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• W2101960933 abstract "I read with interest the article by Magalski et al1Magalski A. McCoy M. Zabel M. Magee L.M. Goeke J. Main M.L. et al.Cardiovascular screening with electrocardiography and echocardiography in collegiate athletes.Am J Med. 2011; 124: 511-518Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar about the role of electrocardiography (ECG) and transthoracic echocardiography (TTE) for preparticipation screening of athletes. The authors elegantly report their results in one of the largest single cohorts of collegiate athletes undergoing a screening program that includes both ECG and TTE. Their 9.9% prevalence of distinctly abnormal ECG patterns is in line with our recent report on this field.2Hevia A.C. Fernández M.M. Palacio J.M. Martín E.H. Castro M.G. Reguero J.J. ECG as a part of the preparticipation screening programme: an old and still present international dilemma.Br J Sports Med. 2011; 45: 776-779Crossref PubMed Scopus (51) Google Scholar We found 75 of 1220 athletes (6.14%) with abnormal ECG, who were referred for further screening using TTE to rule out structural abnormalities. One of the strongest points of Magalski et al's work1Magalski A. McCoy M. Zabel M. Magee L.M. Goeke J. Main M.L. et al.Cardiovascular screening with electrocardiography and echocardiography in collegiate athletes.Am J Med. 2011; 124: 511-518Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar is that TTE was performed systematically. However, their 0.2% rate of athletes disqualified is similar to our 0.16%,2Hevia A.C. Fernández M.M. Palacio J.M. Martín E.H. Castro M.G. Reguero J.J. ECG as a part of the preparticipation screening programme: an old and still present international dilemma.Br J Sports Med. 2011; 45: 776-779Crossref PubMed Scopus (51) Google Scholar and the authors admitted a negligible incremental value of TTE. On the other hand, we found that none of the cases with abnormal history or physical examination revealed structural findings on TTE. Magalski et al1Magalski A. McCoy M. Zabel M. Magee L.M. Goeke J. Main M.L. et al.Cardiovascular screening with electrocardiography and echocardiography in collegiate athletes.Am J Med. 2011; 124: 511-518Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar pointed out how the addition of ECG resulted in higher sensitivity, as well as higher positive and negative predictive values. Therefore, I agree with the authors that: 1) preparticipation screening with history and physical examination is not enough; 2) routine TTE adds little incremental value; 3) routine ECG is probably the best approach to raise suspicion of underlying cardiac diseases, which helps in the selection of athletes who should undergo further diagnostic scrutiny.The importance of ECG in the screening of athletes for recognizing silent cardiovascular disease is widely recognized,3Uberoi A. Stein R. Perez M.V. et al.Interpretation of the electrocardiogram of young athletes.Circulation. 2011; 124: 746-757Crossref PubMed Scopus (178) Google Scholar, 4Corrado D. Pelliccia A. Heidbuchel H. et al.Recommendations for interpretation of 12-lead electrocardiogram in the athlete.Eur Heart J. 2010; 31: 243-259Crossref PubMed Scopus (680) Google Scholar, 5Baggish A.L. Hutter Jr, A.M. Wang F. et al.Cardiovascular screening in college athletes with and without electrocardiography: a cross-sectional study.Ann Intern Med. 2010; 152: 269-275Crossref PubMed Scopus (242) Google Scholar although its cost-effectiveness is still being debated.6Wheeler M.T. Heidenreich P.A. Froelicher V.F. Hlatky M.A. Ashley E.A. Cost-effectiveness of preparticipation screening for prevention of sudden cardiac death in young athletes.Ann Intern Med. 2010; 152: 276-286Crossref PubMed Scopus (206) Google Scholar To reduce the financial and psychological burden of false-positive ECGs, interpretation should be carried out using athlete-specific criteria. Recent reports3Uberoi A. Stein R. Perez M.V. et al.Interpretation of the electrocardiogram of young athletes.Circulation. 2011; 124: 746-757Crossref PubMed Scopus (178) Google Scholar, 4Corrado D. Pelliccia A. Heidbuchel H. et al.Recommendations for interpretation of 12-lead electrocardiogram in the athlete.Eur Heart J. 2010; 31: 243-259Crossref PubMed Scopus (680) Google Scholar have provided improved approaches to interpreting athletic ECG. These recommendations represent the consensus opinions of experts from many countries with decades of experience in dealing with athletes and ECGs. They do not represent an official guideline, but offer a new framework for ECG to be introduced in athletic preparticipation screening. I read with interest the article by Magalski et al1Magalski A. McCoy M. Zabel M. Magee L.M. Goeke J. Main M.L. et al.Cardiovascular screening with electrocardiography and echocardiography in collegiate athletes.Am J Med. 2011; 124: 511-518Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar about the role of electrocardiography (ECG) and transthoracic echocardiography (TTE) for preparticipation screening of athletes. The authors elegantly report their results in one of the largest single cohorts of collegiate athletes undergoing a screening program that includes both ECG and TTE. Their 9.9% prevalence of distinctly abnormal ECG patterns is in line with our recent report on this field.2Hevia A.C. Fernández M.M. Palacio J.M. Martín E.H. Castro M.G. Reguero J.J. ECG as a part of the preparticipation screening programme: an old and still present international dilemma.Br J Sports Med. 2011; 45: 776-779Crossref PubMed Scopus (51) Google Scholar We found 75 of 1220 athletes (6.14%) with abnormal ECG, who were referred for further screening using TTE to rule out structural abnormalities. One of the strongest points of Magalski et al's work1Magalski A. McCoy M. Zabel M. Magee L.M. Goeke J. Main M.L. et al.Cardiovascular screening with electrocardiography and echocardiography in collegiate athletes.Am J Med. 2011; 124: 511-518Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar is that TTE was performed systematically. However, their 0.2% rate of athletes disqualified is similar to our 0.16%,2Hevia A.C. Fernández M.M. Palacio J.M. Martín E.H. Castro M.G. Reguero J.J. ECG as a part of the preparticipation screening programme: an old and still present international dilemma.Br J Sports Med. 2011; 45: 776-779Crossref PubMed Scopus (51) Google Scholar and the authors admitted a negligible incremental value of TTE. On the other hand, we found that none of the cases with abnormal history or physical examination revealed structural findings on TTE. Magalski et al1Magalski A. McCoy M. Zabel M. Magee L.M. Goeke J. Main M.L. et al.Cardiovascular screening with electrocardiography and echocardiography in collegiate athletes.Am J Med. 2011; 124: 511-518Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar pointed out how the addition of ECG resulted in higher sensitivity, as well as higher positive and negative predictive values. Therefore, I agree with the authors that: 1) preparticipation screening with history and physical examination is not enough; 2) routine TTE adds little incremental value; 3) routine ECG is probably the best approach to raise suspicion of underlying cardiac diseases, which helps in the selection of athletes who should undergo further diagnostic scrutiny. The importance of ECG in the screening of athletes for recognizing silent cardiovascular disease is widely recognized,3Uberoi A. Stein R. Perez M.V. et al.Interpretation of the electrocardiogram of young athletes.Circulation. 2011; 124: 746-757Crossref PubMed Scopus (178) Google Scholar, 4Corrado D. Pelliccia A. Heidbuchel H. et al.Recommendations for interpretation of 12-lead electrocardiogram in the athlete.Eur Heart J. 2010; 31: 243-259Crossref PubMed Scopus (680) Google Scholar, 5Baggish A.L. Hutter Jr, A.M. Wang F. et al.Cardiovascular screening in college athletes with and without electrocardiography: a cross-sectional study.Ann Intern Med. 2010; 152: 269-275Crossref PubMed Scopus (242) Google Scholar although its cost-effectiveness is still being debated.6Wheeler M.T. Heidenreich P.A. Froelicher V.F. Hlatky M.A. Ashley E.A. Cost-effectiveness of preparticipation screening for prevention of sudden cardiac death in young athletes.Ann Intern Med. 2010; 152: 276-286Crossref PubMed Scopus (206) Google Scholar To reduce the financial and psychological burden of false-positive ECGs, interpretation should be carried out using athlete-specific criteria. Recent reports3Uberoi A. Stein R. Perez M.V. et al.Interpretation of the electrocardiogram of young athletes.Circulation. 2011; 124: 746-757Crossref PubMed Scopus (178) Google Scholar, 4Corrado D. Pelliccia A. Heidbuchel H. et al.Recommendations for interpretation of 12-lead electrocardiogram in the athlete.Eur Heart J. 2010; 31: 243-259Crossref PubMed Scopus (680) Google Scholar have provided improved approaches to interpreting athletic ECG. These recommendations represent the consensus opinions of experts from many countries with decades of experience in dealing with athletes and ECGs. They do not represent an official guideline, but offer a new framework for ECG to be introduced in athletic preparticipation screening. Cardiovascular Screening with Electrocardiography and Echocardiography in Collegiate AthletesThe American Journal of MedicineVol. 124Issue 6PreviewCurrent guidelines for preparticipation screening of competitive athletes in the US include a comprehensive history and physical examination. The objective of this study was to determine the incremental value of electrocardiography and echocardiography added to a screening program consisting of history and physical examination in college athletes. Full-Text PDF The ReplyThe American Journal of MedicineVol. 125Issue 5PreviewWe thank Carro for the comments regarding our article1 and the review of additional data supporting incorporation of the electrocardiogram into pre-participation athletic screening programs in addition to the history and physical examination.2 We agree that accumulating evidence supports electrocardiogram (ECG) interpretation using athlete-specific criteria as described by Corrado et al3 and Uberoi et al4 to reduce false-positive findings. Full-Text PDF" @default.
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