Background

The Seattle Criteria (SC) and International Criteria (IC) were both developed for cardiovascular pre-participation screening in young athletes. Neither set of Criteria has been systematically evaluated in high level indigenous black African athletes.

Objectives

(1) To determine the pattern of ECG findings in athletes of the University of Port Harcourt, Nigeria; (2) To determine the predictors of altered repolarization in these athletes; and (3) To evaluate the diagnostic performance of the SC and IC in these athletes.

Methods

77 athletes (42 males, 35 females) without any known cardiovascular disease were recruited alongside 78 similarly healthy non-athletic controls (44 males, 34 females). The two groups were matched for age, sex, and body mass index. Clinical assessment was according to the Lausanne Recommendations. All subjects underwent electrocardiography and echocardiography. Analysis with the IC was retrospective.

Results

The most common physiological finding in the athletes was sinus bradycardia (n = 37; 48.1%). Early repolarization pattern, ERP (n = 27, 35.1% with SC; n = 42, 54.5% with IC), and dome-shaped ST-segment elevation with T-wave inversion (DSSTWI) in leads V1–4 (n = 21, 29.3% with both criteria), were also prevalent. Compared to controls, only male sex (adjusted odds ratio 2.89, 1.05 to 7.97, p = .040 with SC; OR 2.57, 1.19 to 5.53, p = .016 with IC) and ECG LVH (OR 2.82, 1.18 to 6.75, p = .020 with SC alone) independently predicted ERP, while athletic status (OR 4.76, 1.66 to 13.68, p = .004 with both criteria) alone had a significant multivariate association with DSSTWI. Three athletes (3.9%) had abnormal ECGs while two (2.6%) had major echocardiographic abnormalities. The sensitivity, specificity and accuracy of the SC for structural cardiac disease in the athletes were 50.0% (1.3 to 98.7), 97.3% (90.7 to 99.7) and 96.1% (89.0 to 99.2) respectively. The respective figures for the IC were 50.0% (1.3 to 98.7), 98.7% (92.8 to 100) and 97.4% (90.9 to 99.7).

Conclusion

Both criteria showed high accuracy in this Black African cohort with a high frequency of electrocardiographic repolarization changes. While ERP seems to be primarily related to black ethnicity, DSSTWI appears to be a bona fide marker of Athlete's Heart in blacks.

中文翻译：

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对尼日利亚精英运动员的西雅图和国际标准的评估

背景

西雅图标准 (SC) 和国际标准 (IC) 都是为年轻运动员的心血管参与前筛查而制定的。这两套标准都没有在高水平的土著非洲黑人运动员中进行系统评估。

目标

(1) 确定尼日利亚哈科特港大学运动员的心电图结果模式；(2) 确定这些运动员复极改变的预测因素；(3) 评估这些运动员的 SC 和 IC 的诊断性能。

方法

招募了 77 名没有任何已知心血管疾病的运动员（42 名男性，35 名女性）以及 78 名类似健康的非运动对照组（44 名男性，34 名女性）。两组的年龄、性别和体重指数相匹配。临床评估是根据洛桑建议进行的。所有受试者均接受心电图和超声心动图检查。IC 的分析是回顾性的。

结果

运动员最常见的生理表现是窦性心动过缓（n = 37；48.1%）。早期复极模式、ERP（n = 27，35.1% 与 SC；n = 42，54.5% 与 IC），以及 V1-4 导联中圆顶状 ST 段抬高伴 T 波倒置 (DSSTWI)（n = 21 , 29.3% 的标准），也很普遍。与对照组相比，只有男性（调整后的优势比 2.89、1.05 至 7.97，SC 的p = .040；IC 的OR 2.57、1.19 至 5.53，p = .016）和 ECG LVH（OR 2.82、1.18 至p 6.75，= .020 单独使用 SC）独立预测 ERP，而运动状态（OR 4.76，1.66 至 13.68，p= .004 与两个标准）单独与 DSSTWI 具有显着的多变量关联。三名运动员 (3.9%) 有异常的心电图，而两名 (2.6%) 有严重的超声心动图异常。SC对运动员结构性心脏病的敏感性、特异性和准确性分别为50.0%（1.3～98.7）、97.3%（90.7～99.7）和96.1%（89.0～99.2）。IC 的相应数字为 50.0%（1.3 至 98.7）、98.7%（92.8 至 100）和 97.4%（90.9 至 99.7）。

结论

这两个标准在这个具有高频心电图复极变化的非洲黑人队列中都显示出很高的准确性。虽然 ERP 似乎主要与黑人种族有关，但 DSSTWI 似乎是黑人运动员之心的真正标志。