Comparison of electrocardiographic criteria for the detection of cardiac abnormalities in elite black and white athletes

Nabeel Sheikh, Michael Papadakis, Saqib Ghani, Abbas Zaidi, Sabiha Gati, Paolo Emilio Adami, François Carré, Frédéric Schnell, Mathew Wilson, Paloma Avila, William McKenna, Sanjay Sharma

Research output: Contribution to journalArticle

164 Citations (Scopus)

Abstract

BACKGROUND-: Recent efforts have focused on improving the specificity of the European Society of Cardiology (ESC) criteria for ECG interpretation in athletes. These criteria are derived predominantly from white athletes (WAs) and do not account for the effect of Afro-Caribbean ethnicity or novel research questioning the relevance of several isolated ECG patterns. We assessed the impact of the ESC criteria, the newly published Seattle criteria, and a group of proposed refined criteria in a large cohort of black athletes (BAs) and WAs. METHODS AND RESULTS-: Between 2000 and 2012, 1208 BAs were evaluated with history, examination, 12-lead ECG, and further investigations as appropriate. ECGs were retrospectively analyzed according to the ESC recommendations, Seattle criteria, and proposed refined criteria which exclude several specific ECG patterns when present in isolation. All 3 criteria were also applied to 4297 WAs and 103 young athletes with hypertrophic cardiomyopathy. The ESC recommendations raised suspicion of a cardiac abnormality in 40.4% of BAs and 16.2% of WAs. The Seattle criteria reduced abnormal ECGs to 18.4% in BAs and 7.1% in WAs. The refined criteria further reduced abnormal ECGs to 11.5% in BAs and 5.3% in WAs. All 3 criteria identified 98.1% of athletes with hypertrophic cardiomyopathy. Compared with ESC recommendations, the refined criteria improved specificity from 40.3% to 84.2% in BAs and from 73.8% to 94.1% in WAs without compromising the sensitivity of the ECG in detecting pathology. CONCLUSION-: Refinement of current ECG screening criteria has the potential to significantly reduce the burden of false-positive ECGs in athletes, particularly BAs.

Original languageEnglish
Pages (from-to)1637-1649
Number of pages13
JournalCirculation
Volume129
Issue number16
DOIs
Publication statusPublished - 22 Apr 2014
Externally publishedYes

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Hypertrophic Cardiomyopathy

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Sheikh, N., Papadakis, M., Ghani, S., Zaidi, A., Gati, S., Adami, P. E., ... Sharma, S. (2014). Comparison of electrocardiographic criteria for the detection of cardiac abnormalities in elite black and white athletes. Circulation, 129(16), 1637-1649. https://doi.org/10.1161/CIRCULATIONAHA.113.006179
Sheikh, Nabeel ; Papadakis, Michael ; Ghani, Saqib ; Zaidi, Abbas ; Gati, Sabiha ; Adami, Paolo Emilio ; Carré, François ; Schnell, Frédéric ; Wilson, Mathew ; Avila, Paloma ; McKenna, William ; Sharma, Sanjay. / Comparison of electrocardiographic criteria for the detection of cardiac abnormalities in elite black and white athletes. In: Circulation. 2014 ; Vol. 129, No. 16. pp. 1637-1649.
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abstract = "BACKGROUND-: Recent efforts have focused on improving the specificity of the European Society of Cardiology (ESC) criteria for ECG interpretation in athletes. These criteria are derived predominantly from white athletes (WAs) and do not account for the effect of Afro-Caribbean ethnicity or novel research questioning the relevance of several isolated ECG patterns. We assessed the impact of the ESC criteria, the newly published Seattle criteria, and a group of proposed refined criteria in a large cohort of black athletes (BAs) and WAs. METHODS AND RESULTS-: Between 2000 and 2012, 1208 BAs were evaluated with history, examination, 12-lead ECG, and further investigations as appropriate. ECGs were retrospectively analyzed according to the ESC recommendations, Seattle criteria, and proposed refined criteria which exclude several specific ECG patterns when present in isolation. All 3 criteria were also applied to 4297 WAs and 103 young athletes with hypertrophic cardiomyopathy. The ESC recommendations raised suspicion of a cardiac abnormality in 40.4{\%} of BAs and 16.2{\%} of WAs. The Seattle criteria reduced abnormal ECGs to 18.4{\%} in BAs and 7.1{\%} in WAs. The refined criteria further reduced abnormal ECGs to 11.5{\%} in BAs and 5.3{\%} in WAs. All 3 criteria identified 98.1{\%} of athletes with hypertrophic cardiomyopathy. Compared with ESC recommendations, the refined criteria improved specificity from 40.3{\%} to 84.2{\%} in BAs and from 73.8{\%} to 94.1{\%} in WAs without compromising the sensitivity of the ECG in detecting pathology. CONCLUSION-: Refinement of current ECG screening criteria has the potential to significantly reduce the burden of false-positive ECGs in athletes, particularly BAs.",
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Sheikh, N, Papadakis, M, Ghani, S, Zaidi, A, Gati, S, Adami, PE, Carré, F, Schnell, F, Wilson, M, Avila, P, McKenna, W & Sharma, S 2014, 'Comparison of electrocardiographic criteria for the detection of cardiac abnormalities in elite black and white athletes', Circulation, vol. 129, no. 16, pp. 1637-1649. https://doi.org/10.1161/CIRCULATIONAHA.113.006179

Comparison of electrocardiographic criteria for the detection of cardiac abnormalities in elite black and white athletes. / Sheikh, Nabeel; Papadakis, Michael; Ghani, Saqib; Zaidi, Abbas; Gati, Sabiha; Adami, Paolo Emilio; Carré, François; Schnell, Frédéric; Wilson, Mathew; Avila, Paloma; McKenna, William; Sharma, Sanjay.

In: Circulation, Vol. 129, No. 16, 22.04.2014, p. 1637-1649.

Research output: Contribution to journalArticle

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T1 - Comparison of electrocardiographic criteria for the detection of cardiac abnormalities in elite black and white athletes

AU - Sheikh, Nabeel

AU - Papadakis, Michael

AU - Ghani, Saqib

AU - Zaidi, Abbas

AU - Gati, Sabiha

AU - Adami, Paolo Emilio

AU - Carré, François

AU - Schnell, Frédéric

AU - Wilson, Mathew

AU - Avila, Paloma

AU - McKenna, William

AU - Sharma, Sanjay

PY - 2014/4/22

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N2 - BACKGROUND-: Recent efforts have focused on improving the specificity of the European Society of Cardiology (ESC) criteria for ECG interpretation in athletes. These criteria are derived predominantly from white athletes (WAs) and do not account for the effect of Afro-Caribbean ethnicity or novel research questioning the relevance of several isolated ECG patterns. We assessed the impact of the ESC criteria, the newly published Seattle criteria, and a group of proposed refined criteria in a large cohort of black athletes (BAs) and WAs. METHODS AND RESULTS-: Between 2000 and 2012, 1208 BAs were evaluated with history, examination, 12-lead ECG, and further investigations as appropriate. ECGs were retrospectively analyzed according to the ESC recommendations, Seattle criteria, and proposed refined criteria which exclude several specific ECG patterns when present in isolation. All 3 criteria were also applied to 4297 WAs and 103 young athletes with hypertrophic cardiomyopathy. The ESC recommendations raised suspicion of a cardiac abnormality in 40.4% of BAs and 16.2% of WAs. The Seattle criteria reduced abnormal ECGs to 18.4% in BAs and 7.1% in WAs. The refined criteria further reduced abnormal ECGs to 11.5% in BAs and 5.3% in WAs. All 3 criteria identified 98.1% of athletes with hypertrophic cardiomyopathy. Compared with ESC recommendations, the refined criteria improved specificity from 40.3% to 84.2% in BAs and from 73.8% to 94.1% in WAs without compromising the sensitivity of the ECG in detecting pathology. CONCLUSION-: Refinement of current ECG screening criteria has the potential to significantly reduce the burden of false-positive ECGs in athletes, particularly BAs.

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KW - cardiomyopathies

KW - echocardiography

KW - electrocardiography

KW - ethnic groups

KW - exercise

KW - hypertrophy

KW - mass screening

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