Clinical research study
Cardiovascular Screening with Electrocardiography and Echocardiography in Collegiate Athletes

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Abstract

Background

Current guidelines for preparticipation screening of competitive athletes in the US include a comprehensive history and physical examination. The objective of this study was to determine the incremental value of electrocardiography and echocardiography added to a screening program consisting of history and physical examination in college athletes.

Methods

Competitive collegiate athletes at a single university underwent prospective collection of medical history, physical examination, 12-lead electrocardiography, and 2-dimensional echocardiography. Electrocardiograms (ECGs) were classified as normal, mildly abnormal, or distinctly abnormal according to previously published criteria. Eligibility for competition was determined using criteria from the 36th Bethesda Conference on Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities.

Results

In 964 consecutive athletes, ECGs were classified as abnormal in 334 (35%), of which 95 (10%) were distinctly abnormal. Distinct ECG abnormalities were more common in men than women (15% vs 6%, P < .001) as well as black compared with white athletes (18% vs 8%, P < .001). Echocardiographic and electrocardiographic findings initially resulted in exclusion of 9 athletes from competition, including 1 for long QT syndrome and 1 for aortic root dilatation; 7 athletes with Wolff-Parkinson-White patterns were ultimately cleared for participation. (Four received further evaluation and treatment, and 3 were determined to not need treatment.) After multivariable adjustment, black race was a statistically significant predictor of distinctly abnormal ECGs (relative risk 1.82, 95% confidence interval, 1.22-2.73; P = .01).

Conclusions

Distinctly abnormal ECGs were found in 10% of athletes and were most common in black men. Noninvasive screening using both electrocardiography and echocardiography resulted in identification of 9 athletes with important cardiovascular conditions, 2 of whom were excluded from competition. These findings offer a framework for performing preparticipation screening for competitive collegiate athletes.

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Study Population and Definitions

Consecutive male and female varsity athletes enrolled at the University of Kansas (Lawrence, KS) were prospectively screened. After informed consent, comprehensive medical and family history and physical examination were performed in all subjects in accordance with American Heart Association (AHA)/American College of Cardiology (ACC) recommendations.7 All subjects also underwent standard 12-lead ECGs and 2-dimensional echocardiography. This study was approved by the Saint Luke's Hospital of

Results

During 2004-2009, 964 consecutive athletes (ages 18-21 years, 52% female, 19% black) were enrolled (Table 2). Athletes represented 14 competitive sporting events, most commonly football (n = 240, 24.9%), rowing (n = 171, 17.7%), and track and field (n = 156, 16.2%). Among all subjects, 83 (8.6%) reported a family history of premature death, and 142 (14.7%) reported symptoms. Female subjects were more likely to have experienced symptoms, whereas males were more likely to have a history of hypertension

Discussion

In this consecutive cohort of collegiate athletes undergoing preparticipation screening with comprehensive medical and family history, 12-lead ECG, and 2-dimensional echocardiography, ECG findings were abnormal in one third and distinctly abnormal in 10%. Distinct ECG abnormalities were more common in males than females as well as black than white athletes. The relationship between race and distinctly abnormal ECG patterns persisted after multivariable adjustment for sex and body mass index.

Conclusions

In a cohort of consecutive collegiate competitive athletes undergoing comprehensive preparticipation screening, distinct ECG abnormalities were present in 10% and were more common in males as well as black athletes. Black race was an independent predictor of distinctly abnormal ECG patterns. Noninvasive screening using ECG and 2-dimensional echocardiography identified 9 athletes with important cardiovascular conditions, 2 of whom were excluded from participation. The presence of a distinctly

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  • Cited by (0)

    Funding: This work was supported by a grant from the Saint Luke's Hospital Foundation (Kansas City, Mo).

    Conflict of Interest: Dr. Magalski and Ms. McCoy jointly hold a pending provisional patent on the echocardiography protocol used in this study. All remaining authors reported that they have no conflicts of interest.

    Authorship: All authors had access to the data and participated in writing the manuscript.

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