Clinical significance of electrocardiographic right ventricular hypertrophy in athletes: comparison with arrhythmogenic right ventricular cardiomyopathy and pulmonary hypertension

Zaidi, Abbas; Ghani, Saqib; Sheikh, Nabeel; Gati, Sabiha; Bastiaenen, Rachel; Madden, Brendan; Papadakis, Michael; Raju, Hariharan; Reed, Matthew; Sharma, Rajan; Behr, Elijah R.; Sharma, Sanjay

doi:10.1093/eurheartj/eht391

Cited by 73 publications

(47 citation statements)

References 24 publications

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“…On the basis of our long-standing experience of evaluating several thousand athletes and in line with recent consensus documents and research findings, 7,12,14,15,17,19,20,26 we identified certain ECG anomalies (borderline variants; Figure 1A) currently included in the group 2 category of the ESC recommendations and some deemed abnormal by the Seattle criteria that we would now consider normal variants in asymptomatic athletes without a relevant family history or abnormal cardiac examination. Specifically, we would not recommend further investigation of athletes with any one of the following ECG patterns when present either in isolation or in association with recognized training-related ECG changes: (1) left atrial enlargement, (2) right atrial enlargement, (3) left axis deviation, (4) right axis deviation, and (5) Sokolow-Lyon voltage criteria for right ventricular hypertrophy.…”

Section: Refined Ecg Criteriasupporting

confidence: 57%

“…13 New data based on large athlete cohorts from our group have revealed several isolated ECG patterns to have a low diagnostic yield for cardiac disease, questioning their relevance as markers of pathology in elite athletes. 14,15 Current guidelines in practice are consensus based and do not fully incorporate such scientific observations in their recommendations. Furthermore, they are derived almost exclusively from unselected white athletes (WAs) 16 and have not been evaluated in large cohorts of elite athletes of African/Afro-Caribbean origin (black athletes; BAs).…”

Section: Editorial See P 1626 Clinical Perspective On P 1649mentioning

confidence: 99%

“…7,14,15,17,19,20 To determine their sensitivity for the detection of hypertrophic cardiomyopathy (HCM), all 3 criteria were applied to a well-characterized cohort of young, asymptomatic athletes with HCM.…”

Section: Circulationmentioning

confidence: 99%

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Comparison of Electrocardiographic Criteria for the Detection of Cardiac Abnormalities in Elite Black and White Athletes

et al. 2014

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Background-Recent efforts have focused on improving the specificity of the European Society of Cardiology (ESC) criteria for ECG interpretation in athletes. These criteria are derived predominantly from white athletes (WAs) and do not account for the effect of Afro-Caribbean ethnicity or novel research questioning the relevance of several isolated ECG patterns. We assessed the impact of the ESC criteria, the newly published Seattle criteria, and a group of proposed refined criteria in a large cohort of black athletes (BAs)

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Section: Refined Ecg Criteriasupporting

confidence: 57%

Section: Editorial See P 1626 Clinical Perspective On P 1649mentioning

confidence: 99%

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Comparison of Electrocardiographic Criteria for the Detection of Cardiac Abnormalities in Elite Black and White Athletes

et al. 2014

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“…Athletes of Afro-Caribbean origin, who comprised 20% of Sheikh's study group, are more likely to present TWI than are Caucasians [10,27]. Many publications based on additional tests such as echocardiography and cardiac magnetic resonance revealed that TWI is closely associated with cardiac diseases, particularly with HCM [28][29][30][31]. In the cited paper, the TWI was present in 97% of athletes with diagnosed HCM [10].…”

Section: Discussionmentioning

confidence: 97%

The differences in electrocardiogram interpretation in top-level athletes

et al. 2017

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A b s t r a c tBackground: The Ministry of Health in Poland recommends electrocardiogram (ECG)-based cardiovascular screening in athletes, but so far there has been a lack of guidelines on preparticipation assessment. We compared different criteria of ECG screening assessment in a group of top-level athletes. Aim:The aims were to evaluate the prevalence of ECG changes in athletes that necessitate further cardiological work-up according to three criteria in various age groups as well as to identify factors determining the occurrence of changes related and unrelated to the training.Methods: 262 high-dynamic, high-static Polish athletes (rowers, cyclists, canoeists) were divided into two age categories: young (≤ 18 years of age; n = 177, mean age 16.9 ± 0.8; 15-18 years) and elite (> 18 years of age; n = 85, mean age 22.9 ± 3.4; 19-34 years). All sports persons had a 12-lead ECG performed and evaluated according to 2010 European Society of Cardiology (ESC) recommendations, 2012 Seattle criteria, and 2014 Refined criteria. Results:The Refined criteria reduced (p < 0.001) the number of training-unrelated ECG findings to 8.0% vs. 12.6% (Seattle criteria) and 30.5% (ESC recommendations). All three criteria revealed more training-related changes in the group of older athletes (76.5% vs. 55.9%, p = 0.001). Predictors that significantly (p < 0.005) affected the occurrence of adaptive changes were the age of the athlete, training duration (in years), and male gender.Conclusions: 1. The ESC criteria identified a group of athletes that was unacceptably large, as for the screening test, requiring verification with other methods (every fourth athlete). 2. The use of the Refined criteria helps to significantly reduce the frequency and necessity for additional tests. 3. The dependence of adaptive changes on training duration and athletes' age confirms the benign nature of those ECG findings.

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“…Current European Society of Cardiology guidelines recommend that Sokolow-Lyon RVH should prompt further assessment for 'pathological RV dilatation/ hypertrophy' in young athletes [3]. Nevertheless, a recent study in asymptomatic young athletes demonstrated that Sokolow-Lyon RVH was present in around one in eight athletes, indicating that such a strategy would be associated with an unacceptably high rate of false positive screening outcomes [16]. In an attempt to reduce the number of false positives, the more recently proposed Seattle criteria for athlete ECG interpretation suggest that Sokolow-Lyon RVH should be accompanied by right-axis deviation N 120°before further investigation is initiated [13].…”

Section: Introductionmentioning

confidence: 99%

Signs of RV overload on the athlete’s ECG

Claessen

Brosnan

Gerche

et al. 2015

Journal of Electrocardiology

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There is increasing evidence that regular intense endurance exercise can promote structural and electrical remodeling of the right ventricle (RV). These physiological changes can be profound and are frequently accompanied by ECG changes in the right precordial leads, thereby mimicking features observed in arrhythmogenic right ventricular cardiomyopathy (ARVC). Because the 12-lead ECG is used as both a screening and diagnostic tool for the detection of conditions associated with sudden death in athletes, it is of fundamental importance to have a good understanding of the ECG features that distinguish physiological adaptations to endurance exercise from those related to RV pathology as well as their potential overlap. This article describes ECG findings observed in healthy endurance athletes versus athletes with underlying RV pathology and illustrates their differentiation using 4 case presentations.

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Clinical significance of electrocardiographic right ventricular hypertrophy in athletes: comparison with arrhythmogenic right ventricular cardiomyopathy and pulmonary hypertension

Cited by 73 publications

References 24 publications

Comparison of Electrocardiographic Criteria for the Detection of Cardiac Abnormalities in Elite Black and White Athletes

Comparison of Electrocardiographic Criteria for the Detection of Cardiac Abnormalities in Elite Black and White Athletes

The differences in electrocardiogram interpretation in top-level athletes

Signs of RV overload on the athlete’s ECG

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