Outcomes in Athletes with Marked ECG Repolarization Abnormalities

Pelliccia, Antonio; Paolo, Fernando M. Di; Quattrini, Filippo M.; Basso, Cristina; Culasso, Franco; Popoli, Gloria; Luca, Rosanna De; Spataro, Antonio; Biffi, Alessandro; Thiene, Gaetano; Maron, Barry J.

doi:10.1056/nejmoa060781

Cited by 264 publications

(168 citation statements)

References 30 publications

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“…16 Our results reaffirm that marked PTWI is associated with a high prevalence of cardiac pathologies that are associated with conditions that may predispose athletes to SCD. 9 Although our prevalence of disease is slightly higher than previously reported (45% versus 36%), 9 in keeping with the majority of studies, HCM was our most common identified pathology (81% of all cases). Accordingly, all athletes with disease were excluded from competitive sports as recommended.…”

Section: Prevalence Of Cardiac Disease In Athletes Presenting With Ptwicontrasting

confidence: 41%

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Recognition and Significance of Pathological T-Wave Inversions in Athletes

et al. 2015

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Background— Pathological T-wave inversion (PTWI) is rarely observed on the ECG of healthy athletes, whereas it is common in patients with certain cardiac diseases. All ECG interpretation guidelines for use within athletes state that PTWI (except in leads aVR, III and V1 and in V1–V4 when preceded by domed ST segment in asymptomatic Afro-Caribbean athletes only) cannot be considered a physiological adaptation. The aims of the present study were to prospectively determine the prevalence of cardiac pathology in athletes presenting with PTWI, and to examine the efficacy of cardiac magnetic resonance in the work-up battery of further examinations. Methods and Results— Athletes presenting with PTWI (n=155) were investigated with clinical examination, ECG, echocardiography, exercise testing, 24h Holter ECG, and cardiac magnetic resonance. Cardiac disease was established in 44.5% of athletes, with hypertrophic cardiomyopathy (81%) the most common pathology. Echocardiography was abnormal in 53.6% of positive cases, and cardiac magnetic resonance identified a further 24 athletes with disease. Five athletes (7.2%) considered normal on initial presentation subsequently expressed pathology during follow-up. Familial history of sudden cardiac death and ST-segment depression associated with PTWI were predictive of cardiac disease. Conclusions— PTWI should be considered pathological in all cases until proven otherwise, because it was associated with cardiac pathology in 45% of athletes. Despite echocardiography identifying pathology in half of these cases, cardiac magnetic resonance must be considered routine in athletes presenting with PTWI with normal echocardiography. Although exclusion from competitive sport is not warranted in the presence of normal secondary examinations, annual follow-up is essential to ascertain possible disease expression.

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Section: Prevalence Of Cardiac Disease In Athletes Presenting With Ptwicontrasting

confidence: 41%

“…9 Our data demonstrate the importance of annual follow-up, because almost 6% athletes who presented with PTWI but normal secondary investigations in initial examination later went onto develop clear pathology during follow-up.…”

Section: Importance Of Annual Cardiovascular Follow-upmentioning

confidence: 99%

Recognition and Significance of Pathological T-Wave Inversions in Athletes

et al. 2015

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“…Early repolarization was noted in about one-third of the athletes, and LVH together with early repolarization occurred in 22% of the players. No evidence of deeply inverted T-waves suggestive of increased risk for cardiomyopathy 6 were found in any of our football athletes. None of the athletes showed evidence of significant atrial ectopy other than mild sinus arrhythmia, nor was there evidence of ventricular ectopy, bundle branch block, or second-degree or thirddegree AV block.…”

Section: Resultsmentioning

confidence: 49%

“…2,4 In contrast to this conclusion, recent evidence from a large pool of athletes in various sports suggests that deeply inverted T-waves (≥2 mm) in at least 3 ECG leads may be predictive of serious, later-developing cardiomyopathies. 6 None of our football athletes showed this potentially serious abnormality. In light of the high frequency of abnormal resting ECG findings in our study, it is noteworthy that all maximal treadmill exercise stress tests were completed by the athletes without cardiovascular incident, and evaluated as normal with no evidence of ischemia or arrhythmias.…”

Section: Discussionmentioning

confidence: 79%

“…Deeply inverted T-waves have been linked to underlying cardiomyopathies and delayed adverse outcomes. 6 Specific ECG changes and the frequency of abnormal findings are dependent on the sport in which the athlete participates, as well as the nature of their training. More men than women athletes exhibit ECG abnormalities, and data are limited for African-American athletes.…”

Section: Introductionmentioning

confidence: 99%

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Electrocardiograms of Collegiate Football Athletes

Crouse

Meade

Hansen

et al. 2009

Clinical Cardiology

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Background: The prevalence of electrocardiogram (ECG) abnormalities in American collegiate football athletes is virtually unknown. Purpose: The purpose of this study was to characterize the type and frequency of ECG abnormalities in a sample of football athletes entering National Collegiate Athletic Association (NCAA) Division I Football Bowl Subdivision university program. Methods: Over a 4-y period, resting and exercise 12-lead ECG recordings were analyzed by a cardiologist from 68 freshmen and 9 transfer football athletes (n = 77; 54 African-Americans and 23 Caucasians, aged 18±1 y, height = 1.89±0.06 m, weight = 104.4±19.8 kg) as part of their entry physical examination. Results: A total of 79% of the athletes demonstrated at least 1 abnormal ECG finnding, and significantly more African-America athletes (85%) than Caucasian (65%) athletes. Wolff-Parkinson-White (WPW) syndrome was found in 1 African-American player. Frequencies of various ECG abnormal findings in all athletes were: left ventricular hypertrophy = 64.5%, ST-T wave = 6.5%, interventricular conduction delay = 2.6%, sinus bradycardia = 9.1%, sinus arrhythmia = 15.6%, first-degree atrioventricular (AV) block = 11.7%, left atrial enlargement = 48.1%, early repolarization = 33.8%, and right axis deviation = 20.8%. Average values for the PR (0.17±0.03 s), QRS (0.08±0.02 s), and QT intervals (0.38±0.05 s), P-wave duration (0.10±0.02 s), and QRS axis (79.1±18.2 degrees) were normal. The ECG responses to maximal treadmill exercise stress tests were evaluated as normal without ischemia or arrhythmias. Conclusion: Abnormal resting ECG findings are common in a sample of collegiate football athletes, exceeding the rate expected for their age, and are more frequent in African-American athletes as compared with Caucasian athletes.

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Physiologic and Clinical Features of the Paralympic Athlete’s Heart

et al. 2021

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IMPORTANCE Paralympic medicine is a newly adopted term to describe the varied health care issues associated with athletes in the Paralympics. Scarce scientific data, however, are currently available describing the cardiac remodeling in Paralympic athletes. OBJECTIVE To investigate the physiological and clinical characteristics of the Paralympic athlete's heart and derive the normative values. DESIGN, SETTING, AND PARTICIPANTS This is a single-center study on a relatively large cohort of Paralympic athletes, conducted at the Italian Institute of Sport Medicine and Science. Paralympic athletes free of cardiac or systemic pathologic conditions other than their cause of disability were selected for participation in the Paralympic Games from January 2000 to June 2014. Athletes were arbitrarily classified for disability in 2 groups: those with spinal cord injuries (SCI) and those with non-SCI (NSCI). Data analysis occurred from March 2019 to June 2020. MAIN OUTCOMES AND MEASURES The primary outcome was the difference in cardiac remodeling in Paralympic athletes according to disability type and sports discipline type. Athletes underwent cardiac evaluation, including 12-lead and exercise electrocardiograms, echocardiography, and cardiopulmonary exercise testing. RESULTS Among 252 consecutive Paralympic athletes (median [interquartile range (IQR)] age, 34 [29-41] years; 188 men [74.6%]), 110 had SCI and 142 had NSCI. Those with SCI showed a higher prevalence of abnormal electrocardiogram findings than those with NSCI (13 of 110 [11.8%] vs 6 of 142 [4.2%]; P = .003), smaller left ventricular end-diastolic dimension (median [IQR], 48 [46-52] vs 51 [48-54] mm; P = .001) and left ventricular mass index (median [IQR], 80.6 [69-94] vs 91.3 [80-108] g/m 2 ; P = .001), and lower peak oxygen uptake (VO 2 ) (median [IQR], 27.1 [2-34] vs 38.5 [30-47] mL/min/kg; P = .001) in comparison with those with NSCI.Regarding sport discipline, endurance athletes had a larger left ventricular cavity (median [IQR], 52 [47-54] vs 49 [47-53] mm; P = .006) and higher peak VO 2 (median [IQR],[46][47][48][49][50][51][52][53][54][55] mL/min/kg; P = .001) than athletes in nonendurance sports.CONCLUSIONS AND RELEVANCE Cardiac remodeling in Paralympic athletes differed by disability and sport discipline. Having NSCI lesions and engaging in endurance sports were associated with the largest left ventricular cavity and left ventricular mass and highest VO 2 peak. Having SCI lesions and engaging in nonendurance disciplines, on the contrary, were associated with the smallest left ventricular cavity and mass and lowest VO 2 peak.

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Outcomes in Athletes with Marked ECG Repolarization Abnormalities

Cited by 264 publications

References 30 publications

Recognition and Significance of Pathological T-Wave Inversions in Athletes

Recognition and Significance of Pathological T-Wave Inversions in Athletes

Electrocardiograms of Collegiate Football Athletes

Physiologic and Clinical Features of the Paralympic Athlete’s Heart

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