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Limitations of Electrocardiography for Detecting Left Ventricular Hypertrophy or Concentric Remodeling in Athletes
Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Clinical Physiology in Linköping. Stanford University, Stanford, USA.ORCID iD: 0000-0002-3751-7180
Stanford University, Stanford, USA.
Stanford University, Stanford, USA.
Stanford University, Stanford, USA.
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2020 (English)In: American Journal of Medicine, ISSN 0002-9343, E-ISSN 1555-7162, Vol. 133, no 1, p. 123-132.e8Article in journal (Refereed) Published
Abstract [en]

Background

Electrocardiography (ECG) is used to screen for left ventricular hypertrophy (LVH), but common ECG-LVH criteria have been found less effective in athletes. The purpose of this study was to comprehensively evaluate the value of ECG for identifying athletes with LVH or a concentric cardiac phenotype.

Methods

A retrospective analysis of 196 male Division I college athletes routinely screened with ECG and echocardiography within the Stanford Athletic Cardiovascular Screening Program was performed. Left-ventricular mass and volume were determined using echocardiography. LVH was defined as left ventricular mass (LVM) > 102 g/m²; a concentric cardiac phenotype as LVM-to-volume (M/V) ≥ 1.05 g/mL. Twelve-lead electrocardiograms including high-resolution time intervals and QRS voltages were obtained. Thirty-seven previously published ECG-LVH criteria were applied, of which the majority have never been evaluated in athletes. C-statistics, including area under the receiver operating curve (AUC) and likelihood ratios were calculated.

Results

ECG lead voltages were poorly associated with LVM (r = 0.18-0.30) and M/V (r = 0.15-0.25). The proportion of athletes with ECG-LVH was 0%-74% across criteria, with sensitivity and specificity ranging between 0% and 91% and 27% and 99.5%, respectively. The average AUC of the criteria in identifying the 11 athletes with LVH was 0.57 (95% confidence interval [CI] 0.56-0.59), and the average AUC for identifying the 8 athletes with a concentric phenotype was 0.59 (95% CI 0.56-0.62).

Conclusion

The diagnostic capacity of all ECG-LVH criteria were inadequate and, therefore, not clinically useful in screening for LVH or a concentric phenotype in athletes. This is probably due to the weak association between LVM and ECG voltage.

Place, publisher, year, edition, pages
Elsevier, 2020. Vol. 133, no 1, p. 123-132.e8
Keywords [en]
Athletes heart; electrocardiography (ECG); echocardiography; left ventricular mass (LVM); preparticipation evaluation
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-163104DOI: 10.1016/j.amjmed.2019.06.028ISI: 000504857800032PubMedID: 31738876Scopus ID: 2-s2.0-85076027061OAI: oai:DiVA.org:liu-163104DiVA, id: diva2:1385077
Note

Funding Agencies|Fulbright Commission; Swedish Heart Foundation; Swedish Society of Medicine; County Council of Ostergotland, Sweden; Stanford Cardiovascular Institute

Available from: 2020-01-13 Created: 2020-01-13 Last updated: 2020-01-20Bibliographically approved

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Hedman, Kristofer

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Division of Diagnostics and Specialist MedicineFaculty of Medicine and Health SciencesDepartment of Clinical Physiology in Linköping
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