Indications for follow-up and positive predictive value for cardiovascular disease
| Indicator | n | Positive predictive value for CAD (%)‡ | Positive predictive value for valvular disease (%)* |
| AHA questionnaire | 147§ | 11.6 | 3.4 |
| Exertional dyspnoea | 26 | 23.1 | 0.0 |
| Exertional syncope/presyncope | 34 | 14.7 | 5.9 |
| Previously known AF, other† | 40 | 12.5 | 2.5 |
| Exertional chest pain | 34 | 11.8 | 0.0 |
| Palpitations with exercise | 86 | 8.1 | 3.5 |
| Exertional fatigue | 4 | 0.0 | 0.0 |
| Family history | 120§ | 10.8 | 5.8 |
| Family history of premature CAD (<50 years) | 52 | 15.4 | 7.7 |
| Family history of inheritable heart conditions | 48 | 10.4 | 6.3 |
| Family history of unexplained SCD | 32 | 6.3 | 0.0 |
| Physical examination | 122§ | 9.0 | 7.4 |
| Diastolic murmur | 1 | 0.0 | 100.0 |
| Systolic click | 22 | 9.1 | 18.2 |
| ≥2/6 systolic murmur | 92 | 9.8 | 4.3 |
| Abnormal second heart sound | 2 | 0.0 | 0.0 |
| Hypertension (≥180/110) | 2 | 0.0 | 0.0 |
| Irregular pulse | 8 | 0.0 | 0.0 |
| Abnormal resting 12-lead ECG | 98§ | 11.2 | 3.1 |
| Significant q-waves | 6 | 33.3 | – |
| Premature ventricular contractions | 11 | 27.3 | – |
| Complete RBBB | 12 | 16.7 | – |
| Left axis deviation | 36 | 11.1 | – |
| Right axis deviation | 12 | 8.3 | – |
| T-wave inversions | 13 | 7.7 | – |
| ST depression | 5 | 0.0 | – |
| Complete LBBB | 5 | 0.0 | – |
| Left atrial enlargement | 12 | 0.0 | – |
| Right axis enlargement | 2 | 0.0 | – |
| Prolonged QT interval | 1 | 0.0 | – |
| LVH + RVH | 1 | 0.0 | – |
| Atrial tachyarrhythmia (ie, atrial fibrillation) | 3 | 0.0 | – |
| Cardiovascular risk | |||
| Diabetes | 8 | 50.0 | 0.0 |
| FBS ≥7.0 | 5 | 40.0 | 0.0 |
| High FRS | 68 | 38.2 | 1.5 |
| ≥65 years | 130 | 13.8 | 0.8 |
| Intermediate FRS | 196 | 13.3 | 3.1 |
| Cholesterol >8 mmol/L | 2 | 0.0 | 0.0 |
| Total participants with abnormal findings | 513 |
*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.