Kardiovaskulārā skrīninga veikšana Latvijas augstskolu volejbola komandās pēkšņas kardiālas nāves izslēgšanai
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Date
2020
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Ievads. Pēkšņa kardiāla nāve (PKN) ir biežākais iemesls, kas saistīts ar atlēta mirstību sacensību vai treniņu laikā. Amerikas sirds asociācijas (AHA) 14 punktu metode un 12 novadījuma miera elektrokardiogrāfija (EKG) ir kardiovaskulārā skrīninga metodes, lai novērtētu atlēta veselību un sirds slimības, kuras saistītas ar PKN. Latvijā nav izstrādāta kardiovaskulāra skrīninga programma studentiem un atlētiem amatieriem, kuri piedalās organizētos treniņos un sacensībās.
Mērķis. Veikt kardiovaskulāro skrīningu Latvijas augstskolu studentu komandās spēlējošiem volejbolistiem, vērtējot 12 novadījumu EKG pieraksta izmaiņas, kas saistītas ar PKN, un to salīdzināt ar AHA 14 punktu metodes efektivitati.
Materiāls un metodes. Prospektīvs pētījums, kurā piedalījās atlēti volejbolisti no Latvijas augstskolām, kuriem tika veikts kardiovaskulārs skrīnings izmantojot AHA 14 punktu metodi un 12 novadījumu miera EKG. Anketā tika iekļauti atlētu demogrāfiskie dati, ziņas par slodzi un pieredzi volejbolā. Skrīnings notika no 2019. gada novembra līdz 2020. gada martam augstskolu sporta klubu telpās. Datu statistikas analīzei tika izmantotas MS Excel un IBM SPSS 23.0 programmatūras.
Rezultāti. Latvijas augstskolu volejbolistiem kardiovaskulārais skrīnings ar 12 novadījumu EKG tika veikts 154 atlētiem no kuriem 21 (13,6%) atlētam ir nepieciešami papildus izmeklējumi. 100 (64,9%) atlētiem bija atrodamas EKG pierakstā izmaiņas, kas atbilst fizioloģiskai sirds adaptācijas slodzei. Biežākās izmaiņas bija kreisā kambara hipertrofija 66 (42,9%) atlētiem, 49 (31,8%) atlētiem nepilna labā hisa kūlīša zara blokāde, 34 (22,1%) atlētiem miera bradikardija. Anormālas EKG pieraksta pārmaiņas tika atrastas 11 ( 7,1%) atlētiem, biežākās T viļņa inversija 8(5,2%) atlētiem, pagarināts QT intervāls 2 (1,3%) atlētiem un ekstrasistoles 2(1,3%) atlētiem. Robežizmaiņas tika novērotas 24 (15,6%) atlētiem no kuriem 4 (2,6%) bija vairāk par 2 robežizmaiņām un 6 (3,9%) ar vienu robežizmaiņu, un kardiovaskulārām sūdzībām vai pozitīvu ģimenes anamnēzī saistībā ar PKN. 121 (78,5%) volejbolistam AHA 14 punktu anketa bija pozitīva. AHA 14 punktu metode uzrādīja augstu jūtīgumu 90,5% (69,7%-98,8%(CI95%)), bet zemu specifiskumu 24,8% (17,7%-33%(CI95%)) pret patoloģisku 12 novadījuma EKG pieraksta atradni.
Secinājumi. AHA 14 punktu metodei ir augsts jūtīgums, bet zems specifiskums pret patoloģisku 12 novadījuma EKG pieraksta atradni, kas rada daudz viltus pozitīvu rezultātu. Nepieciešama tālāka izpēte, lai izveidotu specifiskāku skrīninga anketu Latvijas atlētu populācijai.
Introduction. Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sports activities. American Heart Association (AHA) 14‐point evaluation method and a resting 12-lead electrocardiogram (ECG) are cardiovascular screening methods for evaluation of athlete health and heart diseases that are associated with SCD events. In Latvia there are none organized cardiovascular screening programs for student and amateur athletes who participates in organized training and competitions. Aim. Perform screening for volleyball teams of universities in Latvia, examine resting 12-lead ECG record changes that are associated with SCD, and compare it to AHA 14‐point evaluation method effectiveness. Materials and methods. A prospective study were volleyball athletes from universities of Latvia participated in cardiovascular screening using the AHA 14-point evaluation method and a resting 12-lead ECG. The questionnaire included athletes demographic data, details of time and experience in volleyball. Research takes place from November 2019 till March 2020 in university sports clubs. SPSS 23 and MS Excel was used for statistical analysis. Results. 154 athletes participated in this research. 21 (13.6%) athletes needed further evaluation after resting 12-lead ECG. 100 (64.9%) athletes were found to have at least one physiological change in their resting 12-lead ECG. The most frequent physiological change was left ventricular hypertrophy - 66 (42.9%) athletes, incomplete right bundle branch block - 49 (31.8%) athletes, resting bradycardia - 34 (22,1%) athletes. Abnormal ECG findings were found for 11 (7.1%) athletes, most frequent were T wave inversion for 8 ( 5.2%) athletes, long QT interval for 2 (1.3%) and premature ventricular contractions for 2 (1.3). Borderline ECG findings were found for 24(15.6%) athletes, from which 4 (2.6%) had 2 borderline findings and 6(3.9%) had cardiovascular complain or have a positive family history of inherited cardiac disease or SCD. 121 (78.5%) volleyball players answered positively to at least one question in the AHA 14 point evaluation survey. The sensitivity of the AHA 14-point evaluation test compared to resting 12-lead ECG with abnormal findings was 90.5% (69,.7%-98.8%(CI95%)), specificity – 24.8% (17.7%-33%(CI95%)) Conclusions. The AHA 14-point evaluation method has high sensitivity but low specificity test compared to resting 12-lead ECG with abnormal findings, which makes many false-positive results. Further research is needed to find a more specific question-based screening method for the Latvian athlete population.
Introduction. Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sports activities. American Heart Association (AHA) 14‐point evaluation method and a resting 12-lead electrocardiogram (ECG) are cardiovascular screening methods for evaluation of athlete health and heart diseases that are associated with SCD events. In Latvia there are none organized cardiovascular screening programs for student and amateur athletes who participates in organized training and competitions. Aim. Perform screening for volleyball teams of universities in Latvia, examine resting 12-lead ECG record changes that are associated with SCD, and compare it to AHA 14‐point evaluation method effectiveness. Materials and methods. A prospective study were volleyball athletes from universities of Latvia participated in cardiovascular screening using the AHA 14-point evaluation method and a resting 12-lead ECG. The questionnaire included athletes demographic data, details of time and experience in volleyball. Research takes place from November 2019 till March 2020 in university sports clubs. SPSS 23 and MS Excel was used for statistical analysis. Results. 154 athletes participated in this research. 21 (13.6%) athletes needed further evaluation after resting 12-lead ECG. 100 (64.9%) athletes were found to have at least one physiological change in their resting 12-lead ECG. The most frequent physiological change was left ventricular hypertrophy - 66 (42.9%) athletes, incomplete right bundle branch block - 49 (31.8%) athletes, resting bradycardia - 34 (22,1%) athletes. Abnormal ECG findings were found for 11 (7.1%) athletes, most frequent were T wave inversion for 8 ( 5.2%) athletes, long QT interval for 2 (1.3%) and premature ventricular contractions for 2 (1.3). Borderline ECG findings were found for 24(15.6%) athletes, from which 4 (2.6%) had 2 borderline findings and 6(3.9%) had cardiovascular complain or have a positive family history of inherited cardiac disease or SCD. 121 (78.5%) volleyball players answered positively to at least one question in the AHA 14 point evaluation survey. The sensitivity of the AHA 14-point evaluation test compared to resting 12-lead ECG with abnormal findings was 90.5% (69,.7%-98.8%(CI95%)), specificity – 24.8% (17.7%-33%(CI95%)) Conclusions. The AHA 14-point evaluation method has high sensitivity but low specificity test compared to resting 12-lead ECG with abnormal findings, which makes many false-positive results. Further research is needed to find a more specific question-based screening method for the Latvian athlete population.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Pēkšņa kardiāla nāve, Amerikas sirds asociācijas 14 punktu metode, 12 novadījuma miera elektrokardiogrāfija atlētiem., Sudden cardiac death, American Heart Association 14‐point evaluation, athlete resting 12-lead electrocardiogram.