背景:由于高的假阳性率,参与前筛查(PPS)模式在预防运动员心脏猝死(SCD)中的作用存在争议。聚焦心脏超声(FoCUS)显示出更高的灵敏度和特异性,但其成本效益仍不确定。本研究旨在确定FoCUS在PPS中使用的诊断性能和成本效益。
方法:2111名运动员(男性占77.4%,平均年龄24.9±15,2岁)接受标准化家族史和病史收集(MH),体检(PEX),静息心电图,FoCUS(10分钟/5视图协议),综合超声心动图和运动负荷试验(EST)。我们前瞻性评估了三种PPS增量模型:模型A=标准化MH和体格检查;模型B=模型A加静息和压力ECG;模型C=模型B加FoCUS(10min/5views协议)。我们确定了他们的增量诊断准确性和成本效益比。
结果:30名运动员被诊断患有与SCD相关的心脏疾病:模型A确定了3名,14由型号B,13名运动员按Model-CFoCUS的引入显着增加了PPS的敏感性,与模型A和模型B相比(灵敏度94%与19%vs.58%,特异性93%vs.93%vs.92%)。总筛查成本(TSC)为:型号A35.64Eur,型号B87.68欧元和型号C120.89欧元。考虑到有SCD风险的唯一条件,模型B的增量成本效益比为135.62Eur,模型C的增量成本效益比为114.31。
结论:在PPS中实施FoCUS可以识别出更多有SCD风险的运动员,并显着降低假阴性率。此外,已证明将FoCUS纳入筛选过程具有成本效益.
显著的ECG假阳性率使得运动员心脏性猝死(SCD)的参与前筛查(PPS)备受争议。FoCUS可增加敏感性和特异性。,然而,其成本效益是未知的。本研究评估了FoCUS在PPS中的诊断性能和成本效益。将称为“聚焦心脏超声”(FoCUS)的简化超声心动图检查纳入PPS可提高诊断可靠性。假阴性率较低,有SCD风险的运动员数量较多。在我们的运动员队列中,将FoCUS整合到筛选过程中具有成本效益。
The role of pre-participation screening (PPS) modalities in preventing sudden cardiac death (SCD) in athletes is debated due to a high false-positive rate. Focused cardiac ultrasound (FoCUS) has shown higher sensitivity and specificity, but its cost-effectiveness remains uncertain. This
study aimed to determine the diagnostic performance and cost-effectiveness of FoCUS use in PPS.
A total of 2111 athletes (77.4% male, mean age 24.9 ± 15.2years) underwent standardized family and medical history collection, physical examination, resting electrocardiography (ECG), FoCUS (10 min/5 views protocol), comprehensive echocardiography and exercise stress test. We prospectively evaluated three PPS incremental models: Model A, standardized medical history and physical examination Model B, Model A plus resting and stress ECG and Model C, Model B plus FoCUS (10 min/5 views protocol). We determined their incremental diagnostic accuracy and cost-effectiveness ratio. A total of 30 athletes were diagnosed with a cardiac condition associated with SCD: 3 were identified by Model A, 14 by Model B, and 13 athletes by Model C. The introduction of FoCUS markedly increased the sensitivity of PPS, compared with Model A and Model B (sensitivity 94% vs. 19% vs. 58% specificity 93% vs. 93% vs. 92%). The total screening costs were as follows: Model A 35.64 euros, Model B 87.68 euros, and Model C 120.89 euros. Considering the sole conditions at risk of SCD, the incremental cost-effectiveness ratio was 135.62 euros for Model B and 114.31 for Model C.
The implementation of FoCUS into the PPS allows to identify a significantly greater number of athletes at risk of SCD and markedly lowers the false negative rate. Furthermore, the incorporation of FoCUS into the screening process has shown to be cost-effective.
A significant electrocardiography false-positive rate makes pre-participation screening (PPS) for sudden cardiac death (SCD) in athletes controversial. Focused cardiac ultrasound (FoCUS) may increase sensitivity and specificity however, its cost-effectiveness is unknown. This
study evaluates the diagnostic performance and cost-effectiveness of FoCUS in PPS. Incorporating a simplified echocardiographic exam called FoCUS into PPS resulted in higher diagnostic reliability, with a lower rate of false negatives and a higher number of athletes at risk for SCD identified.The integration of FoCUS into the screening process resulted to be cost-effective in our athletes’ cohort.