OBJECTIVE:Because the International left atrial enlargement electrocardiographic (ECG) screening criteria (ECG-LAE) for athletes are rarely fulfilled in young athletes, we compared it with evidence-based criteria from a recent clinical outcome study of ECG left atrial abnormality (ECG-LAA). DESIGN:Retrospective analyses. SETTING:Routine preparticipation ECG screening in California. PARTICIPANTS:Four thousand four hundred thirty-eight young individuals (18.5 ± 5.4 years, 40% women). ASSESSMENT OF RISK FACTORS:The International criteria for ECG-LAE were applied: prolonged P wave duration of ≥120 ms in leads I or II AND negative portion of ≥1 mm in depth in lead V1. This was compared with Stanford criteria for ECG-LAA: prolonged P wave duration of ≥140 ms odds ratio (OR) negative portion in V1 and V2 greater than 1 mm. MAIN OUTCOME MEASURES:Differences in the classification of abnormal ECGs between the 2 criteria applied to the same population of young athletes. RESULTS:Only 33 (0.7%) of our subjects fulfilled the International criteria for ECG-LAE while 110 (2.5%) fulfilled the ECG-LAA criteria. Adding our new ECG-LAA criterion and considering it a major criterion raised the abnormal ECG prevalence and athletes referred for further evaluation from 2.9% to 4.4%. CONCLUSIONS:The Stanford evidence-based criterion for ECG-LAA incorporating V2 and replacing "or" for "and" regarding P wave duration increased the yield of abnormal classification for P waves. Future follow-up studies are needed to confirm that this new criterion should be included in future ECG screening consensus documents.

译文

目的:由于国际上很少针对年轻运动员满足运动员的国际左心房扩大心电图(ECG-LAE)筛查标准(ECG-LAE),因此,我们将其与最近进行的ECG左心室异常(ECG- LAA)。
设计:回顾性分析。
地点:加州常规的参与性心电图筛查。
参与者:448.38个年轻人(18.5±5.4岁,女性占40%)。
危险因素评估:采用ECG-LAE的国际标准:I或II导线延长P波持续时间≥120ms,V1导线深度≥1 mm负值。将此与ECG-LAA的斯坦福标准进行了比较:V1和V2中延长的P波持续时间≥140 ms比值比(OR)负部分大于1 mm。
主要观察指标:适用于同一年龄段年轻运动员的2项标准对异常心电图的分类存在差异。
结果:只有33(0.7%)名受试者符合ECG-LAA的国际标准,而110名(2.5%)符合ECG-LAA的国际标准。添加我们的新ECG-LAA标准并将其视为主要标准会提高异常心电图患病率,运动员转介进一步评估的比例从2.9%增至4.4%。
结论:斯坦福基于证据的ECG-LAA纳入V2并在P波持续时间上用“或”替换“和”的标准增加了P波异常分类的产生。需要进行进一步的随访研究,以确认该新标准应包括在未来的ECG筛查共识文件中。

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