ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiovascular Epidemiology and Prevention
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1637853
This article is part of the Research TopicFrom the Heart of the Athlete to Athlete’s Heart to Cardiopathy: Approaches and Challenges in Risk Management in Cardiovascular Sports MedicineView all 3 articles
The Diagnostic Accuracy of Contemporary ECG Interpretation Criteria in Risk Stratification of Master Athletes
Provisionally accepted
Geza Halasz1*
Bruno Capelli2Simone Pasquale Crispino3Andrea Segreti3
Raffella Mistrulli4,5Federico Andreoli5Armando Ferrera6
Francesco Perone7Michele Villa2Tiziano Cassina2Vincenzo Biasini8Francesco Grigioni3Domenico Gabrielli1Massimo Piepoli9- 1Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- 2Istituto Cardiocentro Ticino, Lugano, Switzerland
- 3Universita Campus Bio-Medico di Roma, Rome, Italy
- 4Azienda Ospedaliera Sant'Andrea, Rome, Italy
- 5Universita degli Studi di Roma La Sapienza, Rome, Italy
- 6Instituto di Medicina e Scienza dello Sport, Rome, Italy
- 7Casa di Cura Villa Delle Magnolie, Castel Morrone, Italy
- 8Sport Medicine and Exercise Medicine, Centro di Medicina dello Sport I° Livello, L'Aquila, Aquila, Italy
- 9IRCCS Policlinico San Donato, San Donato Milanese, Italy
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Background: Limited data are available on the diagnostic performance of contemporary ECG interpretation criteria in master athletes (aged over 35). This study aimed to describe ECG findings and compare the diagnostic accuracy of the 2017 International, 2010 ESC, and 2013 Seattle criteria in identifying high-risk cardiovascular conditions in a cohort of competitive master athletes.We included 506 consecutive Caucasian master athletes (mean age 47.9 ± 8.7 years, 85.6% male) who underwent ECG-based preparticipation screening. ECGs were retrospectively interpreted according to the three criteria. Transthoracic echocardiography was included to calculate sensitivity and specificity.Results: Thirteen athletes (2.5%) were diagnosed with a condition potentially related to sudden cardiac death (SCD), including severe aortic regurgitation (1), Type 1 Brugada pattern (1), chronic coronary syndromes (4), dilated cardiomyopathy (3), aortic dilation (3), and moderate aortic stenosis (1). Diagnostic accuracy for conditions at risk of SCD was 0.73 for International, 0.81 for Seattle, and 0.77 for ESC criteria. Seattle demonstrated a significantly higher AUC than the International criteria (p = 0.0032). The International criteria failed to identify two athletes with dilated cardiomyopathy and left axis deviation, while no significant structural abnormalities were found in athletes with complete right bundle branch block (RBBB). The most common ECG abnormalities were left axis deviation (7.1%), left atrial enlargement (4.2%), and T-wave inversion (3%). A prolonged QT interval was diagnosed in 5.7% according to ESC criteria but in only one athlete under the International and Seattle criteria.The Seattle criteria demonstrated the highest overall accuracy, with significantly better discriminative performance than the International criteria , and a lower false-positive rate compared to the ESC criteria. These findings support the use of the Seattle criteria as part of a comprehensive screening strategy in master athletes.
Keywords: Master, Preparticipaition screening, ECG, sudden death, Athlete
Received: 29 May 2025; Accepted: 08 Aug 2025.
Copyright: © 2025 Halasz, Capelli, Crispino, Segreti, Mistrulli, Andreoli, Ferrera, Perone, Villa, Cassina, Biasini, Grigioni, Gabrielli and Piepoli. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Geza Halasz, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
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