Clinical, Electrocardiographic, Echocardiographic Characteristics and Long-Term Follow-Up of Elite Soccer Players With J-Point Elevation

Biasco, Luigi; Cristoforetti, Yvonne; Castagno, Davide; Giustetto, Carla; Astegiano, Piero; Ganzit, G. P.; Gribaudo, Carlo Gabriele; Gaïta, Fiorenzo

doi:10.1161/circep.113.000434

Cited by 20 publications

(23 citation statements)

References 25 publications

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“…7 In a recent report on professional athletes, a correlation between J-point elevation and interventricular septum thickness was observed, suggesting a possible mechanistic role of exercise-induced left ventricular hypertrophy as the basis for J-point elevation, and no cardiac death was observed in a median of 13 years follow-up. 8 Similarly, in the CARDIA study, the presence of early repolarisation in young adults was not associated with higher risk of death during long-term follow-up. 9 The possibility that false tendons, e.g.…”

Section: Clinical Significancementioning

confidence: 84%

“…Inferolateral early repolarisation pattern is seen in 25-35 % of competitive athletes, and inferior only in 4 %, and is considered a dynamic phenomenon related to physical activity. 8,21,22 Finally, a large genome-wide association study has been unable to identify genetic variants associated with the pattern, possibly reflecting the phenotypic heterogeneity that exists among these individuals. 23 It seems, therefore, that the majority of individuals with early repolarisation are at no or minimal risk for arrhythmic events.…”

Section: Clinical Significancementioning

confidence: 99%

See 1 more Smart Citation

Early Repolarisation Syndrome – New Concepts

Katritsis

Gersh

2015

Arrhythmia &Amp; Electrophysiology Review

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Early repolarisation pattern is defined electrocardiographically by a distinct J wave or J-point elevation that is either a notch or a slur of the terminal part of the QRS entirely above the baseline, with or without ST-segment elevation. The peak of the notch or slur (J p ) should be ≥0.1 mV in two or more contiguous leads, excluding leads V1 to V2 (see Figure 1).1,2 Early repolarisation syndromes (ERS) refer to sudden cardiac death or documented VT/VF in individuals with an early repolarisation pattern.A prominent J wave has been long observed in cases of hypothermia hypercalcaemia and ischaemia.3 The term J-wave syndromes usually denotes inherited conditions such as ERS and the Brugada syndrome, 4 which are due to mutations affecting calcium, potassium and sodium channels and may contribute to overlap syndromes. 4,5 Genetics and PathophysiologyThe J-wave deflection occurring at the QRS-ST junction (also known as the Osborn wave) was first described in 1953 and is seen in many conditions such as acute ischaemia (especially in true posterior myocardial infarction), hypothermia, hypercalcaemia, brain injury, acidosis and early repolarisation syndromes. An increase in net repolarising current, due to either a decrease of inward Na + or Ca 2+ currents (I Na, and I Ca,L ), or augmentation of outward currents, such as Ito, I K-ATP, and I K-ACh, lead to augmentation of the J wave or the appearance of ST-segment elevation that is more prominent during slow heart rates.Overlap with other syndromes may be seen. Mutations in the SCN10A gene may produce patterns of Brugada, early repolarisation and conduction disease, 5 and a high prevalence of early repolarisation in short QT syndrome has also been reported. 6 Physiological heterogeneity of electrical properties and transmural gradients in ion channel distribution in the endocardial, midmyocardial (M cells) and epicardial layers result in regional differences in electrophysiological properties. Clinical SignificanceThe early repolarisation pattern has long been considered to be a benign ECG manifestation (6-13 % in the general population), that is seen more commonly in young healthy men and athletes (22-44 %) and its clinical significance has been questioned. 7 In a recent report on professional athletes, a correlation between J-point elevation and interventricular septum thickness was observed, suggesting a possible mechanistic role of exercise-induced left ventricular hypertrophy as the basis for J-point elevation, and no cardiac death was observed in a median of 13 years follow-up. 8 Similarly, in the CARDIA study, the presence of early repolarisation in young adults was not associated with higher risk of death during long-term follow-up. 9 The possibility that false tendons, e.g. discrete, fibromuscular structures that transverse the LV cavity, are related to the genesis of J waves has also been raised. 10 However, there has been evidence suggesting that the early repolarisation pattern may be associated with a risk for VF, depending on the location of early repol...

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Section: Clinical Significancementioning

confidence: 84%

Section: Clinical Significancementioning

confidence: 99%

Early Repolarisation Syndrome – New Concepts

Katritsis

Gersh

2015

Arrhythmia &Amp; Electrophysiology Review

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“…-familial hyperlipidemia (congenital elevated levels of low-density lipoproteins (LDL) and insufficient levels of high-density lipoproteins (HDL) in the blood), which results in atherosclerotic heart disease [3,4]; -hypertrophic cardiomyopathy [3,8,9]; J. P. Guillem, M. Haissaguerre and co-authors back in 1988 suggested the correlation of ERS with borderline forms of obstructive hypertrophic cardiomyopathy (HCM) on the basis of similar echocardiographic signs (the state of the basal interventricular septum, ventricular hyperkinesia, the movement of the anterior mitral valve, reduction of the area of the outgoing LV tract); -with congenital and acquired heart defects [10]; -connective tissue disorders (СTD) in the form of the appearance of longitudinal, oblique and transverse additional chords in the ventricular cavity of the heart. According to S. N. Shulenin et al [11], in patients with ERS some isolated signs of СTD (dolichomorphy, hypermobility of joints, arachnodactyly, the presence of abnormal chords and mitral valve prolapse) were significantly more often revealed (51 %) than in individuals without this phenomenon (41 %).…”

Section: Aimmentioning

confidence: 99%

Early repolarization syndrome in modern interpretation

2019

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“…In a recent retrospective analysis of 118 male soccer players with early repolarization, no cardiac deaths occurred during a mean follow-up of 13.3 years. 69 16, because of RV dominance and repolarization polarity directed posteriorly. 65 In the interpretation of athletes' ECG, it should be stressed that some normal cut-offs differ between the sexes (e.g.…”

Section: Electrical Adaptationmentioning

confidence: 99%

The hearts of competitive athletes: An up-to-date overview of exercise-induced cardiac adaptations

Dores¹,

Freitas²,

Malhotra³

et al. 2015

Revista Portuguesa de Cardiologia

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Intense and regular physical exercise is responsible for various cardiac changes (electrical, structural and functional) that represent physiological adaptation to exercise training. This remodeling, commonly referred to as 'athlete's heart', can overlap with several pathological entities, in which sudden cardiac death may be the first clinical presentation. Although pre-competitive screening can identify athletes with life-threatening cardiovascular abnormalities, there are no widely used standardized pre-participation programs and those currently implemented are controversial. Data from personal and family history, features of physical examination and changes in the 12-lead electrocardiogram can raise the suspicion of cardiac disease and lead to early detection of entities such as hypertrophic cardiomyopathy. However, interpreting the electrocardiogram is often challenging, because some changes are considered physiological in athletes. Thus, clinical decision-making in such cases can prove difficult: missing a condition associated with an increased risk of life-threatening events, or conversely, mislabeling an athlete with a disease that leads to unnecessary disqualification, are both situations to avoid. This paper provides an up-to-date review of the physiological cardiac effects of exercise training and highlights key points that should be taken into consideration in the assessment of young competitive athletes.

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Clinical, Electrocardiographic, Echocardiographic Characteristics and Long-Term Follow-Up of Elite Soccer Players With J-Point Elevation

Cited by 20 publications

References 25 publications

Early Repolarisation Syndrome – New Concepts

Early Repolarisation Syndrome – New Concepts

Early repolarization syndrome in modern interpretation

The hearts of competitive athletes: An up-to-date overview of exercise-induced cardiac adaptations

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