Kristofer Hedman1, Kegan J Moneghetti2, David Hsu2, Jeffrey W Christle2, Alessandro Patti3, Euan Ashley2, David Hadley4, Francois Haddad5, Victor Froelicher2. 1. Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, Calif; Stanford Cardiovascular Institute, Department of Medicine, Stanford University, Stanford, Calif; Department of Clinical Physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. Electronic address: Kristofer.Hedman@liu.se. 2. Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, Calif; Stanford Sports Cardiology, Stanford University, Stanford, Calif. 3. Stanford Sports Cardiology, Stanford University, Stanford, Calif; Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Italy. 4. Cardiac Insight Inc., Bellevue, Wash. 5. Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, Calif; Stanford Cardiovascular Institute, Department of Medicine, Stanford University, Stanford, Calif; Stanford Sports Cardiology, Stanford University, Stanford, Calif.
Abstract
BACKGROUND: Electrocardiography (ECG) is used to screen for left ventricular hypertrophy (LVH), but common ECG-LVH criteria have been found less effective in athletes. The purpose of this study was to comprehensively evaluate the value of ECG for identifying athletes with LVH or a concentric cardiac phenotype. METHODS: A retrospective analysis of 196 male Division I college athletes routinely screened with ECG and echocardiography within the Stanford Athletic Cardiovascular Screening Program was performed. Left-ventricular mass and volume were determined using echocardiography. LVH was defined as left ventricular mass (LVM) >102 g/m²; a concentric cardiac phenotype as LVM-to-volume (M/V) ≥1.05 g/mL. Twelve-lead electrocardiograms including high-resolution time intervals and QRS voltages were obtained. Thirty-seven previously published ECG-LVH criteria were applied, of which the majority have never been evaluated in athletes. C-statistics, including area under the receiver operating curve (AUC) and likelihood ratios were calculated. RESULTS: ECG lead voltages were poorly associated with LVM (r = 0.18-0.30) and M/V (r = 0.15-0.25). The proportion of athletes with ECG-LVH was 0%-74% across criteria, with sensitivity and specificity ranging between 0% and 91% and 27% and 99.5%, respectively. The average AUC of the criteria in identifying the 11 athletes with LVH was 0.57 (95% confidence interval [CI] 0.56-0.59), and the average AUC for identifying the 8 athletes with a concentric phenotype was 0.59 (95% CI 0.56-0.62). CONCLUSION: The diagnostic capacity of all ECG-LVH criteria were inadequate and, therefore, not clinically useful in screening for LVH or a concentric phenotype in athletes. This is probably due to the weak association between LVM and ECG voltage.
BACKGROUND: Electrocardiography (ECG) is used to screen for left ventricular hypertrophy (LVH), but common ECG-LVH criteria have been found less effective in athletes. The purpose of this study was to comprehensively evaluate the value of ECG for identifying athletes with LVH or a concentric cardiac phenotype. METHODS: A retrospective analysis of 196 male Division I college athletes routinely screened with ECG and echocardiography within the Stanford Athletic Cardiovascular Screening Program was performed. Left-ventricular mass and volume were determined using echocardiography. LVH was defined as left ventricular mass (LVM) >102 g/m²; a concentric cardiac phenotype as LVM-to-volume (M/V) ≥1.05 g/mL. Twelve-lead electrocardiograms including high-resolution time intervals and QRS voltages were obtained. Thirty-seven previously published ECG-LVH criteria were applied, of which the majority have never been evaluated in athletes. C-statistics, including area under the receiver operating curve (AUC) and likelihood ratios were calculated. RESULTS: ECG lead voltages were poorly associated with LVM (r = 0.18-0.30) and M/V (r = 0.15-0.25). The proportion of athletes with ECG-LVH was 0%-74% across criteria, with sensitivity and specificity ranging between 0% and 91% and 27% and 99.5%, respectively. The average AUC of the criteria in identifying the 11 athletes with LVH was 0.57 (95% confidence interval [CI] 0.56-0.59), and the average AUC for identifying the 8 athletes with a concentric phenotype was 0.59 (95% CI 0.56-0.62). CONCLUSION: The diagnostic capacity of all ECG-LVH criteria were inadequate and, therefore, not clinically useful in screening for LVH or a concentric phenotype in athletes. This is probably due to the weak association between LVM and ECG voltage.
Authors: Kristofer Hedman; Alessandro Patti; Kegan J Moneghetti; David Hsu; Jeffrey W Christle; Euan Ashley; David Hadley; Francois Haddad; Victor Froelicher Journal: BMJ Open Sport Exerc Med Date: 2020-03-08
Authors: Hye-Bin Gwag; Su-Hyun Lee; Hyeon-Jun Kim; June-Soo Kim; Young-Keun On; Seung-Jung Park; Kyoung-Min Park Journal: Int J Environ Res Public Health Date: 2021-12-07 Impact factor: 3.390