Prevalence of abnormal ECGs in male soccer players decreases with the Seattle criteria, but is still high

Abstract

Electrocardiogram (ECG) and echocardiography are mandatory in preparticipation cardiac screening in soccer players. Abnormal ECG findings usually require follow-up investigations. The main aim of this study was to compare the prevalence of abnormal ECG findings in male professional soccer players according to European Society of Cardiology's (ESC) recommendations and the Seattle criteria, and to assess the need for echocardiography. ECGs from 587 of 595 (99%) players were recorded with ClickECG, and measurements were derived with visually adjusted on-screen calipers on the computer-based averaged PQRST complex. Echocardiographic recordings were performed with Vivid 7/i and categorized according to reference values for athlete's heart. After the initial screening, 32 (5.5%) players were recommended for follow-up. The prevalence of abnormal ECGs was 29.3% vs 11.2% according to the ESC's recommendations and the Seattle criteria, respectively. None of the players with abnormal ECGs only according to the ESC's recommendations had abnormal echocardiograms. Echocardiography alone detected one player with abnormalities (athlete's heart). The Seattle criteria reduced the number of athletes with abnormal ECGs considerably compared with the ESC recommendations. Based on echocardiographic evaluations, this increased the specificity of the Seattle criteria, without increasing the number of false-negative ECGs. The need for mandatory echocardiography in soccer players seems limited.

Health conditions detected in a comprehensive periodic health evaluation of 558 professional football players

“…It is argued in the literature that the value of including echocardiography is limited 52 55. We found that echocardiography gave reason for additional testing in 14 players (2.5%) and resulted in a diagnosis of abnormal coronary artery origin in one player who presented with a normal ECG.…”

Decreased false-positive adolescent pre-athletic screening with Seattle Criteria-interpreted electrocardiograms

“…To date, several studies have demonstrated the efficacy of the Seattle Criteria in elite athletes and young adults. [17][18][19][20] Our study is the first to look at applying the Seattle Criteria to a representative population of peri-adolescent students, less than 14 years of age, in Arizona. The results demonstrate that Seattle Criteria electrocardiogram interpretation decreases the rate of false-positive results without adverse effects on identifying true-positive electrocardiograms.…”

“…This statement also discussed the efforts of the Seattle Criteria to increase specificity of electrocardiogram screening, but recommended a prospective application of this approach to a large, general population under 35 years of age. To date, several studies have demonstrated the efficacy of the Seattle Criteria in elite athletes and young adults 17 20 Our study is the first to look at applying the Seattle Criteria to a representative population of peri-adolescent students, less than 14 years of age, in Arizona.…”

Criteria for interpretation of the athlete's ECG: A critical appraisal

“…13,14 Finally, the Seattle Criteria provided more clear definitions for some abnormal ECG parameters like pathological Q waves and intraventricular conduction delay. Studies on various athletic populations confirmed that the use of the Seattle criteria, compared to the ESC criteria, significantly decreased the number of false positive ECG findings, [15][16][17][18][19] without compromising the specificity for the detection of serious diseases.…”