title: Comparison of three current sets of electrocardiographic interpretation criteria for use in screening athletes.
abstract: BACKGROUND
  An increasing number of sporting bodies report unacceptably high levels of false-positive ECGs when undertaking pre-participation cardiac screening. To address this issue, modified ECG interpretation criteria have become available for use within athletes.
  
  
  OBJECTIVE
  This study assessed the accuracy of the new 2014 'Refined Criteria' against the 2013 Seattle Criteria and the 2010 European Society of Cardiology (ESC) recommendations in a cohort of Arabic, black and Caucasian athletes.
  
  
  METHODS
  2491 male athletes (1367 Arabic, 748 black and 376 Caucasian) undertook pre-participation screening including a 12-lead ECG, with further investigation(s) upon indication.
  
  
  RESULTS
  Ten athletes (0.4%) were identified with cardiac pathology; seven with hypertrophic cardiomyopathy (HCM; five black and two Arabic) and three Arabs with Wolff-Parkinson-White syndrome (WPW). All three ECG criteria were 100% sensitive identifying all cases of HCM and WPW. The 2014 Refined Criteria reduced (p<0.0001) the prevalence of an abnormal ECG to 5.3% vs 11.6% (Seattle Criteria) and 22.3% (2010 ESC recommendations). The 2014 Refined Criteria significantly (p<0.0001) improved specificity (94.0%) across all ethnicities compared with the Seattle Criteria (87.5%) and ESC recommendations (76.6%). Black athletes continue to present a higher prevalence (p<0.0001) of abnormal ECGs compared with Arabic and Caucasian athletes (10% vs 3.6% and 2.1%).
  
  
  CONCLUSIONS
  The 2014 Refined Criteria for athlete ECG interpretation outperformed both the 2013 Seattle Criteria and the 2010 ESC recommendations by significantly reducing the number of false-positive ECGs in Arabic, black and Caucasian athletes while maintaining 100% sensitivity for serious cardiac pathologies.
authors.affiliation: Athlete Health and Performance Research Centre, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Research Institute for Sport and Exercise Science, Liverpool John Moores University, UK.
authors.forename: Nathan R
authors.initials: NR
authors.lastname: Riding
authors.affiliation: Department of Cardiovascular Sciences, St Georges University of London, UK.
authors.forename: Nabeel
authors.initials: N
authors.lastname: Sheikh
authors.affiliation: Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
authors.forename: Carmen
authors.initials: C
authors.lastname: Adamuz
authors.affiliation: Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
authors.forename: Victoria
authors.initials: V
authors.lastname: Watt
authors.affiliation: Athlete Health and Performance Research Centre, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
authors.forename: Abdulaziz
authors.initials: A
authors.lastname: Farooq
authors.affiliation: Research Institute for Sport and Exercise Science, Liverpool John Moores University, UK.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Whyte
authors.affiliation: Research Institute for Sport and Exercise Science, Liverpool John Moores University, UK.
authors.forename: Keith P
authors.initials: KP
authors.lastname: George
authors.affiliation: Department of Family Medicine, University of Washington, Seattle, Washington USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Drezner
authors.affiliation: Department of Cardiovascular Sciences, St Georges University of London, UK.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Athlete Health and Performance Research Centre, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.
authors.forename: Mathew G
authors.initials: MG
authors.lastname: Wilson
mesh_terms: D056352:Athletes; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D004562:Electrocardiography; D006330:Heart Defects, Congenital / Q000175:diagnosis*; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D017410:Practice Guidelines as Topic; D044469:Racial Groups; D012680:Sensitivity and Specificity; D055815:Young Adult