Accuracy of the ECG for differential diagnosis between hypertrophic cardiomyopathy and athlete's heart: comparison between the European Society of Cardiology (2010) and International (2017) criteria.
BACKGROUND
Interpretation of the athlete's ECG is based on differentiation between benign ECG changes and potentially pathological abnormalities. The aim of the study was to compare the 2010 European Society of Cardiology (ESC) and the 2017 International criteria for differential diagnosis between hypertrophic cardiomyopathy (HCM) and athlete's heart.


METHODS
The study populations included 200 patients with HCM and 563 athletes grouped as follows: 'group 1', including normal ECG and isolated increase of QRS voltages, which are considered non-pathologic according to ESC and International criteria; 'group 2', including left atrial enlargement or left axis deviation in isolation and Q-waves with an amplitude ≥4 mm but <25% of the ensuing R-wave and a duration <0.04 s which are considered pathologic according to the ESC but not according to the International criteria; and 'group 3', including abnormalities which are considered pathologic according to ESC and International criteria.


RESULTS
Overall, the 2010 ESC criteria showed a sensitivity of 95.5% and a specificity of 86.9%. Considering group 2 ECG changes as normal according to the International criteria led to a statistically significant (p<0.001) increase of specificity to 95.9%, associated with a non-significant (p=0.47) reduction of sensitivity to 93%. Among patients with HCM, there was a significant increase of maximal left ventricular wall thickness from group 1 to 3 (p=0.02).


CONCLUSIONS
The use of 2017 International criteria is associated with a substantial increase in specificity and a marginal decrease in sensitivity for differential diagnosis between HCM and athlete's heart.
['Zorzi|Alessandro|A|', 'Calore|Chiara|C|', 'Vio|Riccardo|R|', 'Pelliccia|Antonio|A|', 'Corrado|Domenico|D|']
D000293:Adolescent D000328:Adult D056352:Athletes D006332:Cardiomegaly D009202:Cardiomyopathies D002312:Cardiomyopathy, Hypertrophic D016022:Case-Control Studies D003937:Diagnosis, Differential D004562:Electrocardiography D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D011237:Predictive Value of Tests D012680:Sensitivity and Specificity D055815:Young Adult
Hypertrophic cardiomyopathy athlete’s heart electrocardiogram screening.