Pre-participation electrocardiographic (ECG) screening is a very sensitive approach to detecting abnormalities conferring risk for sudden cardiac death. Because training alters the ECG, athlete-specific criteria such as the Seattle criteria have been developed to reduce the false discovery rate. Emerging data regarding Seattle criteria demonstrate a higher false discovery rate in black athletes than white athletes. Furthermore, gender differences in Seattle criteria performance are not well described.


To characterize the positive predictive value of ECGs read by Seattle criteria for cardiovascular abnormalities in a large, multi-ethnic cross-section of athletes at an NCAA Division I program.


In 2014 and 2015, 712 collegiate athletes (353 males, 359 females, average age 20) were evaluated by history, physical examination, 12-lead ECG, and further follow-up testing as needed. ECGs were analyzed according to Seattle Criteria. Positive rates by race and gender were determined; Fisher's exact test was used to compute significance.


Of 712 athletes screened, Seattle criteria were positive in 28 (3.9%). Positive ECGs were found in 12/109 (11.0%) black athletes and 16/562 (2.8%) white athletes (P < 0.001). In athletes of other races, 0/41 (0%) ECGs were positive. By race and gender, 11/255 (4.3%) white males, 5/307 (1.6%) white females, 6/86 (6.9%) black males, and 6/23 (26%) black females had positive findings. Compared to gender matched controls, black male athletes had a 2.4x (P < 0.05), and black female athletes had a 16.3x (P < 0.0001) relative risk of an abnormal ECG by Seattle criteria. Downstream testing disclosed bicuspid aortic valve in one white male athlete. Thus in this cohort, the positive predictive value of ECG screening by Seattle criteria was 1/28 (3.5%), for a false discovery rate of 96.4%.


In this cohort, positive rates for ECGs were higher in black athletes compared to white athletes, and the overall positive predictive value of ECG screening by Seattle Criteria was low. High rates of ECG abnormalities were found in black female athletes. Subanalyses in other published cohorts can confirm if this finding is robust. 

Autor / Fonte:Sunny Intwala; Arif Jivan; Michael Milligan; Tory Lindley; Micah Eimer; Raja Mutharasan. J Am Coll Cardiol. 2016;67(13_S):897-897. doi:10.1016/S0735-1097(16)30898-1
Link: http://content.onlinejacc.org/data/Journals/JAC/935148/08981.pdf