Cardiovascular evaluation, including resting and exercise electrocardiography, before participation in competitive sports: cross sectional study

OBJECTIVE To evaluate the clinical usefulness of complete preparticipation cardiovascular screening in a large cohort of sports participants. DESIGN Cross sectional study of data over a five year period. SETTING Institute of Sports Medicine in Florence, Italy. PARTICIPANTS 30,065 (23,570 men) people seeking to obtain clinical eligibility for competitive sports. MAIN OUTCOME MEASURES Results of resting and exercise 12 lead electrocardiography. RESULTS Resting 12 lead ECG patterns showed abnormalities in 1812 (6%) participants, with the most common abnormalities (>80%) concerning innocent ECG changes. Exercise ECG showed an abnormal pattern in 1459 (4.9%) participants. Exercise ECG showed cardiac anomalies in 1227 athletes with normal findings on resting ECG. At the end of screening, 196 (0.6%) participants were considered ineligible for competitive sports. Among the 159 participants who were disqualified at the end of the screening for cardiac reasons, a consistent proportion (n=126, 79.2%) had shown innocent or negative findings on resting 12 lead ECG but clear pathological alterations during the exercise test. After adjustment for possible confounders, logistic regression analysis showed that age >30 years was significantly associated with an increased risk of being disqualified for cardiac findings during exercise testing. CONCLUSIONS Among people seeking to take part in competitive sports, exercise ECG can identify those with cardiac abnormalities. Follow-up studies would show if disqualification of such people would reduce the incidence of CV events among athletes.