Performance of the American Heart Association 14-point evaluation versus electrocardiography for the cardiovascular screening of university's volleyball teams players in Latvia

The objective was to perform cardiovascular screening for volleyball teams of universities in Latvia and compare the American Heart Association (AHA) 14-point evaluation and resting 12-lead electrocardiogram (ECG) methods. A prospective study was where volleyball athletes from universities of Latvia participated in cardiovascular screening using the AHA 14-point evaluation method and a resting 12-lead ECG. Research takes place from November 2019 till March 2020 in each university sports club facility. Collected data were analyzed with SPSS 23 using descriptive and inferential statistic methods (binary classification test). 154 athletes participated in this research. 21 (13.6%) athletes needed further evaluation after resting 12-lead ECG screening. 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%), long QT interval for 2 (1.3%) athletes, and premature ventricular contractions for 2 (1.3%) athletes. 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 symptoms or have a positive family history of inherited cardiac disease or sudden cardiac death. 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 compared to resting 12-lead ECG with abnormal findings was 90.5% (69.7%-98.8% (CI95%)), specificity – 24.8% (17.7%-33% (CI95%)) The AHA 14-point evaluation has high sensitivity but low specificity compared to resting 12-lead ECG with abnormal findings, which lead to many false-positive results. Further research is needed to find a more specific question-based screening method for the Latvian athlete population.