title: The medical value and cost-effectiveness of an exercise test for sport preparticipation evaluation in asymptomatic middle-aged white male and female athletes.
abstract: BACKGROUND
  Cardiovascular events related to high-intensity sport practice are rare but dramatic. Coronary artery disease (CAD) is the leading cause of these events after the age of 35 years. The value of a maximal exercise test (ET) for detection of athletes at risk remains a matter of debate.
  
  
  OBJECTIVE
  The aim of this prospective multicentre study was to clarify the medical value and cost-effectiveness of an ET in middle-aged white asymptomatic athletes who participate in high-intensity sport.
  
  
  METHODS
  All athletes had a physical examination, assessment of cardiovascular risk factors, a resting electrocardiogram and an ET. In case of abnormal ET, complementary cardiovascular evaluation was performed, when requested, to detect potential cardiovascular disease.
  
  
  RESULTS
  1361 asymptomatic athletes (mean age 50.4±9.6 years; mean training 5.1±3.2h/week; 10.4% women) with a normal resting electrocardiogram and without cardiovascular disease were consecutively included. An abnormal ET was reported in 144 subjects (94% men); this was positively related to the subject's age and cardiovascular risk level. Cardiac arrhythmias (48%) and CAD symptoms (33.3%) were mainly reported. Cardiovascular disease was confirmed in 24 cases (1.7% from the whole population; 16.7% from those with an abnormal ET) - mainly CAD (n=12) and arterial hypertension (n=8). Seventy athletes presented significant unexplained arrhythmias. The cost was approximately €8450 for every confirmed case of cardiovascular disease.
  
  
  CONCLUSIONS
  In this multicentre study in middle-aged athletes, a systematic ET was abnormal in 10.6% of cases. About 2% of subjects had cardiovascular disease, mainly arrhythmias and CAD. From these results, it seems that in a trained population aged >35 years, ET should be targeted at men with at least two cardiovascular risk factors, with acceptable cost-effectiveness.
authors.affiliation: Clinique du Sport, Bordeaux-Mérignac, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Chevalier
authors.affiliation: CIC-IT, INSERM 1414, Rennes, France.
authors.forename: Gaelle
authors.initials: G
authors.lastname: Kervio
authors.affiliation: Service Physiologie et Explorations Fonctionnelles, CHU Strasbourg, Strasbourg, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Doutreleau
authors.affiliation: Clinique Générale, Annecy, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Mathieu
authors.affiliation: Centre de Réadaptation Cardio-Respiratoire de la Loire, Saint-Etienne, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Guy
authors.affiliation: Clinique du Sport, Bordeaux-Mérignac, France.
authors.forename: Aude
authors.initials: A
authors.lastname: Mignot
authors.affiliation: Clinique du Sport, Bordeaux-Mérignac, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Corneloup
authors.affiliation: Hôpital Privé La Louvière, Lille, France.
authors.forename: François
authors.initials: F
authors.lastname: Passard
authors.affiliation: Unité Médicale de l'Activité Physique et Sportive, Talence, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Laporte
authors.affiliation: Hôpital Georges Pianta, Thonon les Bains, France.
authors.forename: Aude
authors.initials: A
authors.lastname: Girard-Girod
authors.affiliation: Hôpital Privé La Louvière, Lille, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Hennebert
authors.affiliation: Clinique du Sport, Bordeaux-Mérignac, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bernadet
authors.affiliation: Clinique du Sport, Bordeaux-Mérignac, France.
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Vincent-Chevalier
authors.affiliation: Clinique du Sport, Bordeaux-Mérignac, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Gencel
authors.affiliation: CIC-IT, INSERM 1414, Rennes, France; Service de Médecine du Sport, CHU Rennes, Rennes, France; Laboratoire de Traitement du Signal et de l'Image (LTSI), INSERM UMR 1099, Rennes, France. Electronic address: francois.carre@univ-rennes1.fr.
authors.forename: François
authors.initials: F
authors.lastname: Carré
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000191:economics / Q000401:mortality / Q000503:physiopathology; D058070:Asymptomatic Diseases; D056352:Athletes; D001794:Blood Pressure; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000191:economics / Q000401:mortality / Q000503:physiopathology; D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D004562:Electrocardiography / Q000191:economics; D005080:Exercise Test / Q000191:economics*; D005260:Female; D005602:France; D017048:Health Care Costs; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors
keywords: Cost-effectiveness; Coût efficacité; Dépistage cardiovasculaire pré-participation; Epreuve d’effort; Exercise test; Middle-aged athletes; Sport preparticipation cardiovascular screening; Sportifs d’âge moyen