Maria Brosnan1, Andre La Gerche2, Saurabh Kumar3, Wilson Lo4, Jonathan Kalman5, David Prior2. 1. Department of Cardiology, St. Vincent's Hospital, Fitzroy, Australia; St. Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia. Electronic address: maria.brosnan@svhm.org.au. 2. Department of Cardiology, St. Vincent's Hospital, Fitzroy, Australia; St. Vincent's Department of Medicine, University of Melbourne, Fitzroy, Australia. 3. Department of Cardiology, Royal Melbourne Hospital, Parkville, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia. 4. SportsMed ACT, Canberra, Australia. 5. Department of Cardiology, Royal Melbourne Hospital, Parkville, Australia.
Abstract
BACKGROUND: Athlete ECG screening has been recommended by several international sporting bodies; however, a number of controversies remain regarding the accuracy of ECG screening. An important component that has not been assessed is the reproducibility of ECG interpretation. OBJECTIVE: The purpose of this study was to assess the variability of ECG interpretation among experienced physicians when screening a large number of athletes. METHODS: A sports cardiologist, a sports medicine physician, and an electrophysiologist analyzed 440 consecutive screening ECGs from asymptomatic athletes and were asked to classify the ECGs according to the 2010 European Society of Cardiology criteria as normal (or demonstrating training related ECG changes) or abnormal. When an abnormal ECG was identified, they were asked to outline what follow-up investigations they would recommend. RESULTS: The reported prevalence of abnormal ECGs ranged from 13.4% to 17.5%. Agreement on which ECGs were abnormal ranged from poor (κ = 0.297) to moderate (κ = 0.543) between observers. Suggested follow-up investigations were varied, and follow-up costs ranged from an additional A$30-A$129 per screening episode. Neither of the 2 subjects (0.45%) in the cohort with significant pathology diagnosed as a result of screening were identified correctly by all 3 physicians. CONCLUSION: Even when experienced physicians interpret athletes' ECGs according to current standards, there is significant interobserver variability that results in false-positive and false-negative results, thus reducing the effectiveness and increasing the social and economic cost of screening.
BACKGROUND: Athlete ECG screening has been recommended by several international sporting bodies; however, a number of controversies remain regarding the accuracy of ECG screening. An important component that has not been assessed is the reproducibility of ECG interpretation. OBJECTIVE: The purpose of this study was to assess the variability of ECG interpretation among experienced physicians when screening a large number of athletes. METHODS: A sports cardiologist, a sports medicine physician, and an electrophysiologist analyzed 440 consecutive screening ECGs from asymptomatic athletes and were asked to classify the ECGs according to the 2010 European Society of Cardiology criteria as normal (or demonstrating training related ECG changes) or abnormal. When an abnormal ECG was identified, they were asked to outline what follow-up investigations they would recommend. RESULTS: The reported prevalence of abnormal ECGs ranged from 13.4% to 17.5%. Agreement on which ECGs were abnormal ranged from poor (κ = 0.297) to moderate (κ = 0.543) between observers. Suggested follow-up investigations were varied, and follow-up costs ranged from an additional A$30-A$129 per screening episode. Neither of the 2 subjects (0.45%) in the cohort with significant pathology diagnosed as a result of screening were identified correctly by all 3 physicians. CONCLUSION: Even when experienced physicians interpret athletes' ECGs according to current standards, there is significant interobserver variability that results in false-positive and false-negative results, thus reducing the effectiveness and increasing the social and economic cost of screening.
Authors: Bradley C Clark; Joshua M Hayman; Charles I Berul; Kristin M Burns; Jonathan R Kaltman Journal: Ann Noninvasive Electrocardiol Date: 2017-02-21 Impact factor: 1.468
Authors: Juan Carlos Aviles-Solis; Sophie Vanbelle; Peder A Halvorsen; Nick Francis; Jochen W L Cals; Elena A Andreeva; Alda Marques; Päivi Piirilä; Hans Pasterkamp; Hasse Melbye Journal: BMJ Open Respir Res Date: 2017-12-18
Authors: S Schneiter; L D Trachsel; T Perrin; S Albrecht; T Pirrello; P Eser; B Gojanovic; A Menafoglio; M Wilhelm Journal: PLoS One Date: 2018-11-21 Impact factor: 3.240
Authors: Rutger R van de Leur; Lennart J Blom; Efstratios Gavves; Irene E Hof; Jeroen F van der Heijden; Nick C Clappers; Pieter A Doevendans; Rutger J Hassink; René van Es Journal: J Am Heart Assoc Date: 2020-05-14 Impact factor: 5.501
Authors: Kathleen Bird; Gabriel Chan; Huiqi Lu; Heloise Greeff; John Allen; Derek Abbott; Carlo Menon; Nigel H Lovell; Newton Howard; Wee-Shian Chan; Richard Ribon Fletcher; Aymen Alian; Rabab Ward; Mohamed Elgendi Journal: Front Med (Lausanne) Date: 2020-12-04