The Stanford Legacy and the Future of Electrocardiographic Screening of Athletes
Main Article Content
Abstract
Though some controversy remains regarding the place of the 12 lead Electrocardiogram (ECG) in the routine screening of young athletes and how and where the pre-participation examination should be performed, studies continue to support the ECG and properly organized mass screening. The purpose of this paper is to provide brief historical perspective, the experiences at our institution and our view of the future application of computerized Electrocardiography in screening for cardiovascular risk. The focus is on the process and improvement of Electrocardiographic criteria for estimating the cardiovascular risk of young athletes.
Article Details
How to Cite
FROELICHER, Victor et al.
The Stanford Legacy and the Future of Electrocardiographic Screening of Athletes.
Medical Research Archives, [S.l.], v. 12, n. 5, may 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5355>. Date accessed: 04 nov. 2024.
doi: https://doi.org/10.18103/mra.v12i5.5355.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Corrado D, Basso C, Schiavon M, Pelliccia A, Thiene G. Pre-participation screening of young competitive athletes to prevent sudden cardiac death. J Am Coll Cardiol. 2008 Dec 9;52(24):1981-9. doi: 10.1016/j.jacc.2008.06.053. PMID: 19055989.
2. Harmon KG, Zigman M, Drezner JA. The effectiveness of screening history, physical exam, and ECG to detect potentially lethal cardiac disorders in athletes: a systematic review/meta-analysis. J Electrocardiol. 2015 May-Jun;48(3):329-38. doi: 10.1016/j.jelectrocard.2015.02.001. Epub 2015 Feb 8. PMID: 25701104
3. The Cardiovascular Preparticipation Evaluation (PPE) for the Primary Care and Sports Medicine Physician, Part I: Erratum. Current Sports Medicine Reports 14(4):p 345, July/September 2015. | DOI: 10.1097/01.CSMR.0000469518.09353.9e
4. Parizher G, Putzke JD, Lampert R, Levine, B. Web-based multimedia athlete preparticipation questionnaire: introducing the video-PPE (v-PPE). British Journal of Sports Medicine 2020;54:67-68.
5. Drezner JA, Sharma S, Baggish A, Papadakis M, Wilson MG, Prutkin JM, Gerche A, Ackerman MJ, Borjesson M, Salerno JC, Asif IM, Owens DS, Chung EH, Emery MS, Froelicher VF, Heidbuchel H, Adamuz C, Asplund CA, Cohen G, Harmon KG, Marek JC, Molossi S, Niebauer J, Pelto HF, Perez MV, Riding NR, Saarel T, Schmied CM, Shipon DM, Stein R, Vetter VL, Pelliccia A, Corrado D. International criteria for electrocardiographic interpretation in athletes: Consensus statement. Br J Sports Med. 2017 May;51(9):704-731.
6. Uberoi A, Stein R, Perez MV, Freeman J, Wheeler M, Dewey F, Peidro R, Hadley D, Drezner J, Sharma S, Pelliccia A. Interpretation of the electrocardiogram of young athletes. Circulation. 2011 Aug 9;124(6):746-57.
7. Pickham D, Zarafshar S, Sani D, Kumar N, Froelicher V. Comparison of three ECG criteria for athlete pre-participation screening. Journal of Electrocardiology. 2014 Nov 1;47(6):769-74.
8. Petek BJ, Baggish AL. Current controversies in preparticipation cardiovascular screening for young competitive athletes. Expert Rev Cardiovasc Ther. 2020 Jul;18(7):435-442.
9. Froelicher VF, Lehmann KG, Thomas R, Goldman S, Morrison D, Edson R, Lavori P, Myers J, Dennis C, Shabetai R, Do D. The electrocardiographic exercise test in a population with reduced workup bias: diagnostic performance, computerized interpretation, and multivariable prediction. Annals of internal Medicine. 1998 Jun 15;128(12_Part_1):965-74.
10. Marshall M, Malik A, Shah M, Fish FA, Etheridge SP, Aziz PF, Russell MW, Tisma S, Pflaumer A, Sreeram N, Kubus P. Patterns of Electrocardiographic Abnormalities in Children with Hypertrophic Cardiomyopathy. Pediatric cardiology. 2023 Sep 9:1-0.
11. Maclachlan H, Bhatia R, Dhutia H, Fyyaz S, Chatrath N, Basu J, Miles C, Finocchiaro G, Gati S, Specterman M, Tome M. Outcome of a nationwide screening programme in young individuals. European Journal of Preventive Cardiology. 2023 Jun;30(Supplement_1):zwad125-068.
12. Dhutia H, Malhotra A, Finocchiaro G, Parpia S, Bhatia R, D’Silva A, Gati S, Mellor G, Narain R, Chandra N, Behr E. Diagnostic yield and financial implications of a nationwide electrocardiographic screening program to detect cardiac disease in the young. EP Europace. 2021 Aug 1;23(8):1295-301
13. Saarel EV, Granger S, Kaltman JR, et al. Electrocardiograms in Healthy North American Children in the Digital Age. Circulation: Arrhythmia and Electrophysiology 2018;11(7).
14. Hedman K, Moneghetti KJ, Hsu D, et al. Limitations of electrocardiography for detecting left ventricular hypertrophy or concentric remodeling in athletes. Am J Med 2020;133(1):123–132.e8.
15. Dunn TP, Pickham D, Aggarwal S, et al. Limitations of current AHA guidelines and proposal of new guidelines for the preparticipation examination of athletes. Clin J Sport Med 2015;25(6):472–7.
16. Perez MV, Friday K, Froelicher V. Semantic confusion: the case of early repolarization and the J point. The American journal of medicine. 2012 Sep 1;125(9):843-4.
17. Haïssaguerre M, Derval N, Sacher F, Jesel L, Deisenhofer I, de Roy L, Pasquié JL, Nogami A, Babuty D, Yli-Mayry S, De Chillou C. Sudden cardiac arrest associated with early repolarization. New England Journal of Medicine. 2008 May 8;358(19):2016-23.
18. Viskin S. Idiopathic ventricular fibrillation “Le Syndrome d'Haissaguerre” and the fear of J waves. Journal of the American College of Cardiology. 2009 Feb 17;53(7):620-2.
19. CSE Working Party. Recommendations for measurement standards in quantitative electrocardiography. European Heart Journal. 1985 Oct 1;6(10):815-25.
20. Uberoi A, Jain NA, Perez M, Weinkopff A, Ashley E, Hadley D, Turakhia MP, Froelicher V. Early repolarization in an ambulatory clinical population. Circulation. 2011 Nov 15;124(20):2208-14.
21. Froelicher V, Wagner G. Symposium on the J wave patterns and a J wave syndrome. Journal of Electrocardiology. 2013;5(46):381-2.
22. Grober AF, Hock J, Wheeler M, Elbadawi A, Biniwale N, Baig B, Froelicher V. Electrocardiographic left atrial abnormalities predict cardiovascular mortality. Journal of Electrocardiology. 2018 Jul 1;51(4):652-7.
23. Hock J, Wheeler M, Singh T, Hadley D, Froelicher V. Comparison of the Stanford ECG left atrial criteria with the international ECG criteria for sports screening. Clinical Journal of Sport Medicine. 2021 Jul 1;31(4):388-91.
24. Miranda CP, Lehmann KG, Froelicher VF. Correlation between resting ST segment depression, exercise testing, coronary angiography, and longterm prognosis. Am Heart J. 1991;122:1617–1628.
25. Muramoto D, Singh N, Aggarwal S, et al. Spectrum of ST amplitude in athletes and an ambulatory clinical population. J Electrocardiol. 2013;46:27–433.
26. Leo T, Uberoi A, Jain NA, et al. The impact of ST elevation on athletic screening. Clin J Sport Med. 2011;21:433–440.
27. Ilkhanoff L, Qian X, Lima JA, Tran H, Soliman EZ, Yeboah J, Seliger S, deFilippi CR. ECG associations of Cardiac Biomarkers and Cardiac Magnetic Resonance Measures of Fibrosis in the Multiethnic Study of Atherosclerosis (MESA). The American Journal of Cardiology. 2023 Oct 1;204:287-94.
28. Dai MY, Yan YC, Wang LY, Zhao CX, Wang DW, Jiang JG. Characteristics of electrocardiogram findings in fulminant myocarditis. Journal of Cardiovascular Development and Disease. 2023 Jun 30;10(7):280.
29. Montalvo S, Froelicher VF, Hadley D, Wheeler MT. Digitized Electrocardiography Measurements Support the Biological Plausibility of the Pathological Significance of ST Segments in Athletes. Clinical Journal of Sport Medicine. 2022 Mar 17:10-97.
30. Pelliccia A, Drezner JA, Zorzi A, Corrado D. Prevalence and clinical significance of low QRS voltages in healthy individuals, athletes and patients with cardiomyopathy: implications for sports preparticipation cardiovascular screening. European Journal of Preventive Cardiology. 2024 Jan 19:zwae027.
31. Tso JV, Montalvo S, Christle J, Hadley D, Froelicher V. Should ECG criteria for Low QRS voltage (LQRSV) be specific for Sex? American Heart Journal. Am Heart J. 2024 Apr;270:117-124. doi: 10.1016/j.ahj.2024.02.002. Epub 2024 Feb 9. PMID: 38342392. 2024 Feb 9.
32. MacLachlan H, Antonakaki A, Bhatia R, Fyazz S, Chatrath N, Androulakis E, Marawaha S, Basu J, Miles C, Dhutia H, Zaidi A, Chandra N, Sheikh N, Gati S, Malhotra A, Finocchiaro G, Sharma S, Papadakis M. Prevalence and Clinical Significance of Electrocardiographic Complete Right Bundle Branch Block in Young Individuals. Eur J Prev Cardiol. 2024 Feb 27:zwae082. doi: 10.1093/eurjpc/zwae082. Epub ahead of print. PMID: 38412448.
2. Harmon KG, Zigman M, Drezner JA. The effectiveness of screening history, physical exam, and ECG to detect potentially lethal cardiac disorders in athletes: a systematic review/meta-analysis. J Electrocardiol. 2015 May-Jun;48(3):329-38. doi: 10.1016/j.jelectrocard.2015.02.001. Epub 2015 Feb 8. PMID: 25701104
3. The Cardiovascular Preparticipation Evaluation (PPE) for the Primary Care and Sports Medicine Physician, Part I: Erratum. Current Sports Medicine Reports 14(4):p 345, July/September 2015. | DOI: 10.1097/01.CSMR.0000469518.09353.9e
4. Parizher G, Putzke JD, Lampert R, Levine, B. Web-based multimedia athlete preparticipation questionnaire: introducing the video-PPE (v-PPE). British Journal of Sports Medicine 2020;54:67-68.
5. Drezner JA, Sharma S, Baggish A, Papadakis M, Wilson MG, Prutkin JM, Gerche A, Ackerman MJ, Borjesson M, Salerno JC, Asif IM, Owens DS, Chung EH, Emery MS, Froelicher VF, Heidbuchel H, Adamuz C, Asplund CA, Cohen G, Harmon KG, Marek JC, Molossi S, Niebauer J, Pelto HF, Perez MV, Riding NR, Saarel T, Schmied CM, Shipon DM, Stein R, Vetter VL, Pelliccia A, Corrado D. International criteria for electrocardiographic interpretation in athletes: Consensus statement. Br J Sports Med. 2017 May;51(9):704-731.
6. Uberoi A, Stein R, Perez MV, Freeman J, Wheeler M, Dewey F, Peidro R, Hadley D, Drezner J, Sharma S, Pelliccia A. Interpretation of the electrocardiogram of young athletes. Circulation. 2011 Aug 9;124(6):746-57.
7. Pickham D, Zarafshar S, Sani D, Kumar N, Froelicher V. Comparison of three ECG criteria for athlete pre-participation screening. Journal of Electrocardiology. 2014 Nov 1;47(6):769-74.
8. Petek BJ, Baggish AL. Current controversies in preparticipation cardiovascular screening for young competitive athletes. Expert Rev Cardiovasc Ther. 2020 Jul;18(7):435-442.
9. Froelicher VF, Lehmann KG, Thomas R, Goldman S, Morrison D, Edson R, Lavori P, Myers J, Dennis C, Shabetai R, Do D. The electrocardiographic exercise test in a population with reduced workup bias: diagnostic performance, computerized interpretation, and multivariable prediction. Annals of internal Medicine. 1998 Jun 15;128(12_Part_1):965-74.
10. Marshall M, Malik A, Shah M, Fish FA, Etheridge SP, Aziz PF, Russell MW, Tisma S, Pflaumer A, Sreeram N, Kubus P. Patterns of Electrocardiographic Abnormalities in Children with Hypertrophic Cardiomyopathy. Pediatric cardiology. 2023 Sep 9:1-0.
11. Maclachlan H, Bhatia R, Dhutia H, Fyyaz S, Chatrath N, Basu J, Miles C, Finocchiaro G, Gati S, Specterman M, Tome M. Outcome of a nationwide screening programme in young individuals. European Journal of Preventive Cardiology. 2023 Jun;30(Supplement_1):zwad125-068.
12. Dhutia H, Malhotra A, Finocchiaro G, Parpia S, Bhatia R, D’Silva A, Gati S, Mellor G, Narain R, Chandra N, Behr E. Diagnostic yield and financial implications of a nationwide electrocardiographic screening program to detect cardiac disease in the young. EP Europace. 2021 Aug 1;23(8):1295-301
13. Saarel EV, Granger S, Kaltman JR, et al. Electrocardiograms in Healthy North American Children in the Digital Age. Circulation: Arrhythmia and Electrophysiology 2018;11(7).
14. Hedman K, Moneghetti KJ, Hsu D, et al. Limitations of electrocardiography for detecting left ventricular hypertrophy or concentric remodeling in athletes. Am J Med 2020;133(1):123–132.e8.
15. Dunn TP, Pickham D, Aggarwal S, et al. Limitations of current AHA guidelines and proposal of new guidelines for the preparticipation examination of athletes. Clin J Sport Med 2015;25(6):472–7.
16. Perez MV, Friday K, Froelicher V. Semantic confusion: the case of early repolarization and the J point. The American journal of medicine. 2012 Sep 1;125(9):843-4.
17. Haïssaguerre M, Derval N, Sacher F, Jesel L, Deisenhofer I, de Roy L, Pasquié JL, Nogami A, Babuty D, Yli-Mayry S, De Chillou C. Sudden cardiac arrest associated with early repolarization. New England Journal of Medicine. 2008 May 8;358(19):2016-23.
18. Viskin S. Idiopathic ventricular fibrillation “Le Syndrome d'Haissaguerre” and the fear of J waves. Journal of the American College of Cardiology. 2009 Feb 17;53(7):620-2.
19. CSE Working Party. Recommendations for measurement standards in quantitative electrocardiography. European Heart Journal. 1985 Oct 1;6(10):815-25.
20. Uberoi A, Jain NA, Perez M, Weinkopff A, Ashley E, Hadley D, Turakhia MP, Froelicher V. Early repolarization in an ambulatory clinical population. Circulation. 2011 Nov 15;124(20):2208-14.
21. Froelicher V, Wagner G. Symposium on the J wave patterns and a J wave syndrome. Journal of Electrocardiology. 2013;5(46):381-2.
22. Grober AF, Hock J, Wheeler M, Elbadawi A, Biniwale N, Baig B, Froelicher V. Electrocardiographic left atrial abnormalities predict cardiovascular mortality. Journal of Electrocardiology. 2018 Jul 1;51(4):652-7.
23. Hock J, Wheeler M, Singh T, Hadley D, Froelicher V. Comparison of the Stanford ECG left atrial criteria with the international ECG criteria for sports screening. Clinical Journal of Sport Medicine. 2021 Jul 1;31(4):388-91.
24. Miranda CP, Lehmann KG, Froelicher VF. Correlation between resting ST segment depression, exercise testing, coronary angiography, and longterm prognosis. Am Heart J. 1991;122:1617–1628.
25. Muramoto D, Singh N, Aggarwal S, et al. Spectrum of ST amplitude in athletes and an ambulatory clinical population. J Electrocardiol. 2013;46:27–433.
26. Leo T, Uberoi A, Jain NA, et al. The impact of ST elevation on athletic screening. Clin J Sport Med. 2011;21:433–440.
27. Ilkhanoff L, Qian X, Lima JA, Tran H, Soliman EZ, Yeboah J, Seliger S, deFilippi CR. ECG associations of Cardiac Biomarkers and Cardiac Magnetic Resonance Measures of Fibrosis in the Multiethnic Study of Atherosclerosis (MESA). The American Journal of Cardiology. 2023 Oct 1;204:287-94.
28. Dai MY, Yan YC, Wang LY, Zhao CX, Wang DW, Jiang JG. Characteristics of electrocardiogram findings in fulminant myocarditis. Journal of Cardiovascular Development and Disease. 2023 Jun 30;10(7):280.
29. Montalvo S, Froelicher VF, Hadley D, Wheeler MT. Digitized Electrocardiography Measurements Support the Biological Plausibility of the Pathological Significance of ST Segments in Athletes. Clinical Journal of Sport Medicine. 2022 Mar 17:10-97.
30. Pelliccia A, Drezner JA, Zorzi A, Corrado D. Prevalence and clinical significance of low QRS voltages in healthy individuals, athletes and patients with cardiomyopathy: implications for sports preparticipation cardiovascular screening. European Journal of Preventive Cardiology. 2024 Jan 19:zwae027.
31. Tso JV, Montalvo S, Christle J, Hadley D, Froelicher V. Should ECG criteria for Low QRS voltage (LQRSV) be specific for Sex? American Heart Journal. Am Heart J. 2024 Apr;270:117-124. doi: 10.1016/j.ahj.2024.02.002. Epub 2024 Feb 9. PMID: 38342392. 2024 Feb 9.
32. MacLachlan H, Antonakaki A, Bhatia R, Fyazz S, Chatrath N, Androulakis E, Marawaha S, Basu J, Miles C, Dhutia H, Zaidi A, Chandra N, Sheikh N, Gati S, Malhotra A, Finocchiaro G, Sharma S, Papadakis M. Prevalence and Clinical Significance of Electrocardiographic Complete Right Bundle Branch Block in Young Individuals. Eur J Prev Cardiol. 2024 Feb 27:zwae082. doi: 10.1093/eurjpc/zwae082. Epub ahead of print. PMID: 38412448.