Utility of Exercise Electrocardiography in Pre-participation Screening in Asymptomatic Athletes: A Systematic Review
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SYSTEMATIC REVIEW
Utility of Exercise Electrocardiography in Pre-participation Screening in Asymptomatic Athletes: A Systematic Review Danny A. J. P. van de Sande1
•
Michelle A. W. Breuer2 • Hareld M. C. Kemps1
Springer International Publishing Switzerland 2016
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. Objectives 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 Danny A. J. P. van de Sande and M. A. W. Breuer were equal contributors to the article. & Danny A. J. P. van de Sande [email protected] 1
Department of Cardiology, Ma´xima Medical Center, De Run 4600, Veldhoven 5504 DB, The Netherlands
2
Department of Sports Medicine, Ma´xima Medical Center, Veldhoven, The Netherlands
athletes with a normal exercise test. Among athletes with a false-positive test, only one athlete (3 %) experienced a possible cardiac event. Conclusion 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.
Key Points The prevalence of a positive exercise test result is low in unselected asymptomatic athletes. The positive predictive value of exercise electrocardiography is poor in asymptomatic athletes. Prognostic implications of a false-positive exercise test result remain unclear.
1 Introduction Regular physical activity improves cardiovascular health and reduces mortality and morbidity. In particular, regular exercise at a moderate intensity was shown to reduce the risk for future cardiovascular events [1]. However, during and after vigorous exercise, sudden cardiac death (SCD) occurs with an incidence of 4.6 events per million per year [2], indicating that exercise may als
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