Highlights
- •Sex specific criteria for athlete ECG interpretation is needed
- •The addition of age, race, and ethnicity can provide nuanced ECG interpretation
- •Future guidelines may want to include extremes of RS voltage as abnormalities
ABSTRACT
Objectives
: The 12-lead electrocardiogram (ECG) is used in the preparticipation screening exam
for athletes. Despite known differences in ECG findings by sex, only QTc prolongation
is given a sex specific threshold. We hypothesize that our large dataset – with diversity
in age, race, and sport participation – can be utilized to improve ECG screening in
female student athletes.
Methods
: Computerized 12-lead ECGs were recorded and analyzed in female athletes who underwent
preparticipation screening exam between 06/2010 and 09/2021. The quantitative, empirical
2017 international criteria for electrocardiographic interpretation were compared
to either the 99th percentile in our cohort or the percentile that corresponded to
the known disease prevalence.
Results
: Of 3466 female athletes with ECGs as part of preparticipation screening exam, the
2017 international criteria classified 2.1% of athletes with at least one ECG abnormality
requiring cardiological evaluation. Rates were similar across age, race/ethnicity,
and sporting discipline. Using ranges based on our population, 2.7% of athletes would
require additional workup. Surprisingly, ST depression up to 0.03 mV was a normal
finding in this cohort. If RS voltage extremes were considered findings requiring
follow up, an additional 9.6% of the athlete population would be flagged using current
definitions. This number decreases to 2.7% if using the 99th percentile in this cohort.
Conclusion
: These results highlight a difference in the reported prevalence of ECG abnormalities
when comparing empirically derived thresholds to statistically derived ranges. Consideration
of new metrics specific to the female athlete population has the potential to further
refine athlete ECG screening.
Keywords
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