Significance of False Negative Electrocardiograms in Preparticipation Screening of Athletes for Hypertrophic Cardiomyopathy
Significance of False Negative Electrocardiograms in Preparticipation Screening of Athletes for Hypertrophic Cardiomyopathy
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DOI：
10.1016/j.amjcard.2012.05.035
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发表时间：
2012-10-01
影响因子：
2.8
通讯作者：
Maron, Martin S.
中科院分区：
文献类型：
--
作者：
Rowin, Ethan J.;Maron, Barry J.;Maron, Martin S.
运动员参加前12导联心电图筛查已被推广用于检测无症状心血管疾病，特别是肥厚型心肌病（HC）。虽然HC的假阳性心电图（ECG）结果在运动员筛查中得到了很好的认可，但预期的假阴性率尚不清楚。本研究的目的是使用2010年欧洲心脏病学会推荐的ECG标准，通过心血管磁共振确定一组具有表型表达HC的年轻无症状患者的假阴性ECG结果的特征，以识别受过训练的运动员中的疑似心脏病。在114例年龄≥ 1岁的无症状HC患者中进行心脏磁共振研究和12导联心电图检查，其余11例患者（10%）具有正常或非病理性ECG模式，因此定义了一个亚组，其中ECG筛查预计不会引起心脏病的怀疑（即，假阴性结果）。在该假阴性ECG结果组中，最大左心室壁厚度为17 +/- 2 mm（范围15 - 21），而病理性ECG模式患者的最大左心室壁厚度为22 +/- 5 mm（p = 0.003）。总之，根据2010年欧洲心脏病学会指南，极少数具有表型表达的左心室肥大的年轻无症状HC患者具有非病理性ECG结果。原则上，10%的高假阴性率代表了将12导联心电图应用于大型、明显健康的运动人群以检测HC的重要限制。(C)2012年由Elsevier Inc.出版(Am J Cardiol 2012;110：1027-1032）
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 = 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. (C) 2012 Published by Elsevier Inc. (Am J Cardiol 2012;110:1027-1032)