- Email: [email protected]
Is it possible to reduce the false-positive diagnostic statements in young athlete ECG screening?
Available online at www.sciencedirect.com
ScienceDirect Journal of Electrocardiology 46 (2013) 621 – 626 www.jecgonline.com
ISCE 2013 Poster Session 2
Is it possible to reduce the false-positive diagnostic statements in young athlete ECG screening? Roger Abächerli,a Richard Kobza,b David Hadley,c Johann-Jakob Schmid,a Franz Frey,d Paul Erne,b Victor Froelicherc,e,f a SCHILLER AG, Biomed, Research and Signal Processing, Baar, Switzerland b Division of Cardiology, Cantonal Hospital Luzern, Switzerland c Cardea Associate, Inc., Woodinville, WA, USA d Swiss Army, Ittigen, Switzerland e Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA f Veterans Affairs, Palo Alto Health Care System, Palo Alto, CA, USA
T-wave axis deviation and left ventricular hypertrophy interaction in diabetes and hypertension (MOLI-SANI project) Deodato Assanelli, MD,a Livia Rago, MD,b Augusto Di Castelnuovo, MS, PhD,b Fabio Badilini, PhD, FACC,c Martino Vaglio, MS,c Francesco Gianfagna, MD, PhD,b Massimo Salvetti, MD,a Francesco Zito, MD,b Maria Benedetta Donati, MD, PhD,b Giovanni de Gaetano, MD, PhD,b Licia Iacoviello, MD, PhDb a Chair of Internal–Sport Medicine, University of Brescia, Brescia, Italy b Laboratory of Genetic and Environmental Epidemiology, Research Laboratories, Fondazione di Ricerca e Cura “Giovanni Paolo II,” Catholic University, Campobasso, Italy c AMPS LLC, New York, NY, USA
Background: The controversy regarding adding the ECG to the PPE of young athletes is still an ongoing debate. A major challenge is the reduction of false positives. Since a database of athletes with ECGs and outcomes is not available, other means of limiting false-positive ECGs when screening young individuals must be considered. We therefore used the Swiss Army data set as a control set in order to get electrocardiographic limites. Methods: We performed a retrospective study of 41,408 ECGs collected March 1, 2004 to July 31, 2006 on male Swiss Army recruits 18 to 21 years of age. All ECGs were digitized and processed by specialized software designed for athletic screening. Various criteria currently proposed for screening athletes were tested in this low-risk population to demonstrate the rate of positive calls. Those with a heart rate less than 60 bpm were considered to have undergone higher levels of exercise training than those above 60 bpm and a comparison was also made with Stanford collegiate athletes. Results: Q-wave depths of 3, 3.5 and 4 mm had positive rates of 2%, 1% and 0.4%, Q-wave widths of 30, 35 and 40 msec had rates of 2%, 1% and 0.1%, ST depression of 0.5 mm at QRS end or 80 msec average had rates of 3% and 0.4%, LAD of b−30 or − 45 degrees had rates of 1.1% and 0.6%, RAD of N 90 or N115 had rates of 10% and 0.7% and QRS durations of 120 or 125 msec had yields of 1.1% and 0.4%. Using optimal values chosen from these and other measurements, only 5.5% of these young men had abnormal ECGs. Similar rates of ECGs requiring further evaluation prior to athletic participation occurred in those with heart rates less than 60 bpm and collegiate athletes. Conclusions: From this analysis we propose criteria for the major ECG findings requiring further evaluation prior to athletic participation that limit the false-positive rate to less than 6%.
Background: T-wave axis deviation (TA) is a known independent predictor of fatal and nonfatal events. The mechanisms underlying the relationship with events have not been extensively investigated. The evaluation of TA might be useful to identify asymptomatic patients at increased cardiovascular (CV) risk. Aim: We aimed at evaluating the prevalence of TA according to the presence or absence of diabetes (DM) and/or hypertension (HT), two conditions characterized by an increased CV risk, in a large sample of the adult general Italian population. Methods: At total of 10,184 women (54 ± 11 years) and 8775 men (54 ± 11 years) were analyzed from the Moli-sani cohort, a database of randomly recruited healthy adults (age N35) from the general population of Molise, a central region of Italy that includes collection of standard 12lead resting electrocardiogram. Subjects with previous AMI, angina, cerebrovascular disease or left bundle brunch block or missing values for TA or LVH have been excluded. T-wave axis deviation was measured from the standard 12-lead resting electrocardiogram and it was defined as the rotation of the T wave in the frontal plane as computed by a proprietary algorithm (CalECG/Bravo, AMPS-LLC, NY). LVH was defined as Sokolow–Lyon voltage (SLv) N 35 mm or Cornell product (CP) ≥ 2440 mV*sec. Results: TA was abnormal in 1.1% of subjects without both HT and DM, in 1.4% in subjects without HT but with DM, in 2.7% of subjects with HT but without DM, in 4.2% of subjects with both HT and DM (Table 1). Conclusion: Our data suggest that T-axis deviation, a demonstrated marker of increased CV risk, is associated with the presence of arterial hypertension, associated or not with diabetes, but not with diabetes alone.
http://dx.doi.org/10.1016/j.jelectrocard.2013.09.022
http://dx.doi.org/10.1016/j.jelectrocard.2013.09.023
Table 1
a) Hypertension NO and diabetes NO b) Hypertension YES and diabetes NO c) Hypertension NO and diabetes YES d) Hypertension YES and diabetes YES
N
T-axis deviation Normal or borderline
Abnormal
11,504 5920 575 960
11,379 (98.9%) 5760 (97.3%) 567 (98.6%) 920 (95.8%)
125 (1.1%) 160 (2.7%) 8 (1.4%) 40 (4.2%)
p for effect of hypertension (a + c versus b + d) = b 0.0001; p for effect of diabetes (a + b versus c + d) = 0.46; p for interaction effect hypertension * diabetes = 0.39. 0022-0736/$ – see front matter
ScienceDirect Journal of Electrocardiology 46 (2013) 621 – 626 www.jecgonline.com
ISCE 2013 Poster Session 2
Is it possible to reduce the false-positive diagnostic statements in young athlete ECG screening? Roger Abächerli,a Richard Kobza,b David Hadley,c Johann-Jakob Schmid,a Franz Frey,d Paul Erne,b Victor Froelicherc,e,f a SCHILLER AG, Biomed, Research and Signal Processing, Baar, Switzerland b Division of Cardiology, Cantonal Hospital Luzern, Switzerland c Cardea Associate, Inc., Woodinville, WA, USA d Swiss Army, Ittigen, Switzerland e Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA f Veterans Affairs, Palo Alto Health Care System, Palo Alto, CA, USA
T-wave axis deviation and left ventricular hypertrophy interaction in diabetes and hypertension (MOLI-SANI project) Deodato Assanelli, MD,a Livia Rago, MD,b Augusto Di Castelnuovo, MS, PhD,b Fabio Badilini, PhD, FACC,c Martino Vaglio, MS,c Francesco Gianfagna, MD, PhD,b Massimo Salvetti, MD,a Francesco Zito, MD,b Maria Benedetta Donati, MD, PhD,b Giovanni de Gaetano, MD, PhD,b Licia Iacoviello, MD, PhDb a Chair of Internal–Sport Medicine, University of Brescia, Brescia, Italy b Laboratory of Genetic and Environmental Epidemiology, Research Laboratories, Fondazione di Ricerca e Cura “Giovanni Paolo II,” Catholic University, Campobasso, Italy c AMPS LLC, New York, NY, USA
Background: The controversy regarding adding the ECG to the PPE of young athletes is still an ongoing debate. A major challenge is the reduction of false positives. Since a database of athletes with ECGs and outcomes is not available, other means of limiting false-positive ECGs when screening young individuals must be considered. We therefore used the Swiss Army data set as a control set in order to get electrocardiographic limites. Methods: We performed a retrospective study of 41,408 ECGs collected March 1, 2004 to July 31, 2006 on male Swiss Army recruits 18 to 21 years of age. All ECGs were digitized and processed by specialized software designed for athletic screening. Various criteria currently proposed for screening athletes were tested in this low-risk population to demonstrate the rate of positive calls. Those with a heart rate less than 60 bpm were considered to have undergone higher levels of exercise training than those above 60 bpm and a comparison was also made with Stanford collegiate athletes. Results: Q-wave depths of 3, 3.5 and 4 mm had positive rates of 2%, 1% and 0.4%, Q-wave widths of 30, 35 and 40 msec had rates of 2%, 1% and 0.1%, ST depression of 0.5 mm at QRS end or 80 msec average had rates of 3% and 0.4%, LAD of b−30 or − 45 degrees had rates of 1.1% and 0.6%, RAD of N 90 or N115 had rates of 10% and 0.7% and QRS durations of 120 or 125 msec had yields of 1.1% and 0.4%. Using optimal values chosen from these and other measurements, only 5.5% of these young men had abnormal ECGs. Similar rates of ECGs requiring further evaluation prior to athletic participation occurred in those with heart rates less than 60 bpm and collegiate athletes. Conclusions: From this analysis we propose criteria for the major ECG findings requiring further evaluation prior to athletic participation that limit the false-positive rate to less than 6%.
Background: T-wave axis deviation (TA) is a known independent predictor of fatal and nonfatal events. The mechanisms underlying the relationship with events have not been extensively investigated. The evaluation of TA might be useful to identify asymptomatic patients at increased cardiovascular (CV) risk. Aim: We aimed at evaluating the prevalence of TA according to the presence or absence of diabetes (DM) and/or hypertension (HT), two conditions characterized by an increased CV risk, in a large sample of the adult general Italian population. Methods: At total of 10,184 women (54 ± 11 years) and 8775 men (54 ± 11 years) were analyzed from the Moli-sani cohort, a database of randomly recruited healthy adults (age N35) from the general population of Molise, a central region of Italy that includes collection of standard 12lead resting electrocardiogram. Subjects with previous AMI, angina, cerebrovascular disease or left bundle brunch block or missing values for TA or LVH have been excluded. T-wave axis deviation was measured from the standard 12-lead resting electrocardiogram and it was defined as the rotation of the T wave in the frontal plane as computed by a proprietary algorithm (CalECG/Bravo, AMPS-LLC, NY). LVH was defined as Sokolow–Lyon voltage (SLv) N 35 mm or Cornell product (CP) ≥ 2440 mV*sec. Results: TA was abnormal in 1.1% of subjects without both HT and DM, in 1.4% in subjects without HT but with DM, in 2.7% of subjects with HT but without DM, in 4.2% of subjects with both HT and DM (Table 1). Conclusion: Our data suggest that T-axis deviation, a demonstrated marker of increased CV risk, is associated with the presence of arterial hypertension, associated or not with diabetes, but not with diabetes alone.
http://dx.doi.org/10.1016/j.jelectrocard.2013.09.022
http://dx.doi.org/10.1016/j.jelectrocard.2013.09.023
Table 1
a) Hypertension NO and diabetes NO b) Hypertension YES and diabetes NO c) Hypertension NO and diabetes YES d) Hypertension YES and diabetes YES
N
T-axis deviation Normal or borderline
Abnormal
11,504 5920 575 960
11,379 (98.9%) 5760 (97.3%) 567 (98.6%) 920 (95.8%)
125 (1.1%) 160 (2.7%) 8 (1.4%) 40 (4.2%)
p for effect of hypertension (a + c versus b + d) = b 0.0001; p for effect of diabetes (a + b versus c + d) = 0.46; p for interaction effect hypertension * diabetes = 0.39. 0022-0736/$ – see front matter