Comparison of Electrocardiographic Criteria for Identifying Left Ventricular Hypertrophy in Athletes from Different Sports Modalities

Abstract

OBJECTIVES:In athletes, isolated electrocardiogram high voltage criteria are widely used to evaluate left ventricular hypertrophy, but positive findings are thought to represent normal electrocardiogram alterations. However, which electrocardiogram criterion can best detect left ventricular hypertrophy in athletes of various sport modalities remains unknown.METHODS:Five electrocardiogram criteria used to detect left ventricular hypertrophy were tested in 180 male athletes grouped according to their sport modality: 67% low-static and high-dynamic components and 33% high-static and high-dynamic components of exercise. The following echocardiogram parameters are the gold standard for diagnosing left ventricular hypertrophy: left ventricular mass index ≥134 g.m-2, relative wall thickness ≥0.42 mm, left ventricular diastolic diameter index ≥32 mm.m-2, septum wall thickness ≥13 mm, and posterior wall thickness ≥13 mm. Results for the various criteria were compared using the kappa coefficient. Significance was established at p<0.05.RESULTS:Fifty athletes (28%) presented with left ventricular hypertrophy according to electrocardiogram findings, with the following sensitivities and specificities, respectively: 38-53% and 79-83% (Perugia), 22-40% and 89-91% (Cornell), 24-29% and 90% (Romhilt-Estes), 68-87% and 20-23% (Sokolow-Lyon), and 0% and 99% (Gubner). The Perugia and Cornell criteria had higher negative predictive values for the low-static and high-dynamic subgroup. Kappa coefficients were higher for Romhilt-Estes, Cornell and Perugia criteria than for Sokolow-Lyon and Gubner criteria.CONCLUSION:All five evaluated criteria are inadequate for detecting left ventricular hypertrophy, but the Perugia, Cornell and Romhilt-Estes criteria are useful for excluding its presence. The Perugia and Cornell criteria were more effective at excluding left ventricular hypertrophy in athletes involved in a sport modality with low-static and high-dynamic component predominance.

Transthoracic Echocardiography and Dependence of Electrocardiographic Indicators on Physical Activity Type in Lithuanian Athletes

“…The Perugia, Cornell and Romhilt-Estes ECG criteria presented high negative predictive values, which could be helpful for excluding the presence of LVH in athletes. (Samesima et al (2017) found that the Perugia and Cornell criteria were more effective for excluding LVH in athletes involved in sport modalities with a predominance of the dynamic component. The greatest disadvantage of pre-participation screening of young athletes' ECGs for abnormalities that may disclose a cardiac disease is the high number of false positives.…”

Prevalence, Performance and Predictors of Electrocardiographic Left Ventricular Hypertrophy in Male Black Athletes: A Retrospective Study

“…In spite of differences in racial composition and lower Echo-LVH prevalence rates than those in our study, a similarly poor diagnostic accuracy for the Sokolow-Lyon index was found in previous studies among predominantly male and/or endurance athletes. 9, 10 Therefore, even though the athlete ECG interpretation guidelines seem to favor the Sokolow-Lyon index, 4, 5 the available data suggests that all current ECG-LVH criteria are unsuitable for screening for Echo-LVH in athletes and, indeed, in young people in general. 6…”

“…Nevertheless, while the available ECG-LVH criteria admittedly lack sensitivity in the general population, 6,7 their considerably even poorer diagnostic performance among athletes is an ongoing puzzle and concern. [8][9][10] It is also not known if particular voltage criteria are superior in screening efficacy in specific athlete or sport populations 9 or, indeed, have intrinsically greater prognostic significance than others. This would be of particular concern in West Africa where previous studies among athletes have shown a high prevalence of echocardiographic LVH ("Echo-LVH") especially of the concentric type.…”

Left Ventricular Systolic Function Assessed by Speckle Tracking Echocardiography in Athletes with and without Left Ventricle Hypertrophy

“…The remaining data was analyzed by means of repeated measures analysis of variance (ANOVA). Moreover, research shows that about 28% of athletes presented with left ventricular hypertrophy according to echocardiogram parameters (left ventricular mass index > 134 g/m 2 , relative wall thickness > 0.42 mm) [26]. For male cyclists we expected LVMI increase in 48% of athletes; therefore, a sample size of 42 participants is needed to reach 80% power with two-sided test and alpha of 0.05.…”