title: Utility of Exercise Electrocardiography in Pre-participation Screening in Asymptomatic Athletes: A Systematic Review.
abstract: BACKGROUND
  Although test characteristics of exercise electrocardiography are well established in symptomatic patients, data on healthy athletes are scarce. This systematic review focuses on the diagnostic utility of exercise electrocardiography for the detection of coronary heart disease in athletes during pre-participation screening.
  
  
  OBJECTIVE
  This systematic review evaluated the prevalence of an abnormal exercise test result and the positive predictive value of exercise electrocardiography in asymptomatic athletes. In addition, the long-term prognosis of a false-positive test result was evaluated.
  
  
  METHODS
  An electronic search was performed using the Cochrane Library, PubMed, and MEDLINE. Only studies using exercise electrocardiography in an unselected population of asymptomatic athletes were included. Data on population characteristics, cardiovascular risk factors, exercise test parameters, left ventricular hypertrophy, and morbidity/mortality were extracted and analyzed.
  
  
  RESULTS
  The mean prevalence of an abnormal exercise test result was 0.6 % (range 0-29 %), with a positive predictive value of 9 % (range 0-55 %). Left ventricular hypertrophy was observed in 57 % of the athletes with an abnormal exercise test result, in 50 % of the athletes with a false-positive exercise test result, and in 24 % of the athletes with a normal exercise test. Among athletes with a false-positive test, only one athlete (3 %) experienced a possible cardiac event.
  
  
  CONCLUSIONS
  This systematic review revealed a relatively low prevalence of positive exercise test results in asymptomatic athletes, but a very poor positive predictive value. There were insufficient data available to determine the prognostic implications of false-positive test results in asymptomatic athletes.
authors.affiliation: Department of Cardiology, Máxima Medical Center, De Run 4600, Veldhoven, 5504 DB, The Netherlands. d.vandesande@mmc.nl.
authors.forename: Danny A J P
authors.identifier: http://orcid.org/0000-0002-8553-5025
authors.initials: DA
authors.lastname: van de Sande
authors.affiliation: Department of Sports Medicine, Máxima Medical Center, Veldhoven, The Netherlands.
authors.forename: Michelle A W
authors.initials: MA
authors.lastname: Breuer
authors.affiliation: Department of Cardiology, Máxima Medical Center, De Run 4600, Veldhoven, 5504 DB, The Netherlands.
authors.forename: Hareld M C
authors.initials: HM
authors.lastname: Kemps
mesh_terms: D058070:Asymptomatic Diseases; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology; D004562:Electrocardiography / Q000379:methods* / Q000706:statistics & numerical data; D005080:Exercise Test / Q000379:methods* / Q000706:statistics & numerical data; D005189:False Positive Reactions; D006801:Humans; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors