Are the QRS duration and ST depression cut-points from the Seattle criteria too conservative?

Dunn, Tim; Abdelfattah, Ramy; Aggarwal, S.; Pickham, David; Hadley, David; Froelicher, Victor

doi:10.1016/j.jelectrocard.2015.02.009

Cited by 7 publications

(5 citation statements)

References 7 publications

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“…The significance of non-specific intraventricular conduction delay with normal QRS morphology in healthy, asymptomatic athletes is uncertain 96. The physiology underlying intraventricular conduction delay in athletes remains incompletely understood but likely includes some combination of neurally mediated conduction fibre slowing and increased myocardial mass.…”

Section: Abnormal Ecg Findings In Athletesmentioning

confidence: 99%

International criteria for electrocardiographic interpretation in athletes: Consensus statement

et al. 2017

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Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly, advanced by a growing body of scientific data and investigations that both examine proposed criteria sets and establish new evidence to guide refinements. On 26-27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington (USA), to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD.

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Section: Abnormal Ecg Findings In Athletesmentioning

confidence: 99%

International criteria for electrocardiographic interpretation in athletes: Consensus statement

et al. 2017

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“…94,95 The significance of nonspecific IVCD with normal QRS morphology in healthy, asymptomatic athletes is uncertain. 96 The physiology underlying IVCD in athletes remains incompletely understood but likely includes some combination of neurally mediated conduction fiber slowing and increased myocardial mass. In patients with LVH, left ventricular mass seems to be closely related to QRS duration.…”

Section: Profound Nonspecific Intra-ventricular Conduction Delaymentioning

confidence: 99%

International recommendations for electrocardiographic interpretation in athletes

Sharma

Drezner

Baggish

et al. 2017

European Heart Journal

323

307

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Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural, or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly over the last decade; pushed by a growing body of scientific data that both tests proposed criteria sets and establishes new evidence to guide refinements. On 26-27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington, to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD.

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“…The mean age per article varied from 12.4 to 54.6 years. Twenty‐eight articles comprised 59 685 athletes aged ≤35 years (74.5%), 16–44 of which seven articles reported findings in 18 535 athletes ≤18 years 16–23 . Thirty‐one articles reported gender (79619), of which four included men only 25,28,42,44 .…”

Section: Resultsmentioning

confidence: 99%

“…The most used referenced standard for H-PE screening was from the 2007 American Heart Association recommendations (n = 12), 20,25,[28][29][30]34,36,38,41,43,47,49 and for ECG assessment from the 2010 European Society of Cardiology (n = 13) 18,21,23,25,26,32,35,36,[38][39][40][41]43,44 and 2013 Seattle criteria (n = 12). 19,25,28,32,[24][25][26][27][28][29][30][31][32][33][34][35][36]39,41,45,47,48 Ten articles used two or more referenced standards for ECG assessment.…”

Section: Methodological Qualitymentioning

confidence: 99%

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Quality of athlete screening for high‐risk cardiovascular conditions—A systematic review

Panhuyzen‐Goedkoop,

Verbeek,

Goedkoop

et al. 2023

Scandinavian Med Sci Sports

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BackgroundSudden cardiac death (SCD) is the leading medical cause of death in athletes. To prevent SCD, screening for high‐risk cardiovascular conditions (HRCC) is recommended. Screening strategies are based on a limited number of studies and expert consensus. However, evidence and efficacy of athlete HRCC screening is unclear.ObjectiveTo determine methodological quality and quality of evidence of athlete screening, and screening efficacy to detect HRCC in a systematic review.MethodsWe performed a systematic search of Medline, Embase, Scopus and Cochrane Library up to June 2021. We included articles containing original data of athlete cardiovascular screening, providing details of screening strategies, test results and HRCC detection. We assessed methodological quality of the included articles by QUADAS‐2, quality of evidence of athlete HRCC screening by GRADE, and athlete HRCC screening efficacy by SWiM.ResultsOf 2720 citations, we included 33 articles (1991–2018), comprising 82 417 athletes (26.7% elite, 73.4% competitive, 21.7% women, 75.2% aged ≤35). Methodological quality was ‘very low’ (33 articles), caused by absence of data blinding and inappropriate statistical analysis. Quality of evidence was ‘very low’ (33 articles), due to observational designs and population heterogeneity. Screening efficacy could not be reliably established. The prevalence of HRCC was 0.43% with false positive rate (FPR) 13.0%.ConclusionsMethodological quality and quality of evidence on athlete screening are suboptimal. Efficacy could not be reliably established. The prevalence of screen detected HRCC was very low and FPR high. Given the limitations of the evidence, individual recommendations need to be prudent.

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Are the QRS duration and ST depression cut-points from the Seattle criteria too conservative?

Cited by 7 publications

References 7 publications

International criteria for electrocardiographic interpretation in athletes: Consensus statement

International criteria for electrocardiographic interpretation in athletes: Consensus statement

International recommendations for electrocardiographic interpretation in athletes

Quality of athlete screening for high‐risk cardiovascular conditions—A systematic review

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