The effectiveness of screening history, physical exam, and ECG to detect potentially lethal cardiac disorders in athletes: A systematic review/meta-analysis

The optimal cardiovascular preparticipation screen is debated. The purpose of this study was to perform a systematic review/meta-analysis of evidence comparing screening strategies. PRIMSA guidelines were followed. Electronic databases were searched from January 1996 to November 2014 for articles ex...

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Vydané v:Journal of electrocardiology Ročník 48; číslo 3; s. 329 - 338
Hlavní autori: Harmon, Kimberly G., Zigman, Monica, Drezner, Jonathan A.
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States Elsevier Inc 01.05.2015
Predmet:
Athlete
Athletes - classification
Athletes - statistics & numerical data
Cardiovascular
Cardiovascular screening
ECG
Electrocardiography - statistics & numerical data
Heart Diseases - diagnosis
Heart Diseases - mortality
Heart Diseases - prevention & control
Humans
Incidence
Mandatory Testing - statistics & numerical data
Medical History Taking - statistics & numerical data
Physical Examination - standards
Physical Examination - statistics & numerical data
Preparticipation exam
Risk Assessment - methods
Sensitivity and Specificity
Sudden cardiac death
Survival Rate
ECG
Preparticipation exam
Cardiovascular screening
Athlete
Sudden cardiac death
ISSN:0022-0736, 1532-8430, 1532-8430
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Shrnutí:The optimal cardiovascular preparticipation screen is debated. The purpose of this study was to perform a systematic review/meta-analysis of evidence comparing screening strategies. PRIMSA guidelines were followed. Electronic databases were searched from January 1996 to November 2014 for articles examining the efficacy of screening with history and physical exam (PE) based on the American Heart Association (AHA) or similar recommendations and electrocardiogram (ECG). Pooled data was analyzed for sensitivity, specificity, false positive rates and positive and negative likelihood ratios. Secondary outcomes included rate of potentially lethal cardiovascular conditions detected with screening and the etiology of pathology discovered. Fifteen articles reporting on 47,137 athletes were reviewed. After meta-analysis the sensitivity and specificity of ECG was 94%/93%, history 20%/94%, and PE 9%/97%. The overall false positive rate of ECG (6%) was less than that of history (8%), or physical exam (10%). Positive likelihood ratios were ECG 14.8, history 3.22 and PE 2.93 and negative likelihood ratios were ECG 0.055, history 0.85, and PE 0.93. There were a total of 160 potentially lethal cardiovascular conditions detected for a rate of 0.3% or 1 in 294. The most common pathology was Wolff-Parkinson-White (67, 42%), Long QT Syndrome (18, 11%), hypertrophic cardiomyopathy (18, 11%), dilated cardiomyopathy (11, 7%), coronary artery disease or myocardial ischemia (9, 6%) and arrhythmogenic right ventricular cardiomyopathy (4, 3%). The most effective strategy for screening for cardiovascular disease in athletes is ECG. It is 5 times more sensitive than history, 10 times more sensitive than physical exam, has higher positive likelihood ratio, lower negative likelihood ratio and a lower false positive rate. 12-lead ECG interpreted using modern criteria should be considered best practice in screening for cardiovascular disease in athletes while the use of history and physical alone as a screening tool should be reevaluated.
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ISSN:0022-0736
1532-8430
1532-8430
DOI:10.1016/j.jelectrocard.2015.02.001