Significance of false negative electrocardiograms in preparticipation screening of athletes for hypertrophic cardiomyopathy

Ethan J. Rowin, Barry J. Maron, Evan Appelbaum, Mark S. Link, C. Michael Gibson, John R. Lesser, Tammy S. Haas, James E. Udelson, Warren J. Manning, Martin S. Maron

Research output: Contribution to journalArticle

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Abstract

Preparticipation screening of athletes with 12-lead electrocardiography has been promoted for the detection of asymptomatic cardiovascular disease, particularly hypertrophic cardiomyopathy (HC). Although false-positive electrocardiographic (ECG) results for HC are well recognized in athlete screening, expected false-negative rates are unknown. The aim of this study was to characterize the rate of false-negative ECG findings in a cohort of young asymptomatic patients with phenotypically expressed HC, defined by cardiovascular magnetic resonance, using the 2010 European Society of Cardiology recommended ECG criteria for the identification of suspected heart disease in trained athletes. Cardiac magnetic resonance studies and 12-lead electrocardiography were performed in 114 consecutive asymptomatic patients with HC aged ≤35 years (mean age 22 ± 8 years; 77% male patients). Electrocardiograms were analyzed to distinguish pathologic ECG patterns from alterations considered nonpathologic and physiologic consequences of athletic training. Among the 114 patients with HC, 103 (90%) demonstrated <1 pathologic ECG abnormality, while the remaining 11 patients (10%) had normal or nonpathologic ECG patterns and therefore defined a subgroup in whom ECG screening would not be expected to raise suspicion of heart disease (i.e., false-negative results). In this false-negative ECG results group, maximal left ventricular wall thickness was 17 ± 2 mm (range 15 to 21), compared to patients with pathologic ECG patterns, in whom maximal left ventricular wall thickness was 22 ± 5 mm (p = 0.003). In conclusion, a substantial minority of young asymptomatic patients with HC with phenotypically expressed left ventricular hypertrophy have nonpathologic ECG findings on the basis of the 2010 European Society of Cardiology guidelines. In principle, this high false-negative rate of 10% represents an important limitation in applying 12-lead electrocardiography to large, apparently healthy athletic populations for the detection of HC.

Original languageEnglish (US)
Pages (from-to)1027-1032
Number of pages6
JournalAmerican Journal of Cardiology
Volume110
Issue number7
DOIs
StatePublished - Oct 1 2012

Fingerprint

Hypertrophic Cardiomyopathy
Athletes
Electrocardiography
Sports
Heart Diseases
Magnetic Resonance Spectroscopy
Asymptomatic Diseases
Left Ventricular Hypertrophy
Cardiovascular Diseases
Guidelines
Population
Lead

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Significance of false negative electrocardiograms in preparticipation screening of athletes for hypertrophic cardiomyopathy. / Rowin, Ethan J.; Maron, Barry J.; Appelbaum, Evan; Link, Mark S.; Gibson, C. Michael; Lesser, John R.; Haas, Tammy S.; Udelson, James E.; Manning, Warren J.; Maron, Martin S.

In: American Journal of Cardiology, Vol. 110, No. 7, 01.10.2012, p. 1027-1032.

Research output: Contribution to journalArticle

Rowin, EJ, Maron, BJ, Appelbaum, E, Link, MS, Gibson, CM, Lesser, JR, Haas, TS, Udelson, JE, Manning, WJ & Maron, MS 2012, 'Significance of false negative electrocardiograms in preparticipation screening of athletes for hypertrophic cardiomyopathy', American Journal of Cardiology, vol. 110, no. 7, pp. 1027-1032. https://doi.org/10.1016/j.amjcard.2012.05.035
Rowin, Ethan J. ; Maron, Barry J. ; Appelbaum, Evan ; Link, Mark S. ; Gibson, C. Michael ; Lesser, John R. ; Haas, Tammy S. ; Udelson, James E. ; Manning, Warren J. ; Maron, Martin S. / Significance of false negative electrocardiograms in preparticipation screening of athletes for hypertrophic cardiomyopathy. In: American Journal of Cardiology. 2012 ; Vol. 110, No. 7. pp. 1027-1032.
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abstract = "Preparticipation screening of athletes with 12-lead electrocardiography has been promoted for the detection of asymptomatic cardiovascular disease, particularly hypertrophic cardiomyopathy (HC). Although false-positive electrocardiographic (ECG) results for HC are well recognized in athlete screening, expected false-negative rates are unknown. The aim of this study was to characterize the rate of false-negative ECG findings in a cohort of young asymptomatic patients with phenotypically expressed HC, defined by cardiovascular magnetic resonance, using the 2010 European Society of Cardiology recommended ECG criteria for the identification of suspected heart disease in trained athletes. Cardiac magnetic resonance studies and 12-lead electrocardiography were performed in 114 consecutive asymptomatic patients with HC aged ≤35 years (mean age 22 ± 8 years; 77{\%} male patients). Electrocardiograms were analyzed to distinguish pathologic ECG patterns from alterations considered nonpathologic and physiologic consequences of athletic training. Among the 114 patients with HC, 103 (90{\%}) demonstrated <1 pathologic ECG abnormality, while the remaining 11 patients (10{\%}) had normal or nonpathologic ECG patterns and therefore defined a subgroup in whom ECG screening would not be expected to raise suspicion of heart disease (i.e., false-negative results). In this false-negative ECG results group, maximal left ventricular wall thickness was 17 ± 2 mm (range 15 to 21), compared to patients with pathologic ECG patterns, in whom maximal left ventricular wall thickness was 22 ± 5 mm (p = 0.003). In conclusion, a substantial minority of young asymptomatic patients with HC with phenotypically expressed left ventricular hypertrophy have nonpathologic ECG findings on the basis of the 2010 European Society of Cardiology guidelines. In principle, this high false-negative rate of 10{\%} represents an important limitation in applying 12-lead electrocardiography to large, apparently healthy athletic populations for the detection of HC.",
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