The Impact of Ethnicity on Athlete ECG Interpretation: A Systematic Review

Abstract

Athlete ECG interpretation criteria have been developed and refined from research in athlete populations; however, current guidelines are based on available data primarily from Caucasian and Black athletes. This study aimed to assess the impact of ethnicity on ECG interpretation in athletes. A systematic review was conducted of the MEDLINE, EMBASE, Scopus, SPORTDiscus, and Web of Science databases, for papers that assessed athlete screening ECGs and compared findings on the basis of ethnicity. Fifty-one papers which compared ECGs from various ethnicities were included. Most studies assessed Black athletes against Caucasian athletes and found a greater prevalence of T-wave inversion (TWI) (2.6–22.8% vs. 0–5%) and anterior TWI (3.7–14.3% vs. 0.6–2%). Black athlete subgroups in Africa had TWI (20–40%) and anterior TWI (4.3–18.7%) at a higher prevalence than other Black athletes. Athletes who were defined as mixed-race, Asian, and Pacific Islander are potentially more like Black athletes than Caucasian athletes. Black ethnicity is known to have an impact on the accurate interpretation of athlete ECGs; however, there is nuance related to origin of both parents. Asian and Pacific Islander origin also may impact athlete ECG interpretation. Further research is required to assist in distinguishing abnormal and normal athlete ECGs in different ethnic populations.

ST domed Elevation – an Atypical Variant of Early Repolarization in the White Athlete after the COVID-19 Pandemic. A Case Report.

“…It is a concern variant of the norm in the Seattle criteria, 2 although it also occurs with a lower frequency in the White race, but is not included in the standard. 17 Ilodibia et al 25 pointed out that 77% of all athletes are ER and STE with TWI (+TWI), and almost 30% are West Africans (Nigeria, Ghana, Algeria).…”

“…STE is 11-85% in Black meta-analyzes and 1-61% in White. 17,25 On this basis, we propose to include the anterior precordial leads (summarized in Table 1). A rare variant, typical concave STE in V2-V6 (with the smiling sign).…”

“…15 However, a prevalent benign lesion is the concave ST elevations (so-called smiling) in leads V2-V6 with arched high T wave, suggesting benign early repolarization of the ventricular muscle in athletes (standard variant). 16,17 In 2012, Smith introduced the criteria for the diagnosis/calculation based on 3 or 4 parameters (Smith Index) of V2-V4 leads of the LAD stenosis risk price (cellular application: ECG_SMITH), which helped me many times in the hospital emergency department on call. 18 A typical feature of benign early ventricular repolarization is a high J-point departure in precordial, anterior (V2-V4), lateral (V5-V6, I, aVL), and lower (II, aVF) leads in the Afro-American race (Black Athletes).…”

“…18 A typical feature of benign early ventricular repolarization is a high J-point departure in precordial, anterior (V2-V4), lateral (V5-V6, I, aVL), and lower (II, aVF) leads in the Afro-American race (Black Athletes). 17 They were not included in the Seattle and ESC criteria, although it was once suggested that they might constitute a risk of sudden death (Haissaguerre's syndrome). 19,20 On the other hand, a high J-point departure and a high T point are also considered an early pathology of the coronary vessels -de Winter pattern.…”

Comparison of methods for correcting QT interval in athletes and young people: A systematic review

“…Furthermore, most the studies were from Europe or the United States of America, with participants predominantly of a Caucasian background. This may limit the paper's application to different population groups, as ethnicity is known to affect athlete ECGs 37 . The information which was provided in the included studies did not allow for the assessment of heterogeneity in the populations or whether there were different subgroups.…”