Physical Examination and ECG Screening in Relation to Echocardiography Findings in Young Healthy Adults

Abstract

Background and Aims: Cardiovascular screening in young adults is an important tool in many occupational settings. Our aim was to test whether screening physical examination and ECG influence the rate of abnormal echocardiogarphic findings in young healthy subjects. Methods: Consecutive echocardiography results of 18- to 20-year-old flight candidates were analyzed retrospectively. Echocardiographies were performed as part of a screening protocol, which includes ECG, physical examination and referral for echocardiography for any positive finding. A second stage includes universal echocardiography for all candidates. Results: 1,066 subjects were evaluated; 489 subjects underwent echocardiography following referral because of abnormal auscultatory or ECG findings. Findings (mostly mild valvular insufficiencies) were demonstrated in 12.7%, with only 0.6% of subjects disqualified. In subjects who underwent universal echocardiography (n = 577), findings (mostly mild valvular insufficiencies) were detected in 18%, with only 0.5% of subjects disqualified. Conclusions: The rate of significant echocardiography findings is extremely low in this young and healthy population. The presence of abnormal findings on either physical examination or ECG screening was not demonstrated to alter the rate of abnormal echocardiographic findings. We suggest that the low yield of screening should be weighed against the cost of an unidentified congenital cardiac lesion in the specific setting.

Is screening for abnormal ECG patterns justified in long‐term follow‐up of childhood cancer survivors treated with anthracyclines?

“…A study by van der Pal et al 43 In the present study, we found low agreement between abnormal ECG patterns and echocardiographic abnormalities. Landau et al 44 also showed a poor correlation between ECG and echocardiographic abnormalities. The fact that a normal echocardiogram does not rule out an abnormal ECG, and vice versa, is not surprising.…”

“…In the present study, we found low agreement between abnormal ECG patterns and echocardiographic abnormalities. Landau et al . also showed a poor correlation between ECG and echocardiographic abnormalities.…”

Physical Examination and Electrocardiographic Findings in Young Subjects – Are They Predictive of Echocardiographic Findings

“…Previous studies performed at our center reported an extremely low rate of significant echocardiographic findings in subjects who were referred to echocardiography because of clinical or echocardiographic findings and in subjects in whom echocardiography was performed routinely [7,8] . This was in contrast to a study performed by Gray et al [12] in which a much higher rate of findings was reported, although most of these were considered insignificant.…”

“…The present study demonstrated that the rate of significant findings on echocardiography in healthy young subjects is similar to previous reports, although according to the criteria employed, it may be considered cost-effective. The different rate of findings between the tests performed because of physical or electrocardiographic findings and those performed routinely is clinically important as it may serve as preliminary evidence for the importance of the physical examination and ECG in this screening process, in contrast to previous reports [8] . Despite the relatively high cost of echocardiography for screening purposes, if it is employed only for those with physical or ECG findings, it may be cost-effective.…”

“…A previous study performed at the Israel Air Force (IAF) Aeromedical Center revealed that the presence of abnormal findings on either physical examination or ECG did not affect the rates of abnormal echocardiographic findings [8] , but it was of a relatively small scale. This study evaluated a large cohort of young subjects in by 1 of 3 experienced sonographers and interpreted by 1 of 3 cardiologists specialized in echocardiography.…”