) Seattle criteria, (3) refined criteria and (4) the international recommendations for ECG interpretation in young athletes.ResultsThe ESC recommendations resulted in a higher number of abnormal ECGs compared with the Seattle, refined and international criteria (13.2%, 4.3%, 2.9% and 1.8%, respectively). All four criteria were associated with a higher prevalence of abnormal ECGs in black athletes compared with white athletes (ESC: 16.2% vs 12.9%; Seattle: 5.9% vs 4.2%; refined: 3.8% vs 2.8%; international 3.6% vs 1.6%; p<0.001 each). Compared with ESC recommendations, the Seattle, refined and international criteria identified a lower number of abnormal ECGs—by 67%, 78% and 86%, respectively. All four criteria identified 36 (86%) of 42 athletes with serious cardiac pathology. Compared with ESC recommendations, the Seattle criteria improved specificity from 87% to 96% in white athletes and 84% to 94% in black athletes. The international recommendations demonstrated the highest specificity for white (99%) and black (97%) athletes and a sensitivity of 86%.ConclusionsThe 2017 international recommendations for ECG interpretation in young athletes can be applied to adolescent athletes to detect serious cardiac disease. These recommendations perform more effectively than previous ECG criteria in both white and black adolescent soccer players.

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Modest agreement in ECG interpretation limits the application of ECG screening in young athletes

Heart Rhythm ◽

10.1016/j.hrthm.2014.09.060 ◽

2015 ◽

Vol 12 (1) ◽

pp. 130-136 ◽

Cited By ~ 36

Author(s):

Maria Brosnan ◽

Andre La Gerche ◽

Saurabh Kumar ◽

Wilson Lo ◽

Jonathan Kalman ◽

...

Keyword(s):

Young Athletes ◽

Ecg Interpretation

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P313The automatically assessed P-wave axis predicts cardiovascular events in patients with cardiovascular risks: The Japan Morning Surge Home Blood Pressure (J-HOP) Study

EP Europace ◽

10.1093/europace/euaa162.099 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

T Kabutoya ◽

S Hoshide ◽

K Kario

Keyword(s):

Cardiovascular Risk ◽

Left Ventricular Hypertrophy ◽

Left Atrial ◽

Cardiovascular Events ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

P Wave ◽

Axis Deviation ◽

Left Atrial Enlargement ◽

Atrial Enlargement

Abstract Background An abnormal P-wave axis in electrocardiography predicts the development of atrial fibrillation (AF) and cardiovascular events. There have been few reports on the relationships among an automatically assessed P-wave duration, left atrial enlargement, left ventricular hypertrophy, and cardiovascular events in patients with cardiovascular risk factors. Purpose To determine the relationship among an abnormal P-wave axis, left atrial enlargement, left ventricular hypertrophy, and cardiovascular events in patients with cardiovascular risk factors. Methods We enrolled 829 subjects from the J-HOP Study who had ≥1 of four cardiovascular risk factors: hypertension, dyslipidemia, diabetes, and smoking. Twelve-lead electrocardiography was conducted, and the P-wave axis was calculated automatically using a 12-lead ECG Analysis system (Fukuda Denshi, Tokyo) according to the following formula: arctan{√3(II + III) / (2I + II-III)}. We divided the patients into three groups: those with a normal axis (0°–75°, n = 692), left axis deviation (<0°, n = 39), or right axis deviation (≥75°, n = 56). The primary endpoints were fatal/nonfatal cardiovascular events: myocardial infarction, stroke, hospitalization for heart failure, and aortic dissection. We conducted echocardiography and measured the left atrial (LA) diameter, left ventricular mass index (LVMI), and brain natriuretic peptide (BNP). Results The LA diameter, LVMI, and BNP in the patients with left axis deviation were significantly higher than those in the patients with a normal axis (LA diameter: 40.2 ± 7.0 vs. 37.0 ± 5.0, p = 0.008; LVMI: 105.7 ± 25.7 vs. 96.9 ± 25.2 g/m2, p < 0.001; median BNP: 41.6 vs. 16.5 pg/dL, p < 0.001). The mean follow-up period was 101 ± 34 months, and 92 cardiovascular events occurred. A Cox proportional hazards model including age, gender, smoking, history of hypertension, dyslipidemia, diabetes, LA dia., and LVMI revealed that left axis deviation of the P wave was independently associated with cardiovascular events (hazard ratio 2.31, 95%CI 1.18–4.55, p = 0.015). Conclusions: Leftward deviation of the automatically assessed P-wave axis was associated with left atrial enlargement, left ventricular hypertrophy, and cardiovascular events in patients with cardiovascular risk.

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Modern standards of ECG interpretation in young athletes: Yield and effectiveness

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2014.12.017 ◽

2015 ◽

Vol 48 (3) ◽

pp. 292-297 ◽

Cited By ~ 4

Author(s):

Irfan M. Asif ◽

Jordan M. Prutkin

Keyword(s):

Young Athletes ◽

Ecg Interpretation

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Abstract 16848: Evolving Standards for Athlete ECG Interpretation Result in Declining Abnormal Rates

Circulation ◽

10.1161/circ.130.suppl_2.16848 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Joseph C Marek ◽

Kathleen A Marek ◽

Johneen Davis ◽

Ziad Sinno ◽

Frank Zimmerman

Keyword(s):

Cardiac Death ◽

Screening Program ◽

Early Period ◽

Ecg Changes ◽

Young Athletes ◽

Time Period ◽

Abnormal Rate ◽

Screening Protocol ◽

New Interpretation ◽

Ecg Interpretation

Introduction: ECG screening of athletes is believed to be effective in addressing the issue of sudden cardiac death (SCD) in young athletes. One criticism against screening has been the concern for a high percentage of abnormal ECG findings recently reported to be as high as 21.8%. The prevalence of conditions believed to be responsible for SCD is 0.3-0.7%. Since 2007 there have been several modifications of interpretation standards. Hypothesis: We hypothesized that these changing standards in addition to increased experience reading screening ECGs would reduce the abnormal ECG rate in our screening program and bring it closer to the expected prevalence of SCD causing conditions. Methods: The Young Hearts for Life (YH4L) ECG screening program has been performing ECGs on young athletes in the Chicago region since 2006. Interpretation was limited to six cardiologists experienced in the interpretation of adolescent ECGs and possessing knowledge of the ECG changes that occur in conditions associated with SCD. Two of these cardiologists read 90% of the total ECGs during the study. As new standards and research for interpretation were published, they were incorporated into the YH4L screening protocol. The annual abnormal rate for screening ECGs was compiled from 2006-2014. Results: A total of 108,057 ECGs were performed from 2006-2014 on young athletes age 14-19. The abnormal ECG rate gradually declined as the new interpretation standards were employed (see graph). The highest abnormal ECG rate of 2.43% was seen in the early period of the screening program (2007) compared to the rate of 1.00% seen during the most recent ECG screening (2014). The abnormal ECG rate was reduced by 59% over the 8 year time period (p<0.001). Conclusions: Greater experience and evolving standards for interpretation of screening ECGs in young athletes have resulted in a 59% reduction in abnormal rates found in the YH4L screening program. This rate is closer to expected prevalence of SCD causing conditions.

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