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A comparison of the European Society of Cardiology, the Seattle and the Refined Criteria for interpreting the athlete's ECG in a pre-participation screening programme

(2016) ACTA CARDIOLOGICA. 71(6). p.631-637
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Abstract
Objective: Sudden cardiac death is the main cause of non-traumatic mortality in young athletes. It is mainly caused by asymptomatic structural or electrical heart disease. This indicates the potential need for a pre-participation screening programme. Adding a 12-lead resting ECG to a cardiovascular screening programme increases sensitivity, but reduces specificity. ECG-interpretation criteria have been proposed in order to improve specificity and cost-efficiency. This review evaluates three frequently used criteria and their effect on the sensitivity and specificity of a pre-participation screening programme. Methods and results: This non-systematic review assesses the data of four recent studies comparing the European Society of Cardiology (ESC), the Seattle and the Refined Criteria in a pre-participation screening programme. The sensitivity and specificity of the criteria are evaluated in young (<35 years) Caucasian, Arabic and black athletes. There is no significant difference in sensitivity between the three criteria (98.1% - 100%). The Refined Criteria are more specific than the ESC and the Seattle criteria. The specificity of the ESC recommendations ranged from 64.8% to 76.6% and the specificity of the Seattle criteria ranged from 87.5% to 88.8%. The Refined Criteria have the highest specificity, 91.4% to 94.0%. Applying the Refined Criteria results in a significant decrease in abnormal ECGs and an improvement of the positive predictive value of an abnormal ECG. Conclusions: Applying the Refined Criteria results in a significant increase in specificity when compared to the ESC and the Seattle criteria, while retaining the same sensitivity. This reduces the amount of abnormal ECGs from 12.7% - 22.3% with the ESC criteria to 1.9% - 6.6% with the Refined Criteria, which in turn greatly decreases the need for further investigations and thus the costs of a pre-participation screening programme.
Keywords
ELECTROCARDIOGRAPHIC INTERPRETATION, OF-CARDIOLOGY, SUDDEN-DEATH, ABNORMALITIES, ASSOCIATION, STATEMENT, Pre-participation screening, Seattle Criteria, Refined Criteria, ESC, criteria, electrocardiography, screening programme, athlete

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Chicago
De Vos, Laurens, and Johan De Sutter. 2016. “A Comparison of the European Society of Cardiology, the Seattle and the Refined Criteria for Interpreting the Athlete’s ECG in a Pre-participation Screening Programme.” Acta Cardiologica 71 (6): 631–637.
APA
De Vos, Laurens, & De Sutter, J. (2016). A comparison of the European Society of Cardiology, the Seattle and the Refined Criteria for interpreting the athlete’s ECG in a pre-participation screening programme. ACTA CARDIOLOGICA, 71(6), 631–637.
Vancouver
1.
De Vos L, De Sutter J. A comparison of the European Society of Cardiology, the Seattle and the Refined Criteria for interpreting the athlete’s ECG in a pre-participation screening programme. ACTA CARDIOLOGICA. 2016;71(6):631–7.
MLA
De Vos, Laurens, and Johan De Sutter. “A Comparison of the European Society of Cardiology, the Seattle and the Refined Criteria for Interpreting the Athlete’s ECG in a Pre-participation Screening Programme.” ACTA CARDIOLOGICA 71.6 (2016): 631–637. Print.
@article{8510937,
  abstract     = {Objective: Sudden cardiac death is the main cause of non-traumatic mortality in young athletes. It is mainly caused by asymptomatic structural or electrical heart disease. This indicates the potential need for a pre-participation screening programme. Adding a 12-lead resting ECG to a cardiovascular screening programme increases sensitivity, but reduces specificity. ECG-interpretation criteria have been proposed in order to improve specificity and cost-efficiency. This review evaluates three frequently used criteria and their effect on the sensitivity and specificity of a pre-participation screening programme. 
Methods and results: This non-systematic review assesses the data of four recent studies comparing the European Society of Cardiology (ESC), the Seattle and the Refined Criteria in a pre-participation screening programme. The sensitivity and specificity of the criteria are evaluated in young ({\textlangle}35 years) Caucasian, Arabic and black athletes. There is no significant difference in sensitivity between the three criteria (98.1\% - 100\%). The Refined Criteria are more specific than the ESC and the Seattle criteria. The specificity of the ESC recommendations ranged from 64.8\% to 76.6\% and the specificity of the Seattle criteria ranged from 87.5\% to 88.8\%. The Refined Criteria have the highest specificity, 91.4\% to 94.0\%. Applying the Refined Criteria results in a significant decrease in abnormal ECGs and an improvement of the positive predictive value of an abnormal ECG. 
Conclusions: Applying the Refined Criteria results in a significant increase in specificity when compared to the ESC and the Seattle criteria, while retaining the same sensitivity. This reduces the amount of abnormal ECGs from 12.7\% - 22.3\% with the ESC criteria to 1.9\% - 6.6\% with the Refined Criteria, which in turn greatly decreases the need for further investigations and thus the costs of a pre-participation screening programme.},
  author       = {De Vos, Laurens and De Sutter, Johan},
  issn         = {0001-5385},
  journal      = {ACTA CARDIOLOGICA},
  language     = {eng},
  number       = {6},
  pages        = {631--637},
  title        = {A comparison of the European Society of Cardiology, the Seattle and the Refined Criteria for interpreting the athlete's ECG in a pre-participation screening programme},
  url          = {http://dx.doi.org/10.2143/AC.71.6.3178180},
  volume       = {71},
  year         = {2016},
}

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