title: Comparison of electrocardiographic criteria for the detection of cardiac abnormalities in elite black and white athletes.
abstract: BACKGROUND
  Recent efforts have focused on improving the specificity of the European Society of Cardiology (ESC) criteria for ECG interpretation in athletes. These criteria are derived predominantly from white athletes (WAs) and do not account for the effect of Afro-Caribbean ethnicity or novel research questioning the relevance of several isolated ECG patterns. We assessed the impact of the ESC criteria, the newly published Seattle criteria, and a group of proposed refined criteria in a large cohort of black athletes (BAs) and WAs.
  
  
  RESULTS
  Between 2000 and 2012, 1208 BAs were evaluated with history, examination, 12-lead ECG, and further investigations as appropriate. ECGs were retrospectively analyzed according to the ESC recommendations, Seattle criteria, and proposed refined criteria which exclude several specific ECG patterns when present in isolation. All 3 criteria were also applied to 4297 WAs and 103 young athletes with hypertrophic cardiomyopathy. The ESC recommendations raised suspicion of a cardiac abnormality in 40.4% of BAs and 16.2% of WAs. The Seattle criteria reduced abnormal ECGs to 18.4% in BAs and 7.1% in WAs. The refined criteria further reduced abnormal ECGs to 11.5% in BAs and 5.3% in WAs. All 3 criteria identified 98.1% of athletes with hypertrophic cardiomyopathy. Compared with ESC recommendations, the refined criteria improved specificity from 40.3% to 84.2% in BAs and from 73.8% to 94.1% in WAs without compromising the sensitivity of the ECG in detecting pathology.
  
  
  CONCLUSIONS
  Refinement of current ECG screening criteria has the potential to significantly reduce the burden of false-positive ECGs in athletes, particularly BAs.
authors.affiliation: From St. George's University of London, London, UK (N.S., M.P., S.G., A.Z., S.G., P.A., S.S.); University Hospital Lewisham, London, UK (N.S., M.P., S.G., A.Z., S.G., S.S.); Sapienza University of Rome, Rome, Italy (P. Adami); French Institute of Health and Medical Research (INSERM), Rennes, France (F.C., F.S.); ASPETAR, Department of Sports Medicine, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (M.W.); and The Heart Hospital, London, UK (P. Avila, W.M.).
authors.forename: Nabeel
authors.initials: N
authors.lastname: Sheikh
authors.forename: Michael
authors.initials: M
authors.lastname: Papadakis
authors.forename: Saqib
authors.initials: S
authors.lastname: Ghani
authors.forename: Abbas
authors.initials: A
authors.lastname: Zaidi
authors.forename: Sabiha
authors.initials: S
authors.lastname: Gati
authors.forename: Paolo Emilio
authors.initials: PE
authors.lastname: Adami
authors.forename: François
authors.initials: F
authors.lastname: Carré
authors.forename: Frédéric
authors.initials: F
authors.lastname: Schnell
authors.forename: Mathew
authors.initials: M
authors.lastname: Wilson
authors.forename: Paloma
authors.initials: P
authors.lastname: Avila
authors.forename: William
authors.initials: W
authors.lastname: McKenna
authors.forename: Sanjay
authors.initials: S
authors.lastname: Sharma
mesh_terms: D000293:Adolescent; D000328:Adult; D056352:Athletes; D044383:Black People / Q000208:ethnology; D002312:Cardiomyopathy, Hypertrophic / Q000175:diagnosis* / Q000208:ethnology / Q000503:physiopathology*; D004562:Electrocardiography / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D044465:White People / Q000208:ethnology; D055815:Young Adult
keywords: cardiomyopathies; echocardiography; electrocardiography; ethnic groups; exercise; hypertrophy; mass screening