Prevalence and clinical meaning of isolated increase of QRS voltages in hypertrophic cardiomyopathy versus athlete's heart: Relevance to athletic screening

Calore, Chiara; Melacini, Paola; Pelliccia, Antonio; Cianfrocca, Cinzia; Schiavon, Maurizio; Paolo, Fernando M. Di; Bovolato, Francesca; Quattrini, Filippo M.; Basso, Cristina; Thiene, Gaetano; Iliceto, Sabino; Corrado, Domenico

doi:10.1016/j.ijcard.2013.06.123

Cited by 36 publications

(21 citation statements)

References 9 publications

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“…Neither the Sokolow-Lyon nor the Gubner criteria should be used to evaluate this population, because these criteria could not identify or exclude LVH in athletes. Thus, our results demonstrate that the Sokolow-Lyon criterion should be used with caution, as previously demonstrated 14, and any ECG alteration identified by this set of criteria might mainly be due to physiological adaptations related to exercise training 16. The sport modality subgroup analyses showed higher negative predictive values for the Perugia and Cornell criteria in the LSHD subgroup, mainly when LVDDI and/or septum and/or PWT echocardiographic criteria were used.…”

Section: Discussionsupporting

confidence: 75%

“…Many ECGs that fulfill the Sokolow-Lyon voltage criteria for LVH in trained athletes have been reported 8,13-16. Although the previous finding by Pelliccia et al 8 verified that there were 20% more abnormal ECGs when using the criterion of an isolated QRS voltage increase, Calore et al 14 suggested that positive results for an isolated QRS voltage increase should not be used in highly trained athletes when evaluating LVH. Accordingly, the Sokolow-Lyon criterion (QRS voltage analysis) seems to be inadequate for young competitive athletes 15.…”

Section: Introductionmentioning

confidence: 99%

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

Samesima¹,

Azevedo²,

Matos³

et al. 2017

Clinics

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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.

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Section: Discussionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

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

Samesima¹,

Azevedo²,

Matos³

et al. 2017

Clinics

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“…Although clearing athletes with isolated voltage criteria for LVH may not detect a very small minority of individuals with HCM, such individuals have a milder phenotype with a low arrhythmogenic risk 40. Conversely, pathological LVH is commonly associated with additional ECG features such as TWI in the inferior and lateral leads, ST segment depression and pathological Q waves (figure 3).…”

Section: Normal Ecg Findings In Athletesmentioning

confidence: 99%

International criteria for electrocardiographic interpretation in athletes: Consensus statement

et al. 2017

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Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly, advanced by a growing body of scientific data and investigations that both examine proposed criteria sets and establish new evidence to guide refinements. On 26-27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington (USA), to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD.

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“…Voltage criteria for right ventricular hypertrophy were identified exclusively in male athletes, due to more profound cardiac adaptations than in females, and were not associated with cardiac pathology in asymptomatic athletes [ 9 ]. Patients with normal ECGs or with isolated QRS voltage criteria for left ventricular hypertrophy may have hypertrophic cardiomyopathy, but a less severe phenotype, associated with a lower arrhythmic risk [ 89 ].…”

Section: Ecg Ventricular Hypertrophymentioning

confidence: 99%

Electrocardiographic Predictors of Cardiovascular Mortality

Mozoş

Caraba

2015

Disease Markers

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Cardiovascular diseases are the main causes of mortality. Sudden cardiac death may also appear in athletes, due to underlying congenital or inherited cardiac abnormalities. The electrocardiogram is used in clinical practice and clinical trials, as a valid, reliable, accessible, inexpensive method. The aim of the present paper was to review electrocardiographic (ECG) signs associated with cardiovascular mortality and the mechanisms underlying those associations, providing a brief description of the main studies in this area, and consider their implication for clinical practice in the general population and athletes. The main ECG parameters associated with cardiovascular mortality in the present paper are the P wave (duration, interatrial block, and deep terminal negativity of the P wave in V1), prolonged QT and Tpeak-Tend intervals, QRS duration and fragmentation, bundle branch block, ST segment depression and elevation, T waves (inverted, T wave axes), spatial angles between QRS and T vectors, premature ventricular contractions, and ECG hypertrophy criteria.

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Prevalence and clinical meaning of isolated increase of QRS voltages in hypertrophic cardiomyopathy versus athlete's heart: Relevance to athletic screening

Cited by 36 publications

References 9 publications

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

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

International criteria for electrocardiographic interpretation in athletes: Consensus statement

Electrocardiographic Predictors of Cardiovascular Mortality

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