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Utility of Exercise Electrocardiography in Pre-participation Screening in Asymptomatic Athletes: A Systematic Review

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Abstract

Background

Although test characteristics of exercise electrocardiography are well established in symptomatic patients, data on healthy athletes are scarce. This systematic review focuses on the diagnostic utility of exercise electrocardiography for the detection of coronary heart disease in athletes during pre-participation screening.

Objectives

This systematic review evaluated the prevalence of an abnormal exercise test result and the positive predictive value of exercise electrocardiography in asymptomatic athletes. In addition, the long-term prognosis of a false-positive test result was evaluated.

Methods

An electronic search was performed using the Cochrane Library, PubMed, and MEDLINE. Only studies using exercise electrocardiography in an unselected population of asymptomatic athletes were included. Data on population characteristics, cardiovascular risk factors, exercise test parameters, left ventricular hypertrophy, and morbidity/mortality were extracted and analyzed.

Results

The mean prevalence of an abnormal exercise test result was 0.6 % (range 0–29 %), with a positive predictive value of 9 % (range 0–55 %). Left ventricular hypertrophy was observed in 57 % of the athletes with an abnormal exercise test result, in 50 % of the athletes with a false-positive exercise test result, and in 24 % of the athletes with a normal exercise test. Among athletes with a false-positive test, only one athlete (3 %) experienced a possible cardiac event.

Conclusion

This systematic review revealed a relatively low prevalence of positive exercise test results in asymptomatic athletes, but a very poor positive predictive value. There were insufficient data available to determine the prognostic implications of false-positive test results in asymptomatic athletes.

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Correspondence to Danny A. J. P. van de Sande.

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No sources of funding were used to assist in the preparation of this article.

Conflicts of interest

Danny A. J. P. van de Sande, Michelle A. W. Breuer, and Hareld M. C. Kemps declare that they have no conflicts of interest relevant to the content of this review.

Additional information

Danny A. J. P. van de Sande and M. A. W. Breuer were equal contributors to the article.

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van de Sande, D.A.J.P., Breuer, M.A.W. & Kemps, H.M.C. Utility of Exercise Electrocardiography in Pre-participation Screening in Asymptomatic Athletes: A Systematic Review. Sports Med 46, 1155–1164 (2016). https://doi.org/10.1007/s40279-016-0501-5

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