The early repolarization pattern: Echocardiographic characteristics in elite athletes

Abstract

Background: The electrocardiographic early repolarization (ER) pattern is associated with idiopathic ventricular fibrillation and increased long-term cardiovascular mortality. Whether structural cardiac aberrations influence the phenotype is unclear. Since ER is particularly common in athletes, we evaluated its prevalence and investigated predisposing echocardiographic characteristics and cardiopulmonary exercise capacity in a cohort of elite athletes. Methods: A total of 623 elite athletes (age 21 ± 5 years) were examined during annual preparticipation screening from 2006 until 2012 including electrocardiography, echocardiography, and exercise testing. ECGs were analyzed with focus on ER. All athletes participated in a clinical follow-up.Results: The prevalence of ER was 17% (108/623). ER-positive athletes were predominantly male (71%, 77/108), showed a lower heart rate (57.1 ± 9.3 bpm versus 60.0 ± 11.2 bpm; p = 0.015) and a higher lean body mass compared to ER-negative participants (88.1% ± 5.6% versus 86.5% ± 6.3%; p = 0.015). Echocardiographic measurements and cardiopulmonary exercise capacity in male and female athletes with and without ER largely showed similar results. Only the notching ER subtype (n = 15) was associated with an increased left atrial diameter (OR 7.01, 95%CI 1.65-29.83; p = 0.008), a higher left ventricular mass (OR 1.02, 95%CI 1.00-1.03; p = 0.038) and larger relative heart volume (OR 1.01, 95%CI 1.00-1.01; p = 0.01). During a follow-up of 7.4 ± 1.5 years, no severe cardiovascular event occurred in the study sample. Conclusions:In elite athletes presence of ER is not associated with distinct alterations in echocardiography and cardiopulmonary exercise. Athletes presenting with ER are rather male, lean with a low heart rate.

The Diagnostic Value of 2D- Speckle Tracking Echocardiography for Identifying Subclinical Ventricular Dysfunction in Subjects with Early Repolarization Pattern

“…In addition, it was observed that LV mass and RWT were significantly higher in ERP group. Our results are consistent with the previous studies 9, 22,23 . These results suggest that ERP can lead to LV structural changes.…”

KCND3 potassium channel gene variant confers susceptibility to electrocardiographic early repolarization pattern

“…The early repolarization pattern (ERP) is a common ECG finding characterized by an elevation at the QRS-ST junction (J point) of at least 0.1 mV in 2 adjacent ECG leads. The prevalence of ERP in the general population ranges from 2% to 13% and is more common in young athletic men (1)(2)(3)(4)(5). The classical notion of ERP being a benign ECG phenotype was challenged in 2008 by a landmark study by Haïssaguerre and colleagues showing an association of ERP with increased risk of ventricular fibrillation and sudden cardiac death (6): the early repolarization syndrome (ERS) (7).…”

Prospective long-term follow-up analysis of the cardiovascular system in marathon runners: study design of the Pro-MagIC study

“…7 QTc interval will be calculated by formula of Bazett 33 and-in case of very low HRs-by the Sagie-Framingham method. 34 Additionally, abnormal repolarisation (eg, ST-segment alterations, T-wave inversion and early repolarisation pattern) and depolarisation disorder will be analysed manually by experienced medical investigators according to Sharma et al 35 and Reinhard et al 36…”