Electrocardiographic Screening in National Collegiate Athletic Association Athletes

• Published in: The American journal of cardiology Vol. 118; no. 5; pp. 754 - 759
• Main Authors: Drezner, Jonathan A., MD, Owens, David S., MD, MS, Prutkin, Jordan M., MD, MHS, Salerno, Jack C., MD, Harmon, Kimberly G., MD, Prosise, Shelley, Clark, Alana, Asif, Irfan M., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2016; Elsevier Limited
• Subjects: Adolescent; Adult; Athletes; Athletes - statistics & numerical data; Athletic recruitment; Blood pressure; Cardiac arrhythmia; Cardiology; Cardiomyopathy; Cardiomyopathy, Hypertrophic - diagnosis; Cardiovascular; Cardiovascular disease; College basketball; Colleges & universities; Electrocardiography; Ethnic Groups; Family medical history; Female; Heart; Heart Diseases - diagnosis; Heart Diseases - epidemiology; Heart Septal Defects, Atrial - diagnosis; Human subjects; Humans; Male; Marfan syndrome; Mass Screening - statistics & numerical data; Medical History Taking; Mortality; Participation; Physical Examination; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity; Sports; Students - statistics & numerical data; United States - epidemiology; Universities; sudden cardiac arrest; electrocardiogram; sudden cardiac death; sports; prevention
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2016.06.004

Abstract The most effective protocol for cardiovascular screening of competitive athletes remains highly controversial. This study was a prospective, multicenter trial of cardiovascular screening at 35 National Collegiate Athletic Association (NCAA) institutions. Screening included a standardized history and physical examination (PE) as recommended by the American Heart Association and a resting 12-lead electrocardiogram (ECG). Centralized ECG interpretation was provided using the Seattle criteria. Athletes with screening abnormalities underwent additional evaluation directed by the host institution medical team. Primary outcomes included the proportion of total and false-positive screens; the sensitivity, specificity, and positive-predictive value (PPV) of history, PE, and ECG; and the prevalence of serious cardiovascular disorders associated with severe morbidity or sudden cardiac death (SCD). Between August 2012 and June 2014, 5,258 athletes from 17 intercollegiate sports were screened: 55% male (mean age 20.1 years), 73% Caucasian, 16% African-American, and 11% other/mixed race. At least one positive cardiac symptom or family history response was reported by 1,750 (33.3%) athletes. Physical examination was abnormal in 108 (2.1%) athletes, and ECG abnormalities were present in 192 (3.7%) athletes. Thirteen (0.25%) athletes were identified with serious cardiac conditions including hypertrophic cardiomyopathy (HC) (1), large atrial septal defect with right ventricular dilatation (1), and ventricular pre-excitation (11). The false-positive rate for history was 33.3%, PE 2.0%, and ECG 3.4%. The sensitivity/specificity/PPV for history was 15.4%/66.9%/0.1%, PE 7.7%/98.2%/0.9%, and ECG 100%/96.6%/6.8%. In conclusion, ECG screening in NCAA athletes has a low false-positive rate and provides superior accuracy compared to a standardized history and PE to detect athletes with potentially dangerous cardiovascular conditions.