Published 3 July 2008, doi:10.1136/bmj.a346
Cite this as: BMJ 2008;337:a346

Research

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

Francesco Sofi, clinical researcher1, Andrea Capalbo, specialist in sports medicine1,2, Nicola Pucci, specialist in sports medicine1,2, Jacopo Giuliattini, specialist in sports medicine2, Francesca Condino, software engineering technician2, Flavio Alessandri, specialist in sports medicine and vice director of the institute of sports medicine2, Rosanna Abbate, full professor of internal medicine1, Gian Franco Gensini, full professor of internal medicine1,2,3,4, Sergio Califano, specialist in sports medicine and director of the institute of sports medicine2

1 Department of Medical and Surgical Critical Area, Thrombosis Centre, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy, 2 Center for the Study at Molecular and Clinical Level of Chronic, Degenerative and Neoplastic Diseases to Develop Novel Therapies, University of Florence, Italy, 3 Institute of Sports Medicine, Florence, Italy, 4 Don Carlo Gnocchi Foundation, IRCCS, Florence, Italy

Correspondence to: F Sofi, Department of Medical and Surgical Critical Area, Thrombosis Centre, University of Florence, Italy, Viale Morgagni 85, 50134 Florence, Italy francescosofi{at}gmail.com

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.


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