NEW YORK (Reuters Health) - During medical evaluations of sports participants, exercise electrocardiography (ECG) reveals pathology not identified on physical examination and resting ECG, Italian researchers report in the July 4 issue of BMJ Online First.

American and European authorities are unanimous in recommending comprehensive pre-participation evaluations -- including detailed patient and family history and a physical examination -- in young athletes, authors of a related editorial note. More controversial is the universal use of ECGs, with detractors citing a low disease prevalence, poor sensitivity, high false-positive rates, and poor cost-effectiveness.

In their study, Dr. Francesco Sofi and colleagues at the University of Florence analyzed data from more than 30,000 subjects who underwent medical screening at the Institute of Sports Medicine in Florence between 2002 and 2006. Mean age was 30.7 years (range 5-92 years). In addition to history and physical exam, the evaluation included resting and exercise 12 lead ECG.

Ultimately, 156 subjects were considered ineligible for competitive sports for cardiac reasons. Of these, 126 (79%) had negative findings on resting ECG but "clear pathological alterations during the exercise test."

In 56 cases, exercise ECG revealed potentially fatal cardiac disorders, including arrhythmias and coronary heart disease. Other cardiac causes of disqualification included valve diseases, conduction disorders, hypertension, and cardiomyopathies.

In the absence of ECG testing, only six of the disqualified subjects would have been identified on the basis of personal history and physical examination, Dr. Sofi and his associates note.

They recommend follow-up studies to determine whether disqualification based on ECG findings actually reduces the incidence of cardiovascular events among athletes.

Editorialists Dr. Jonathan A. Drezner, at the University of Washington in Seattle, and Dr. Karim Khan, at the University of British Columbia in Vancouver, Canada, maintain that "the existing evidence supports a systematic pre-participation screening programme for all competitive athletes, using a comprehensive personal and family history questionnaire, physical examination, and screening electrocardiography to identify those at risk."

BMJ Online First 2008.

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