12-Lead ECG*† |
ST-segment depression (\(\ge\) 1 mm in depth in 2 or more contiguous leads, excluding aVR, III, V1) |
ST-segment elevation with convex ST morphology (to differentiate from early repolarization) |
QRS prolongation |
• Right bundle branch block (QRS duration > 140 ms) |
• Left bundle branch block (QRS duration > 120 ms) |
• Inter-ventricular conduction delay (QRS duration > 120) |
Multiple premature ventricular extrasystoles (\(\ge\) 2 PVE per 10 s ECG capture) |
Pathologic Q-waves (Q/R ratio \(\ge\) 0.25 or \(\ge 40\) ms duration in 2 or more leads excluding III and aVR) |
Myocardial necrosis biomarkers* |
Conventional or high sensitivity troponin level > ULN acquired > 24 h after exercise |
Transthoracic echocardiography*‡ |
Global systolic LV dysfunction (LVEF < 50% / LVEF < 45% endurance athlete) with or without LV dilation |
Regional/focal LV systolic dysfunction |
Increased wall thickness (> 13 mm) with or without chamber dilation |
Small or greater pericardial effusion |
Intracavitary thrombus |