Table 2

Indications for follow-up and positive predictive value for cardiovascular disease

IndicatornPositive predictive value for CAD (%)‡Positive predictive value for valvular disease (%)*
AHA questionnaire 147§ 11.6 3.4
  Exertional dyspnoea2623.10.0
  Exertional syncope/presyncope3414.75.9
  Previously known AF, other†4012.52.5
  Exertional chest pain3411.80.0
  Palpitations with exercise868.13.5
  Exertional fatigue40.00.0
Family history 120§ 10.8 5.8
  Family history of premature CAD (<50 years)5215.47.7
  Family history of inheritable heart conditions4810.46.3
  Family history of unexplained SCD326.30.0
Physical examination 122§ 9.0 7.4
  Diastolic murmur10.0100.0
  Systolic click229.118.2
  ≥2/6 systolic murmur929.84.3
  Abnormal second heart sound20.00.0
  Hypertension (≥180/110)20.00.0
  Irregular pulse80.00.0
Abnormal resting 12-lead ECG 98§ 11.2 3.1
  Significant q-waves633.3
  Premature ventricular contractions1127.3
  Complete RBBB1216.7
  Left axis deviation3611.1
  Right axis deviation128.3
  T-wave inversions137.7
  ST depression50.0
  Complete LBBB50.0
  Left atrial enlargement120.0
  Right axis enlargement20.0
  Prolonged QT interval10.0
  LVH + RVH10.0
  Atrial tachyarrhythmia (ie, atrial fibrillation)30.0
Cardiovascular risk
  FBS ≥7.0540.00.0
  High FRS68 38.2 1.5
  ≥65 years13013.80.8
  Intermediate FRS19613.33.1
 Cholesterol >8 mmol/L20.00.0
Total participants with abnormal findings513
  • *Pairwise comparisons between all five tests for valve disease were conducted. Statistical significance was not found between any of the tests.

  • †Other: AF/flutter (n=23), sick sinus syndrome (n=1), supraventricular tachycardia (n=1), potential athlete’s heart (n=2), dissection of vein in the neck (n=1), rheumatic heart disease (n=3), unconfirmed stroke (no documentation) (n=1), unconfirmed congestive heart failure (no documentation) (n=1), pulmonary embolism (n=2), unconfirmed myocarditis (no documentation) (n=2), epicardial cyst (n=1) and pulmonary oedema (n=1).

  • ‡Pairwise comparisons between all five tests for CAD were conducted (p<0.00001 was observed in all comparisons). Statistical significance was found only for high FRS. Bonferroni correction has been applied for multiple comparisons and statistical significance was still evident.

  • §Select athletes had more than one abnormal indication within the given section.

  • Bold values indicate the total number of participants that had a positive response and the overall total positive predictive value for the respective section

  • AF, atrial fibrillation; AHA, American Heart Association; CAD, coronary artery disease; FBS, fasting blood sugar; FRS, Framingham Risk Score; LBBB, left bundle branch block; LVH, left ventricular hypertrophy; RBBB, right bundle branch block; RVH, right ventricular hypertrophy; SCD, sudden cardiac death.