Cardiovascular evaluation, including resting and exercise electrocardiography, before participation in competitive sports: Cross sectional study

Abstract

Objective: To evaluate the clinical usefulness of complete preparticipation cardiovascular screening in a large cohort of sports participants. Design: Cross sectional study of data over a five year period. Setting: Institute of Sports Medicine in Florence, Italy. Participants: 30 065 (23 570 men) people seeking to obtain clinical eligibility for competitive sports. Main outcome measures: Results of resting and exercise 12 lead electrocardiography. Results: Resting 12 lead ECG patterns showed abnormalities in 1812 (6%) participants, with the most common abnormalities (>80%) concerning innocent ECG changes. Exercise ECG showed an abnormal pattern in 1459 (4.9%) participants. Exercise ECG showed cardiac anomalies in 1227 athletes with normal findings on resting ECG. At the end of screening, 196 (0.6%) participants were considered ineligible for competitive sports. Among the 159 participants who were disqualified at the end of the screening for cardiac reasons, a consistent proportion (n=126, 79.2%) had shown innocent or negative findings on resting 12 lead ECG but clear pathological alterations during the exercise test. After adjustment for possible confounders, logistic regression analysis showed that age >30 years was significantly associated with an increased risk of being disqualified for cardiac findings during exercise testing. Conclusions: Among people seeking to take part in competitive sports, exercise ECG can identify those with cardiac abnormalities. Follow-up studies would show if disqualification of such people would reduce the incidence of CV events among athletes.