Athlete Heart in Children and Young Athletes. Echocardiographic Findings in 331 Cases

Rodrı́guez-López, Ana M.; Javier, González; Carmen, Padrón; García-Cuenllas, Luisa; Febles, Tomas; Josefa, Hernandez M; Luis, Febles

doi:10.1007/s00246-021-02736-5

Cited by 5 publications

(2 citation statements)

References 29 publications

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“…Current evidence explaining adaptations to high training load in the paediatric heart is few and sometimes with conflicting outcomes [ 33 ]. Indeed, if D’Ascenzi et al described a paediatric physiological training-induced remodelling, especially in RV parameters [ 5 ], Rodriguez-Lopez et al affirmed that cardiac remodelling in young athletes is mainly focused on the left chambers [ 6 ]. Thus, considering only studies analyzing fQRS in athletes, Orlandi et al recently showed how the fQRS pattern was independently associated with LV cardiac mass indices, while a study by Ollitreaut et al demonstrated that fQRSV 1 was associated with training-induced RV remodeling [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

The Fragmented QRS Complex in Lead V1: Time for an Update of the Athlete’s ECG?

Vecchiato,

Quinto,

Borasio

et al. 2023

J. of Cardiovasc. Trans. Res.

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Differentiating between ECG patterns related to athletes' heart remodeling and pathological findings is a challenge in sports cardiology. As the significance of fragmented complex in athletes remains uncertain, this study aimed to assess the presence of fragmented QRS in lead V1 (fQRSV1) among young athletes and its association with heart adaptations and arrhythmias. Young athletes referred for annual pre-participation screening receiving a maximal exercise testing and transthoracic echocardiography from January 2015 to March 2021 were included. The study included 684 young athletes. The prevalence of fQRSV1 was 33%. Subjects with fQRSV1 had higher exercise capacity and indexes of right ventricular function and remodeling. Among highly trained athletes, the fQRSV1 group demonstrated also increased left ventricular wall thickness. No significant association existed between fQRSV1 and exercise-induced arrhythmias, even in highly trained athletes. The high prevalence of fQRSV1 in young athletes is associated with training-induced heart adaptations but not exercise-induced ventricular arrhythmias. Graphical Abstract The fragmented QRS complex in lead V1 in young athletes. PPS = preparticipation screening; EST = exercise stress test; fQRSV1 = fragmented QRS in lead V1; PSBs = premature supraventricular beats; PVBs = premature ventricular beats.

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Section: Discussionmentioning

confidence: 99%

The Fragmented QRS Complex in Lead V1: Time for an Update of the Athlete’s ECG?

Vecchiato,

Quinto,

Borasio

et al. 2023

J. of Cardiovasc. Trans. Res.

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“…Endurance and strength training lead the athlete’s heart to different types of adaptations, even though most disciplines cause mixed adaptation scenarios. The persistence of such modifications in athletes depends on various factors, such as sex, age, ethnicity and physiological characteristics of the subject [ 21 , 22 ], which are largely genetically determined: indeed female [ 21 ] and pediatric [ 23 , 24 ] athlete’s hearts are growing topic in current literature. Furthermore, these adaptations vary on the duration, type and intensity of the sports activity practiced by the subject [ 20 , 25 ].…”

Section: Physiological and Pathological Cardiac Adaptations To Physic...mentioning

confidence: 99%

Athlete's Heart: A Cardiovascular Step-By-Step Multimodality Approach

Palermi¹,

D’Ascenzi²,

Castelletti³

et al. 2023

Rev. Cardiovasc. Med.

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“Athlete’s heart” is a spectrum of morphological, functional, and regulatory changes that occur in people who practice regular and long-term intense physical activity. The morphological characteristics of the athlete’s heart may overlap with some structural and electrical cardiac diseases that may predispose to sudden cardiac death, including inherited and acquired cardiomyopathies, aortopathies and channelopathies. Overdiagnosis should be avoided, while an early identification of underlying cardiac life-threatening disorders is essential to reduce the potential for sudden cardiac death. A step-by-step multimodality approach, including a first-line evaluation with personal and family history, clinical evaluation, 12-lead resting electrocardiography (ECG), followed by second and third-line investigations, as appropriate, including exercise testing, resting and exercise echocardiography, 24-hour ECG Holter monitoring, cardiac magnetic resonance, computed tomography, nuclear scintigraphy, or genetic testing, can be determinant to differentiate between extreme physiology adaptations and cardiac pathology. In this context, cardiovascular imaging plays a key role in detecting structural abnormalities in athletes who fall into the grey zone between physiological adaptations and a covert or early phenotype of cardiovascular disease.

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How to evaluate resting ECG and imaging in children practising sport: a critical review and proposal of an algorithm for ECG interpretation

Ragazzoni

Cavigli

Maffei

et al. 2022

European Journal of Preventive Cardiology

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The athlete’s heart is a well-known phenomenon in adults practicing competitive sports. Unfortunately, to date, most of the studies on training-induced cardiac remodelling have been conducted in adults and the current recommendations refer mainly to adult individuals. However, an appropriate interpretation of resting ECG and imaging in children practising sports is crucial, given the possibility of early detect life-threatening conditions and managing therapy and eligibility to sports competitions in the rapidly growing paediatric athlete population. While several articles have been published on this topic in adult athletes, a practical guide for the clinical evaluation of pediatric athletes is still missing. In this critical review, we provided a comprehensive description of the current evidence on training-induced remodeling in pediatric athletes with a practical approach for clinicians on how to interpret the resting 12-lead ECG and cardiac imaging in pediatric athlete. Indeed, given that training may mimic potential cardiovascular disorders, clinicians evaluating children practicing sports should pay attention to the risk of missing a diagnosis of a life-threatening condition. However, this risk should be balanced with the risk of overdiagnosis and unwarranted disqualification from sports practice, when interpreting an ECG as pathological while, on the contrary, it may represent a physiological expression of athlete’s heart. Accordingly, we proposed an algorithm for the evaluation of normal, borderline, and abnormal ECG findings that can be useful for the readers for their daily clinical practice.

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Athlete Heart in Children and Young Athletes. Echocardiographic Findings in 331 Cases

Cited by 5 publications

References 29 publications

The Fragmented QRS Complex in Lead V1: Time for an Update of the Athlete’s ECG?

The Fragmented QRS Complex in Lead V1: Time for an Update of the Athlete’s ECG?

Athlete's Heart: A Cardiovascular Step-By-Step Multimodality Approach

How to evaluate resting ECG and imaging in children practising sport: a critical review and proposal of an algorithm for ECG interpretation

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