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Accuracy of the ECG for differential diagnosis between hypertrophic cardiomyopathy and athlete’s heart: comparison between the European Society of Cardiology (2010) and International (2017) criteria
  1. Alessandro Zorzi1,
  2. Chiara Calore1,
  3. Riccardo Vio1,
  4. Antonio Pelliccia2,
  5. Domenico Corrado1
  1. 1Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
  2. 2Institute of Sports Medicine and Science, Rome, Italy
  1. Correspondence to Professor Domenico Corrado, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, via Giustiniani, 2, 35121- Padova, Italy; domenico.corrado{at}unipd.it

Abstract

Background Interpretation of the athlete’s ECG is based on differentiation between benign ECG changes and potentially pathological abnormalities. The aim of the study was to compare the 2010 European Society of Cardiology (ESC) and the 2017 International criteria for differential diagnosis between hypertrophic cardiomyopathy (HCM) and athlete's heart.

Methods The study populations included 200 patients with HCM and 563 athletes grouped as follows: ‘group 1’, including normal ECG and isolated increase of QRS voltages, which are considered non-pathologic according to ESC and International criteria; ‘group 2’, including left atrial enlargement or left axis deviation in isolation and Q-waves with an amplitude ≥4 mm but <25% of the ensuing R-wave and a duration <0.04 s which are considered pathologic according to the ESC but not according to the International criteria; and ‘group 3’, including abnormalities which are considered pathologic according to ESC and International criteria.

Results Overall, the 2010 ESC criteria showed a sensitivity of 95.5% and a specificity of 86.9%. Considering group 2 ECG changes as normal according to the International criteria led to a statistically significant (p<0.001) increase of specificity to 95.9%, associated with a non-significant (p=0.47) reduction of sensitivity to 93%. Among patients with HCM, there was a significant increase of maximal left ventricular wall thickness from group 1 to 3 (p=0.02).

Conclusions The use of 2017 International criteria is associated with a substantial increase in specificity and a marginal decrease in sensitivity for differential diagnosis between HCM and athlete’s heart.

  • Hypertrophic cardiomyopathy
  • athlete’s heart
  • electrocardiogram
  • screening.

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Footnotes

  • Competing interests None declared.

  • Ethics approval The study was approved by the Ethical commitee. Consent form was not required as data are completely anonymised.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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