COMPARISON OF DIFFERENT PRE-PARTICIPATION ELECTROCARDIOGRAM SCREENING CRITERIA IN ATHLETES-IS GENDER IMPORTANT?

Tatjana Miljkovic^{1, 2, *}, Aleksandra Milovancev², Marija Bjelobrk^{1, 2}, Bojana Saroskovic², Nemanja Lakicevic³, Mladen Mikic⁴, Patrik Drid⁴

¹Medical Faculty, University of Novi Sad, Serbia - ²Institute of Cardiovascular Diseases of Vojvodina, Serbia - ³Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy - ⁴Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia

Introduction: Screening programs in athletes are aimed to reduce the incidence of sudden death during sports by identifying individuals that need further diagnostic procedures. The aim of this study was to investigate and compare the prevalence of electrocardiogram (ECG) abnormalities using different screening criteria (European society of Cardiology recommendations (ESC), Seattle and Refined criteria) and to evaluate ECG gender-related differences. 

Materials and methods: Prospective cross-sectional study included 80 active athletes aged 22.5±3.4 years, 59.5% males and 40.5% females. All study participants filled the questionnaire, underwent clinical examination, a 12-lead ECG and a transthoracic echocardiogram (TTE). Electrocardiogram abnormalities were then assessed according to three sets of criteria. 

Results: Prevalence of training related ECG changes (Type 1) were: ESC 70% vs. Seattle 62.5% vs. Refined 63.8%, p<0.01. The most frequent type 1 ECG changes were isolated left ventricular hypertrophy, sinus bradycardia and early repolarization. Females had significantly more sinus arrhythmia (31.9% vs. 4.3%, p=0.01) and sinus bradycardia (66.7% vs. 44.6%, p=0.03). The prevalence of type 1 changes was significantly associated to smoking (χ²=4.78, p=0.02), alcohol (χ²=4.36, p=0.04) and family history (χ²=3.58, p=0.05) in athletics and in years engaged in sport (p<0.01) and age (p=0.05) in basketball players. Abnormalities unrelated to training were significantly reduced according to Seattle and Refined criteria compared to ESC (respectively 6.2% vs. 3.8% vs. 22.5%, p<0.01) in males (6.3% vs. 4.3% vs. 19.1%, p<0.01) and females (6% vs. 3% vs. 27.3%, p<0.01). The most frequent type 2 abnormality was T wave inversion. 

Conclusion: Stricter criteria resulted in a significant reduction of all ECG abnormalities in all athletes of both genders. According to ESC recommending females had more ECG abnormalities compared to men, but when assessed with more specific and sensitive criteria males were more prevalent. The study highlights ECG gender specific differences among different screening protocols.