心电图是运动员赛前筛查的关键

罗马——在欧洲心脏病学会(ESC)2013年会上，英国伦敦圣乔治大学的Jakir Ullah报告称，从其所在医院超过15,000例运动员筛查的经验来看，对于青少年和年轻成年运动员，心律失常风险的有效筛查需要了解参赛者的病史、进行体格检查并获取12导联心电图(ECG)检查的结果。

由欧洲心血管预防与康复协会和欧洲心脏病学会联合组建的专家小组于2010年罗列出了13种非常见的潜在病理性ECG异常，即第2组异常(Eur. J. Cardiol. 2010;31:243-59)。其中包括T波倒置、左心房扩大、QT间期延长和右心室肥大。

 

来自32,000多例年龄介于8~78岁并且在2003年接受了体育比赛赛前筛查的意大利人的数据显示，在开始体育比赛之前接受了ECG筛查的受试者中，这些异常加起来的总发生率还不到5%(Eur. Heart J. 2007:28:2006-10)。

研究者之一、圣乔治医院的心脏科医生Saqib Ghani博士说，虽然许多体育组织都呼吁无论年龄和运动强度水平，所有运动员都应接受赛前筛查， 但圣乔治医院的心脏科医生重点关注的是年龄介于14~35岁的运动员，原因是年龄不足14岁的儿童往往会表现出一过性的ECG异常，而对于年龄超过35岁的成年人，体育比赛期间的主要心脏威胁来自于冠状动脉疾病，而非ECG异常。


Jakir Ullah
 
这项研究纳入了2007~2012年接受筛查的15,027名运动员。其中一半以上都没有任何ECG异常或症状，于是立即获准参加比赛。而其余6,598名运动员则需要接受进一步的评估，其中5,415名自称有症状，1,183名存在第2组ECG异常。Ghani博士补充道，该研究中第2组ECG异常的患病率约为8%，高于前述的意大利研究，这与其他研究者报告的英国人患病率略高的结果相符。

Ullah报告称，在因症状而接受进一步检查的5,415名运动员中，均未发现任何可能导致其不能参加比赛的潜在病理学改变。所报告的症状包括胸痛、晕厥、心悸和呼吸困难。

相反，在因第2组ECG异常而接受进一步检查的1,183名运动员中，有67名查出了具有临床意义的潜在病理学改变，占所有筛查者的0.4%；还有44名需继续接受检查，其余1,072名则没有发现任何可能限制其运动的疾病。在这67名存在ECG异常并且确认存在心脏病理学改变的运动员中，25名(37%)也伴有症状。最常见的心脏病理学改变是Wolff-Parkinson-White综合征(29名)，其次是QT间期延长(8名)。

Ullah说：“我们需要综合考虑症状和ECG检查结果，只有其中任何一项都是不够理想的。”在接受筛查的运动员中，症状不一定伴有潜在的心脏病理学改变，除非同时存在第2组ECG异常。

Ghani博士在接受采访时说，对于青少年或年轻成年运动员，大部分可能有危险的心脏异常都是无症状性的。“ECG比症状更有帮助，因为如果患者没有症状，你可能漏诊，而且症状是非常主观的。”他还强调，无论训练或比赛的强度如何，最好所有参赛运动员都接受赛前筛查。“你可能只听说过一些高水平的运动员猝死，但其实这只是冰山一角。有的人只是在路上小跑也会发生猝死。”

Ghani博士和Ullah先生均声明无相关利益冲突。

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By: MITCHEL L. ZOLER, Cardiology News Digital Network

ROME – Efficient screening for potentially dangerous arrhythmias in adolescent and young-adult athletes requires the participant’s history, a physical examination, and results from a 12-lead ECG examination, based on experience with more than 15,000 screenings at one U.K. center.

"You need to use symptoms and the ECG results together," Jakir Ullah said at the European Society of Cardiology annual meeting. "Either technique by itself is not best." Symptoms in sport participants who underwent screening were not associated with underlying cardiac pathology unless they occurred along with a group 2 ECG abnormality, said Mr. Ullah, a researcher at St. George’s University in London.

Most potentially dangerous cardiac abnormalities in adolescent or young-adult sport participants are asymptomatic, said Dr. Saqib Ghani, a cardiologist at St. George’s and a coinvestigator on the study. "ECG is more helpful than symptoms because you can miss the condition if it’s asymptomatic, and symptoms are very subjective," Dr. Ghani said in an interview.

An expert panel organized by the European Association for Cardiovascular Prevention and Rehabilitation and the European Society of Cardiology compiled a list of 13 uncommon, potentially pathological ECG abnormalities, known as group 2 abnormalities, in 2010 (Eur. J. Cardiol. 2010;31:243-59). The list includes T-wave inversion, left atrial enlargement, a long QT interval, and right ventricular hypertrophy.

Together, these abnormalities occur in fewer than 5% of people screened by ECG prior to starting sport participation, according to data collected on more than 32,000 Italians aged 8-78 years who underwent pre–sport participation screening during 2003 (Eur. Heart J. 2007:28:2006-10).

Although many sports organizations call for preparticipation screening regardless of age or intensity level, cardiologists at St. George’s focused on people 14-35 years old because children under age 14 often show transient ECG abnormalities, while among adults over age 35 the main cardiac threat during sport participation comes from coronary artery disease rather than an abnormality, Dr. Ghani said.

The St. George’s series consisted of 15,027 people who were examined during 2007-2012. More than half of them were free of any ECG abnormality or symptoms and received immediate clearance for participation. But 6,598 people required further assessment, with 5,415 reporting symptoms, and 1,183 found with a group 2 ECG abnormality. The 8% prevalence rate for a group 2 abnormality, higher than in Italy, matches the somewhat higher U.K. prevalence rates reported by others, he added.

Among the 5,415 people investigated because of symptoms, none were found to have any underlying pathology that precluded sports participation, Mr. Ullah said. Symptoms included chest pain, syncope, palpitations, and dyspnea.

In contrast, among the 1,183 people identified for further assessment because of a group 2 ECG abnormality, the examination identified a clinically important underlying pathology in 67, 0.4% of everyone screened; another 44 people continue to undergo evaluations, and 1,072 people were found free of any sports-limiting condition. Among the 67 with an ECG abnormality and confirmed cardiac pathology, 25 (37%) also had symptoms. The most common cardiac pathology was Wolff-Parkinson-White syndrome, in 29 people, followed by a long QT interval in 8.

Dr. Ghani also stressed that ideally, pre–sport participation screening should occur for all sport participants regardless of the intensity of training or competition. "You only hear about sudden death in high-level athletes, but that is just the tip of the iceberg," he said. "We never know about the sudden death that happens to someone who is just running on the road."

Dr. Ghani and Mr. Ullah had no disclosures.