Inevitably, pre-participations screening has sparked lively debate among competitive athletes. “Physicians against its implementation declare that it's useless to screen all athletes with electrocardiograms because the resting ECG reveals 'abnormalities' that are normal in the athlete's hearts," said Dr Francesco Sofi from the University of Florence in Italy, "Conversely, supporters say studies show a significant decrease in the incidence of sudden death and accidents related to cardiac abnormalities in athletes who have undergone screening."
In a study reported as abstract, Sofi and colleagues set out to evaluate the clinical usefulness of extensive cardiac screening programmes in 30,065 competitive young and middle-aged athletes referred to the Institute of Sports Medicine of Florence over a five-year period. The study, they say, is the first to include the combination of baseline and exercise electrocardiograms.
Results show that resting 12-lead ECG patterns revealed abnormalities in 1812 (6%) athletes; however, more than 80% of these abnormalities were innocent ECG changes. Exercise ECG reported an abnormal pattern in 1459 (4.9%) of subjects. Interestingly, exercise ECG was able to reveal cardiac anomalies in 1227 athletes who had been found to have normal patterns at resting ECG.
Among the 159 athletes disqualified at the end of screening, the investigators found that 79.2% (n=126) reported significant abnormalities only on exercise testing. A logistic regression analysis showed that being older than 30 was the most significant predictor of disqualification for exercise testing.