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Montalvo S, Froelicher VF, Hadley D, Wheeler MT. Digitized Electrocardiography Measurements Support the Biological Plausibility of the Pathological Significance of ST Segments in Athletes. Clin J Sport Med 2024; 34:362-369. [PMID: 38407231 DOI: 10.1097/jsm.0000000000001199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/07/2023] [Indexed: 02/27/2024]
Abstract
OBJECTIVE ST segment deviations around the isoelectric line are common findings in manifest cardiovascular disease. In athletes, ST elevation is common, while ST depression is considered rare. However, clinical studies in athletes have associated ST depression with myocardial fibrosis and fatty infiltration and ST elevation with pericarditis and myocarditis. This study aims to explore the association between resting ST segment deviations and resting heart rate, an indicator of training and autonomic tone and electrocardiography (ECG) markers of exercise training effect and cardiovascular health R and T wave amplitude. DESIGN Retrospective analysis of digitized ECG data. SETTING Institutional setting. PARTICIPANTS Seven thousand eight hundred thirty-six (male athletes = 4592, female athletes = 3244) healthy asymptomatic athletes (14-35 years). MAIN OUTCOME MEASURES A series of correlations and regressions were conducted between ST depression (<0.0 µV) and ST elevation (>0.0 µV), on R and T wave amplitudes, and heart rate in leads V2, V5, and aVF. RESULTS Positive correlations between ST elevation and R and T wave (S wave in V2) amplitudes and leads V5, V2, and aVF in male and female athletes (range of r = 0.1-0.54). In addition, there was a negative correlation between ST elevation and HR for male and female athletes. Finally, there was a negative correlation between ST depression and R wave and HR for male and female athletes in V5 ( P < 0.01). CONCLUSIONS In athletes, ST segment elevation is correlated with R and T wave amplitudes and negatively correlated with HR. In addition, ST segment elevation is correlated with low heart rate, consistent with its higher prevalence in athletes. ST segment depression is not influenced by HR but is negatively associated with R and T wave amplitudes.
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Affiliation(s)
- Samuel Montalvo
- Wu Tsai Human Performance Alliance, Stanford University, Stanford, California,
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
- Stanford Sports Cardiology, Stanford University, Stanford, California; and
| | - Victor F Froelicher
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
- Stanford Sports Cardiology, Stanford University, Stanford, California; and
| | | | - Matthew T Wheeler
- Wu Tsai Human Performance Alliance, Stanford University, Stanford, California,
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
- Stanford Sports Cardiology, Stanford University, Stanford, California; and
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2
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Idiazabal-Ayesa U, Guía-Galipienso FDL, Ramírez-Vélez R, Sanz-de la Garza M, Izquierdo M. Diagnostic cost-effectiveness of a two-stage cardiovascular evaluation program in young-adolescent athletes. Role of echocardiography. Curr Probl Cardiol 2024; 49:102724. [PMID: 38925205 DOI: 10.1016/j.cpcardiol.2024.102724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Sports medical examinations are a tool to detect potentially life-threatening situations during physical activity, but their usefulness and protocols in young athletes remain controversial. The aim was to describe the diagnostic performance of a 2-step ECG and echocardiogram screening model in a large sample of healthy young-adolescent athletes (aged 11-16 years), evaluating its cost-effectiveness for cardiovascular disease (CVD) detection. METHODS Cross-sectional study of 2617 individuals (81 % male, mean age 15 years), over 20 federated sports (La Rioja-Spain). A cardiological examination included family and personal history, physical examination, ECG, and transthoracic echocardiogram. The previous ECG, conducted at 11-13 years old, was reviewed in 1589 individuals (60 %). ECGs were interpreted according to 2017 international criteria. The prevalence of structural cardiac disease (CD) was investigated, and the diagnostic performance of both tests and the cost of screening was evaluated. RESULTS CVD was diagnosed in 63 athletes (2.4 %) and 16 (0.6 %) with pathology related to sudden cardiac death (SCD). In 3 cases (0.11 %), cessation of sporting activity was indicated, and in 2 cases (0.07 %) treatment for congenital CD was indicated. ECG alterations were infrequent (2.5 %). Eighty percent of the structural CD diagnosed by echocardiogram had a normal ECG. The cost per CVD detected was €3,080, and for CVD associated with SCD, it was €12,323. CONCLUSIONS Our study shows the diagnostic cost-effectiveness of a two-step cardiac screening protocol, including ECG, and highlights the role of echocardiography in young adolescent athletes, which could be implemented at a low and reasonable cost.
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Affiliation(s)
- Uxua Idiazabal-Ayesa
- Department of Cardiology and Internal Medicine, Hospital García Orcoyen, Estella, Navarra, Spain; Navarrabiomed, University Hospital of Navarre (HUN), Public University of Navarre (UPNA), IdiSNA, Pamplona, Spain
| | - Fernando de la Guía-Galipienso
- Policlínica Glorieta, Dénia, Spain; REMA Clinic - Sports Cardiology, Dénia, Spain; HCB Benidorm Hospital, Alicante, Spain; Department of Pathology, Catholic University of Valencia - San Vicente Mártir, Valencia, Spain.
| | - Robinson Ramírez-Vélez
- Navarrabiomed, University Hospital of Navarre (HUN), Public University of Navarre (UPNA), IdiSNA, Pamplona, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - María Sanz-de la Garza
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mikel Izquierdo
- Navarrabiomed, University Hospital of Navarre (HUN), Public University of Navarre (UPNA), IdiSNA, Pamplona, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
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3
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Lazzerini PE, Bertolozzi I, Cartocci A, Ginjupalli VKM, Teneggi PA, Pica D, Merico G, Bogazzi I, Salvini V, Accioli R, Salvadori F, Marzotti T, Cevenini G, Capecchi M, Cantara S, Cantore A, Infantino M, Bisogno S, Finizola F, D'ascenzi F, Laghi-Pasini F, Acampa M, Capecchi PL, Boutjdir M. Advanced Atrioventricular Block in Athletes: Prevalence and Role of Anti-Ro/Sjögren Syndrome-Related Antigen A Antibodies. J Am Heart Assoc 2024; 13:e034893. [PMID: 38879447 DOI: 10.1161/jaha.124.034893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/15/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND Advanced atrioventricular block (AVB), that is, higher than second-degree Mobitz-1, is an abnormal finding in athletes. Despite intensive investigation, in several cases the pathogenesis remains unknown, but frequently pacemaker implantation is still indicated. Increasing evidence points to circulating anti-Ro/Sjögren syndrome-related antigen A (SSA) antibodies cross-reacting with L-type calcium channel and inhibiting the related current as an epidemiologically relevant and potentially reversible cause of isolated AVB in adults. The aim of the study was to determine the prevalence of anti-Ro/SSA-associated advanced AVBs in a large sample of young athletes. METHODS AND RESULTS A total of 2536 consecutive athletes aged <40 years without a history of cardiac diseases/interventions were enrolled in a cross-sectional study. Resting and exercise electrocardiography was performed, and those presenting any AVB were further evaluated by 24-hour Holter ECG. Athletes with second-degree AVBs and their mothers underwent anti-Ro/SSA testing. Moreover, purified immunoglobulin G from subjects with anti-Ro/SSA-positive and anti-Ro/SSA-negative advanced AVB were tested on L-type calcium current and L-type-calcium channel expression using tSA201 cells. The global prevalence of advanced AVB in the overall sample was ≈0.1%, but the risk considerably increased (2%) when intensely trained postpubertal male subjects were selectively considered. While none of the athletes with advanced AVB showed heart abnormalities, in 100% of cases anti-Ro/SSA antibodies were detected. Ex vivo experiments showed that immunoglobulin G from anti-Ro/SSA-positive but not -negative subjects with advanced AVB acutely inhibit L-type calcium current and chronically downregulate L-type-calcium channel expression. CONCLUSIONS Our study provides evidence that advanced AVB occurs in young athletes, in most cases associated with anti-Ro/SSA antibodies blocking L-type calcium channels. These findings may open new avenues for immunomodulating therapies to reduce the risk of life-threatening events in athletes, avoiding or delaying pacemaker implantation.
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Affiliation(s)
- Pietro Enea Lazzerini
- Department of Medical Sciences Surgery and Neurosciences, Division of Internal Medicine and Geriatrics, Electroimmunology Unit University of Siena Siena Italy
| | - Iacopo Bertolozzi
- Cardiology Intensive Therapy Unit Department of Internal Medicine Nuovo Ospedale San Giovanni di Dio Florence Italy
- Former Cardiology Intensive Therapy Unit, Department of Internal Medicine Hospital of Carrara Carrara Italy
| | | | | | | | - Davide Pica
- Center for Sports Medicine of Carrara ASL Nord-Ovest Toscana Massa-Carrara Italy
| | - Giovanni Merico
- Center for Sports Medicine of Carrara ASL Nord-Ovest Toscana Massa-Carrara Italy
| | - Irene Bogazzi
- Emergency Department Nuovo Ospedale Apuano ASL Nord-Ovest Toscana Massa-Carrara Italy
| | - Viola Salvini
- Department of Medical Sciences Surgery and Neurosciences, Division of Internal Medicine and Geriatrics, Electroimmunology Unit University of Siena Siena Italy
| | - Riccardo Accioli
- Department of Medical Sciences Surgery and Neurosciences, Division of Internal Medicine and Geriatrics, Electroimmunology Unit University of Siena Siena Italy
| | - Fabio Salvadori
- Department of Medical Sciences Surgery and Neurosciences, Division of Internal Medicine and Geriatrics, Electroimmunology Unit University of Siena Siena Italy
| | - Tommaso Marzotti
- Department of Medical Sciences Surgery and Neurosciences, Division of Internal Medicine and Geriatrics, Electroimmunology Unit University of Siena Siena Italy
| | - Gabriele Cevenini
- Department of Medical Biotechnologies University of Siena Siena Italy
| | - Matteo Capecchi
- Department of Medical Sciences Surgery and Neurosciences, Division of Internal Medicine and Geriatrics, Electroimmunology Unit University of Siena Siena Italy
| | - Silvia Cantara
- Department of Medical Sciences Surgery and Neurosciences, Division of Internal Medicine and Geriatrics, Electroimmunology Unit University of Siena Siena Italy
- Laboratory of Clinical and Translational Research University Hospital of Siena Siena Italy
| | - Anna Cantore
- Department of Medical Sciences Surgery and Neurosciences, Division of Internal Medicine and Geriatrics, Electroimmunology Unit University of Siena Siena Italy
| | - Maria Infantino
- Immunology and Allergology Laboratory Unit S. Giovanni di Dio Hospital Florence Italy
| | - Stefania Bisogno
- Department of Medical Sciences Surgery and Neurosciences, Division of Internal Medicine and Geriatrics, Electroimmunology Unit University of Siena Siena Italy
| | - Francesco Finizola
- Internal Medicine Department Sant'Antonio Abate Hospital of Fivizzano ASL Nord-Ovest Toscana Massa-Carrara Italy
| | - Flavio D'ascenzi
- Department of Medical Biotechnologies Sports Cardiology and Rehabilitation Unit University of Siena Siena Italy
| | - Franco Laghi-Pasini
- Department of Medical Sciences Surgery and Neurosciences, Division of Internal Medicine and Geriatrics, Electroimmunology Unit University of Siena Siena Italy
| | | | - Pier Leopoldo Capecchi
- Department of Medical Sciences Surgery and Neurosciences, Division of Internal Medicine and Geriatrics, Electroimmunology Unit University of Siena Siena Italy
| | - Mohamed Boutjdir
- Department of Medical Biotechnologies University of Siena Siena Italy
- New York University Grossman School of Medicine New York NY USA
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Lasocka-Koriat Z, Lewicka-Potocka Z, Kaleta-Duss A, Siekierzycka A, Kalinowski L, Lewicka E, Dąbrowska-Kugacka A. Differences in cardiac adaptation to exercise in male and female athletes assessed by noninvasive techniques: a state-of-the-art review. Am J Physiol Heart Circ Physiol 2024; 326:H1065-H1079. [PMID: 38391314 DOI: 10.1152/ajpheart.00756.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 02/24/2024]
Abstract
Athlete's heart is generally regarded as a physiological adaptation to regular training, with specific morphological and functional alterations in the cardiovascular system. Development of the noninvasive imaging techniques over the past several years enabled better assessment of cardiac remodeling in athletes, which may eventually mimic certain pathological conditions with the potential for sudden cardiac death, or disease progression. The current literature provides a compelling overview of the available methods that target the interrelation of prolonged exercise with cardiac structure and function. However, this data stems from scientific studies that included mostly male athletes. Despite the growing participation of females in competitive sport meetings, little is known about the long-term cardiac effects of repetitive training in this population. There are several factors-biochemical, physiological and psychological, that determine sex-dependent cardiac response. Herein, the aim of this review was to compare cardiac adaptation to endurance exercise in male and female athletes with the use of electrocardiographic, echocardiographic, and biochemical examination, to determine the sex-specific phenotypes, and to improve the healthcare providers' awareness of cardiac remodeling in athletes. Finally, we discuss the possible exercise-induced alternations that should arouse suspicion of pathology and be further evaluated.
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Affiliation(s)
- Zofia Lasocka-Koriat
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Zuzanna Lewicka-Potocka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
- First Department of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Kaleta-Duss
- Institute for Radiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Anna Siekierzycka
- Department of Medical Laboratory Diagnostics-Fahrenheit Biobank BBMRI.pl, Medical University of Gdańsk, Gdańsk, Poland
| | - Leszek Kalinowski
- Department of Medical Laboratory Diagnostics-Fahrenheit Biobank BBMRI.pl, Medical University of Gdańsk, Gdańsk, Poland
- BioTechMed Centre/Department of Mechanics of Materials and Structures, Gdańsk University of Technology, Gdańsk, Poland
| | - Ewa Lewicka
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland
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D'Ascenzi F, Cavigli L, Marchese A, Taddeucci S, Cappelli E, Roselli A, Bastone G, Lemme E, Serdoz A, Maestrini V, Squeo MR, Pelliccia A. Electrical and structural remodelling in female athlete's heart: A comparative study in women vs men athletes and controls. Int J Cardiol 2024; 400:131808. [PMID: 38262482 DOI: 10.1016/j.ijcard.2024.131808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/25/2023] [Accepted: 01/18/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Athlete's heart is associated with physiological electrical and structural remodelling. Despite the plethora of data published on male athletes, solid data derived from female athletes, compared to male counterparts or sedentary women, are still scarce. OBJECTIVES We aimed to analyze the electrical, structural, and functional characteristics of athlete's heart in female and male athletes vs sedentary controls. METHODS Olympic athletes and sedentary controls were evaluated by resting ECG and echocardiography. Athletes were divided into 4 different sports groups. RESULTS The study population included 1096 individuals (360 female athletes, 410 male athletes, 130 sedentary women and 196 sedentary men). Female athletes had lower resting heart rate, longer PR interval, higher voltage of R, and T waves and more frequently incomplete RBBB, left ventricular (LV) hypertrophy, early repolarization, and anterior T-wave inversion as compared to controls. Biventricular cavity dimensions and LV wall thickness were greater in female athletes than in female controls. However, women showed a lower degree of training-induced structural remodelling than men. In female athletes, both cavity dimensions and LV wall thickness increased from those engaged in skill and power to mixed and endurance disciplines. However, in female athletes, contrary to males, the ECG changes were not significantly different according to the different types of sport discipline. CONCLUSIONS Highly-trained women demonstrate relevant training-induced electrical and structural remodelling. However, the type of sport did not influence ECG parameters in women, contrary to men, while it impacted biventricular morphologic remodelling, with endurance athletes showing the greatest degree of adaptation.
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Affiliation(s)
- Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Andrea Marchese
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Simone Taddeucci
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Elena Cappelli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Alessandra Roselli
- Institute of Sports Medicine, Florence, Italy; Center for Sports Medicine, San Miniato, Italy
| | - Giuseppe Bastone
- Institute for Sports Medicine and Science, Italian Olympic Committee, Rome, Italy
| | - Erika Lemme
- Institute for Sports Medicine and Science, Italian Olympic Committee, Rome, Italy
| | - Andrea Serdoz
- Institute for Sports Medicine and Science, Italian Olympic Committee, Rome, Italy
| | - Viviana Maestrini
- Institute for Sports Medicine and Science, Italian Olympic Committee, Rome, Italy
| | - Maria Rosaria Squeo
- Institute for Sports Medicine and Science, Italian Olympic Committee, Rome, Italy
| | - Antonio Pelliccia
- Institute for Sports Medicine and Science, Italian Olympic Committee, Rome, Italy
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6
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Graziano F, Schiavon M, Cipriani A, Savalla F, De Gaspari M, Bauce B, Rizzo S, Calore C, Thiene G, Paiaro S, Basso C, Zorzi A. Causes of sudden cardiac arrest and death and the diagnostic yield of sport preparticipation screening in children. Br J Sports Med 2024; 58:255-260. [PMID: 38233088 PMCID: PMC10958295 DOI: 10.1136/bjsports-2023-107357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2024] [Indexed: 01/19/2024]
Abstract
OBJECTIVE Evidence on the increased risk of sports-related sudden cardiac arrest and death (SCA/D) and the potential benefit of cardiovascular preparticipation screening (PPS) in children is limited. We assessed the burden and circumstances of SCA/D and the diagnostic yield of cardiovascular PPS in children aged 8-15 years. METHODS Data on the incidence and causes of SCA/D from 2011 to 2020 were obtained from the Veneto region (Italy) sudden death registry, hospital records and local press. During the same period, we assessed the results of annual PPS in 25 251 young competitive athletes aged 8-15 years who underwent 58 185 evaluations (mean 2.3/athlete) in Padua, Italy. RESULTS Over 10 years, 26 SCA/D occurred in children aged 8-15 years in the Veneto region: 6 in athletes (incidence 0.7/100 000/year, all ≥12 years) versus 20 in non-athletes (0.7/100 000/year, 17/20 ≥12 years). In total, 4/6 athletes versus 1/20 non-athletes survived. The cause of SCA/D remained unexplained in four athletes and in nine non-athletes. No athlete suffered SCA/D from structural diseases potentially identifiable by PPS. The incidence of SCA/D in athletes and non-athletes was 0.2/100 000/year in the 8-11 years group versus 1.3/100 000/year in the 12-15 years group. PPS identified 26 new diagnoses of cardiovascular diseases (CVDs) at risk of SCA/D, more often in children ≥12 years old (0.06%/evaluation) than <12 years old (0.02%/evaluation, p=0.02). Among athletes with a negative PPS, two suffered unexplained SCA/D during follow-up, one during exercise. CONCLUSIONS In children aged 8-15 years, the incidence of SCA/D and the yield of PPS for identifying at-risk CVD were both substantially higher in those ≥12 years, suggesting that systematic PPS may be more useful beyond this age.
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Affiliation(s)
- Francesca Graziano
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Veneto, Italy
- Department of Sports Medicine, Semmelweis University, Budapest, Hungary
| | | | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Veneto, Italy
| | | | - Monica De Gaspari
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Veneto, Italy
| | - Barbara Bauce
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Veneto, Italy
| | - Stefania Rizzo
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Veneto, Italy
| | - Chiara Calore
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Veneto, Italy
| | - Gaetano Thiene
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Veneto, Italy
| | | | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Veneto, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Veneto, Italy
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Ivonina NI, Ivonin AG, Roshchevskaya IM. Body Surface Potential Mapping during Ventricular Depolarization in Athletes with Prolonged PQ Interval after Exercise. Arq Bras Cardiol 2024; 121:e20230179. [PMID: 38451560 PMCID: PMC11081108 DOI: 10.36660/abc.20230179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 09/01/2023] [Accepted: 10/25/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Prolongation of the PQ interval, generally associated with an atrioventricular conduction delay, may be related to changes in intraventricular impulse spreading. OBJECTIVE To assess, using body surface potential mapping (BSPM), the process of ventricular depolarization in athletes with prolonged PQ intervals at rest and after exercise. METHODS The study included 7 cross-country skiers with a PQ interval of more than 200 ms (Prolonged-PQ group) and 7 with a PQ interval of less than 200 ms (Normal-PQ group). The BSPM from 64 unipolar torso leads was performed before (Pre-Ex) and after the bicycle exercise test (Post-Ex). Body surface equipotential maps were analyzed during ventricular depolarization. The significance level was 5%. RESULTS Compared to Normal-PQ athletes, the first and second periods of the stable position of cardiac potentials on the torso surface were longer, and the formation of the "saddle" potential distribution occurred later, at Pre-Ex, in Prolonged-PQ athletes. At Post-Ex, the Prolonged-PQ group showed a shortening of the first and second periods of stable potential distributions and a decrease in appearance time of the "saddle" phenomenon relative to Pre-Ex (to the values near to those of the Normal-PQ group). Additionally, at Post-Ex, the first inversion of potential distributions and the total duration of ventricular depolarization in Prolonged-PQ athletes decreased compared to Pre-Ex and with similar values in Normal-PQ athletes. Compared to Normal-PQ athletes, the second inversion was longer at Pre-Ex and Post-Ex in Prolonged-PQ athletes. CONCLUSION Prolonged-PQ athletes had significant differences in the temporal characteristics of BSPM during ventricular depolarization both at rest and after exercise as compared to Normal-PQ athletes.
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Affiliation(s)
- Natalya I. Ivonina
- Komi Science Centre of the Ural Branch of the Russian Academy of SciencesDepartment of Comparative CardiologySyktyvkarFederação RussaDepartment of Comparative Cardiology – Komi Science Centre of the Ural Branch of the Russian Academy of Sciences, Syktyvkar – Federação Russa
| | - Alexey G. Ivonin
- Komi Science Centre of the Ural Branch of the Russian Academy of SciencesDepartment of Comparative CardiologySyktyvkarFederação RussaDepartment of Comparative Cardiology – Komi Science Centre of the Ural Branch of the Russian Academy of Sciences, Syktyvkar – Federação Russa
| | - Irina M. Roshchevskaya
- Komi Science Centre of the Ural Branch of the Russian Academy of SciencesDepartment of Comparative CardiologySyktyvkarFederação RussaDepartment of Comparative Cardiology – Komi Science Centre of the Ural Branch of the Russian Academy of Sciences, Syktyvkar – Federação Russa
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8
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Petek BJ, Drezner JA, Churchill TW. The International Criteria for Electrocardiogram Interpretation in Athletes: Common Pitfalls and Future Directions. Card Electrophysiol Clin 2024; 16:35-49. [PMID: 38280813 PMCID: PMC11207195 DOI: 10.1016/j.ccep.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Preparticipation cardiovascular screening (PPCS) in young athletes is performed to detect conditions associated with sudden cardiac death. Many medical societies and sports governing bodies support the addition of a 12-lead electrocardiogram (ECG) to the history and physical to improve PPCS sensitivity. The current standard for ECG interpretation in athletes, the International Criteria, was developed to distinguish physiologic from pathologic ECG findings in athletes. Although application of the International Criteria has reduced the PPCS false-positive rate, interpretative challenges and potential areas of improvement remain. This review provides an overview of common pitfalls and future directions for ECG interpretation in athletes.
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Affiliation(s)
- Bradley J Petek
- Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA
| | - Jonathan A Drezner
- University of Washington Medical Center for Sports Cardiology, Massachusetts General Hospital, 3800 Montlake Boulevard Northeast, Box 354060, Seattle, WA 98195, USA
| | - Timothy W Churchill
- Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA.
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9
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Zapata Martínez M, Pardo Ríos M, García Alberola A, López-Picazo Ferrer J, Banacloche Cano C, Iglesias Gómez C, Pérez Gálvez MD, Fernández Redondo C, Gimeno Blanes JR. [Screening for heart disease in kids and adolescents (Prevencar Program)]. Aten Primaria 2024; 56:102782. [PMID: 37924621 PMCID: PMC10654544 DOI: 10.1016/j.aprim.2023.102782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 11/06/2023] Open
Abstract
OBJECTIVE The objective was to develop a screening for heart disease detection in primary care, to identify pathological electrocardiographic changes and underlying heart disease in adolescents. DESIGN The study was carried out for one year using multistage sampling. SITE: Primary care centers in a health area that had digital ECG equipment (12 centers) were selected. PARTICIPANTS Initially, 718 (16.6%) 14-year-old adolescents were recruited and those with a previous diagnosis of heart disease were excluded. INTERVENTIONS Screening consisted of including a health questionnaire in the mandatory 14-year-old check-up. MAIN MEASUREMENTS Screening included a questionnaire, cardiac auscultation, ECG and echocardiography. Abnormality criteria were established to refer for a second evaluation by a cardiologist. RESULTS Finally, the sample was made up of 698 adolescents, with a mean age of 13.7±0.5 years, and 354 (50.7%) were boys. A total of 149 (21.3%) were selected for a second review by cardiology: 88 (12.6%) due to a positive questionnaire, 11 (2.2%) due to abnormal cardiac auscultation, and 66 (9.5%) due to ECG findings. Adolescents with evidence of heart disease were 24 (3.4%). Of these, 14 (2.0%) had suggestive alterations and follow-up was recommended, 6 (0.9%) had a definitive diagnosis of heart disease, and 4 (0.6%) had other pathological findings related to the cardiovascular system. CONCLUSIONS The screening allowed us to identify 1% of adolescents with heart disease and another 2% will remain in follow-up. The ECG detected more pathological cases than the questionnaire.
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Affiliation(s)
- Marta Zapata Martínez
- Centro de Salud de Aljucer, Aljucer, Murcia, España; Universidad de Murcia, Murcia, España; Instituto Murciano de la Investigación Biosanitaria (IMIB), Murcia, España.
| | - Manuel Pardo Ríos
- Gerencia de Urgencias y Emergencias 061 de la Región de Murcia, Murcia, España; UCAM Universidad Católica de Murcia, Guadalupe, Murcia, España
| | - Arcadio García Alberola
- Universidad de Murcia, Murcia, España; Instituto Murciano de la Investigación Biosanitaria (IMIB), Murcia, España; Unidad Arrítmias y Electrofisiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Julio López-Picazo Ferrer
- Universidad de Murcia, Murcia, España; Instituto Murciano de la Investigación Biosanitaria (IMIB), Murcia, España; Unidad de Calidad, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | | | | | - M Dolores Pérez Gálvez
- Dirección y Gerencia, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | | | - Juan Ramón Gimeno Blanes
- Universidad de Murcia, Murcia, España; Instituto Murciano de la Investigación Biosanitaria (IMIB), Murcia, España; Unidad de Cardiopatías Familiares (CSUR- ERN Guard-Heart), Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España; CIBERCV CB16/11/00385 (ISCIII)
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10
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Pelliccia A, Drezner JA, Zorzi A, Corrado D. Prevalence and clinical significance of low QRS voltages in healthy individuals, athletes and patients with cardiomyopathy: implications for sports preparticipation cardiovascular screening. Eur J Prev Cardiol 2024:zwae027. [PMID: 38243782 DOI: 10.1093/eurjpc/zwae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/22/2023] [Accepted: 01/17/2024] [Indexed: 01/21/2024]
Abstract
Low QRS voltages (LQRSV), defined as a QRS amplitude from peak to nadir <0.5 mV in all limb leads, are an emerging diagnostic finding on the electrocardiogram (ECG). In healthy individuals and athletes, LQRSV are rare (2.2-4% of elite athletes, 0.5% of recreational athletes and 0.3% of sedentary individuals). LQRSV athletes commonly show ventricular arrhythmias (VAs) on exercise, and up to 40% of those with LQRSV and VAs have late gadolinium (LGE) on cardiac magnetic resonance (CMR). The prevalence of LQRSV in arrhythmogenic cardiomyopathy (ACM) ranges 17-40%, predicts left ventricular (LV) involvement, and is correlated with more extensive LGE replacement on CMR. In hypertrophic cardiomyopathy (HCM), LQRSV ranges 0.7% to 11%. LQRSV-HCM patients have more segments with LGE, despite relatively smaller LV mass, suggesting a more advanced clinical stage and a worse prognosis. In dilated cardiomyopathy (DCM), LQRSV range 6%-7%, but may be higher (36%) in certain genetic forms of DCM. On a follow-up, LQRSV are independently associated with incident cardiac events, such as sudden death, sustained ventricular arrhythmia, or appropriate internal cardioverter defibrillator discharge. In cardiac amyloid (CA), LQRSV range from 34% to 66% and demonstrate a negative prognostic value, with worse clinical outcomes regardless of underlying biologic, genetic, and clinical variables. In conclusion, LQRSV deserve careful consideration for exclusion of arrhythmogenic substrates in healthy individuals, athletes, and patients. While additional research is needed, it is reasonable that LQRSV should trigger clinical investigation to exclude underlying diseases at risk of life-threatening arrhythmias.
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Affiliation(s)
| | - Jonathan A Drezner
- Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
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11
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Krishnan MN, Geevar Z, Venugopal KN, Mohanan PP, Harikrishnan S, Sanjay G, Thankappan KR. Prevalence of Brugada electrocardiographic pattern in adult population - A community-based study from Kerala, South India. Indian Heart J 2024; 76:54-56. [PMID: 38211772 PMCID: PMC10943531 DOI: 10.1016/j.ihj.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 12/29/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024] Open
Abstract
There is no data for Brugada electrocardiographic pattern (BrEP) from India. In a cross-sectional study of men and women between the ages 20-79 years, electrocardiograms were analyzed following the 2002 consensus. The overall prevalence of BrEP was 1.06 % (95 % CI 0.76, 1.35). There were two cases type I (0.04 %; 95 % CI 0.01, 0.06) and forty-seven type II/III (1.01 %; 95 % CI 1.02, 1.35); the pattern was markedly higher in men. In this study, BrEP was slightly less prevalent compared to South Asia but more than in the west.
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Affiliation(s)
| | | | | | | | | | - Ganapathi Sanjay
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
| | - Kavumpurathu Raman Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum Medical College, P.O. Thiruvananthapuram, Kerala, India.
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12
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Phan PD, Tran VT, Pham MN, Mai AT, An DT, Pham HM. Electrocardiographic and genetic characteristics in first degree relatives of hypertrophic cardiomyopathy probands: A descriptive cross-sectional study from Vietnam. JRSM Cardiovasc Dis 2024; 13:20480040231220100. [PMID: 38186735 PMCID: PMC10768582 DOI: 10.1177/20480040231220100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/16/2023] [Accepted: 11/24/2023] [Indexed: 01/09/2024] Open
Abstract
Objectives In order to study the phenotype-genotype relationship and to better understand the early consequences of the mutation, we would report the spectrum of electrocardiographic and genetic features in the relatives of hypertrophic cardiomyopathy (HCM) patients. Methods Participants underwent a comprehensive clinical assessment, electrocardiography, standardized and echocardiography and genetic testing. In probands, next-generation sequencing was performed using the gene panel associated with HCM, while in relatives, Sanger sequencing was used to screen for mutations identified in their individual probands. Results A total of 84 participants were included in this study. The interventricular septal and posterior wall thickness was highest in the G+/LVH+ group, followed by the G+/LVH- group, and was lowest in G-/LVH- group. Compared to the normal control group, the pathologic Q wave was statistically more prevalent in the G+/LVH- group. The prevalence of repolarization abnormalities and major abnormalities was highest in the G+/LVH+ group, followed by the G+/LVH- group, and lowest in G-/LVH- group. Conclusion Our results suggested that sarcomere mutations have early consequences on myocardial biology. These findings suggest the possibility of implementing a mutation carrier detection model within families affected by HCM, where ECG could play a central role when combined with other relevant clinical factors. Longitudinal studies on a cohort of G+/LVH- patients are required.
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Affiliation(s)
- Phong Dinh Phan
- Hanoi Medical University, Hanoi, Vietnam
- Vietnam National Heart Institute, Hanoi, Vietnam
| | - Viet Tuan Tran
- Hanoi Medical University, Hanoi, Vietnam
- Vietnam National Heart Institute, Hanoi, Vietnam
| | - Minh Nhat Pham
- Hanoi Medical University, Hanoi, Vietnam
- Vietnam National Heart Institute, Hanoi, Vietnam
| | | | | | - Hung Manh Pham
- Hanoi Medical University, Hanoi, Vietnam
- Vietnam National Heart Institute, Hanoi, Vietnam
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13
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Bondarev S, Achkasov E, Zorzi A, Safaryan A, Graziano F, Sizov A. Intrinsic Sinus Node/Atrioventricular Node Dysfunction Requiring Pacemaker Implantation: Role of Former Professional Sport Activity. J Clin Med 2023; 13:203. [PMID: 38202210 PMCID: PMC10779911 DOI: 10.3390/jcm13010203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/24/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Sinus bradycardia and first degree or second degree Mobitz type I atrioventricular (AV) block in an athlete are considered adaptive and reversible phenomena; however, some evidence suggests that they may persist after detraining and become pathological. The aim of the study was to investigate the characteristics of a group of former professional athletes who required pacemaker (PM) implantation for intrinsic (idiopathic) sinus node (SN) dysfunction or AV block in comparison to control groups of sedentary individuals. METHODS We included all patients who underwent PM implantation during 2022. Three groups were compared: group 1 including 18 former professional athletes who received a PM for SN dysfunction/AV block in the absence of heart disease; group 2 including the first 20 sedentary individuals without heart disease who underwent PM implantation; and group 3 including all other 323 patients who received PM, the majority with underlying heart diseases. RESULTS Compared to the non-athlete control group 2, the mean age at diagnosis and at the time of PM implantation of former professional athletes did not show statistically significant differences. However, subgroup analysis revealed significant differences depending on the type of sports discipline: the age at diagnosis and at PM implantation was significantly lower in former endurance athletes than former strength/mixed athletes, control non-athletes, and all other patients. Moreover, former endurance professional athletes exhibited a higher prevalence of second or third degree AV block (78%) as the reason for PM implantation compared to power/mixed athletes (44%). The other clinical characteristics, including echocardiographic parameters, did not differ between former athletes and non-athletes. CONCLUSIONS Former professional endurance athletes with idiopathic SN dysfunction/AV block manifested the disease earlier in the life course compared to former power/mixed athletes and non-athletes. This suggests that bradycardia/AV block caused by intense and prolonged endurance sports may not always be benign and adaptive phenomena.
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Affiliation(s)
- Sergei Bondarev
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (S.B.)
| | - Evgeny Achkasov
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (S.B.)
| | - Alexandr Safaryan
- Department of Sports Medicine and Medical Rehabilitation, Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Francesca Graziano
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy; (S.B.)
| | - Alexey Sizov
- Cardiology Department, St. Alexius Hospital, 119071 Moscow, Russia
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14
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Orchard JJ, Orchard JW, Davis AJ, Puranik R, Isbister JC, La Gerche A, Driscoll T, Doughty RN, Hamilton B. Clinical outcomes of 10 years of cardiac screening in elite New Zealand athletes. J Sci Med Sport 2023; 26:659-666. [PMID: 37932202 DOI: 10.1016/j.jsams.2023.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To report findings from the High Performance Sport New Zealand cardiac screening programme, including comparisons between sexes and ethnicities. DESIGN Retrospective cohort study. METHODS Elite Olympic-sport athletes were screened (2012-2022) with personal/family history, physical examination, resting 12-lead ECG and followed from the date of first screening until July 2022. An audit reviewed screening records, including demographic data, ECGs, follow-up and diagnoses. Flagged/equivocal ECGs were re-reviewed (International Criteria). RESULTS 2075 ECGs from 1189 athletes (53 % female, mean age 21 years; 83 % European, 9 % Māori, 5 % Pacific Islander, 3 % other) were included. No athletes retired for cardiac reasons; there were no cardiac deaths or major cardiac incidents (mean follow-up from first screening: 6.1 years (range: 0.6-10.9 years)). Diagnoses included Wolff-Parkinson-White (WPW) syndrome (0.7 %) and cardiomyopathies (0.3 %). Overall, 3.5 % of ECGs were abnormal, with ECGs of females more commonly abnormal (4.4 % vs 2.5 %, p = 0.02) and with a higher proportion of ECGs with abnormal T-wave inversion (TWI) (3.1 % vs 0.9 %, p < 0.001) compared to males. Of the abnormal TWI in females (all aged ≥16 years), 47 % was limited to V1-V3 with no other abnormalities. Abnormality rates were similar between Māori, Pacific Islander and European athlete ECGs. CONCLUSIONS WPW was the most frequent diagnosis, with very little cardiomyopathy found. The proportion of abnormal ECGs was low overall, but higher in females. This was driven by anterior TWI in V1-V3 which was not associated with diagnoses of conditions associated with sudden cardiac death (SCD). There was no difference in the proportion of abnormal ECGs of Māori or Pacific Island athletes compared to European athletes.
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Affiliation(s)
- Jessica J Orchard
- Sydney School of Public Health, Faculty of Medicine & Health, The University of Sydney, Australia. https://twitter.com/jessicajorchard
| | - John W Orchard
- Sydney School of Public Health, Faculty of Medicine & Health, The University of Sydney, Australia. https://twitter.com/DrJohnOrchard
| | - Angus J Davis
- Sydney School of Public Health, Faculty of Medicine & Health, The University of Sydney, Australia. https://twitter.com/AngusDavis6
| | - Rajesh Puranik
- Faculty of Medicine & Health, The University of Sydney, Australia
| | - Julia C Isbister
- Sydney School of Public Health, Faculty of Medicine & Health, The University of Sydney, Australia. https://twitter.com/JuliaIsbister
| | - Andre La Gerche
- Baker Heart & Diabetes Institute, Australia; National Centre for Sports Cardiology, Australia. https://twitter.com/ALaGerche
| | - Tim Driscoll
- Sydney School of Public Health, Faculty of Medicine & Health, The University of Sydney, Australia
| | - Robert N Doughty
- University of Auckland, New Zealand; The Heart Group, New Zealand
| | - Bruce Hamilton
- High Performance Sport New Zealand, New Zealand; Sport Research Institute of New Zealand, Auckland University of Technology, New Zealand.
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15
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Idiazabal-Ayesa U, Ramírez-Vélez R, Sanz-de la Garza M, Izquierdo M. Electrocardiographic findings in pediatric versus young-adolescent athletes: A comparative analysis using general international criteria. Int J Cardiol 2023; 390:131201. [PMID: 37482093 DOI: 10.1016/j.ijcard.2023.131201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The inclusion of electrocardiogram (ECG) in medical examinations for sports practice serves as a valuable tool for identifying potential life-threatening conditions during physical exercise. However, its applicability in young individuals remains a subject of controversy, primarily due to relatively high rates of false positives and the associated costs of further investigations. Furthermore, the validation of International Criteria for athletes below 12 years of age in optimizing pre-participation screening for young athletes is yet to be established. In light of these considerations, this study aims to describe the prevalence of ECG findings in a sample of children and young-adolescent athletes aged 11-16 years, employing refined Seattle interpretation criteria. Additionally, we seek to compare these findings based on age group and sex. METHODS This was a retrospective and observational study of 3747 athletes 11-16 year-olds. Evaluation included interviewer-administered questionnaires for relevant history, physical examination and resting 12 - lead ECG for each participant. The primary outcome measure was abnormal ECG findings according to the International Recommendations for Electrocardiographic Interpretation in Athletes. RESULTS Among the evaluated population of pediatric and young adolescent athletes (77.5% boys; >99% Caucasian), the vast majority exhibited normal electrocardiogram (ECG) results, with adaptive findings related to sports participation being more frequent among young adolescents and males. The presence of significant ECG abnormalities in young-adolescent athletes was uncommon (2.05%; 1.92% children and 2.32% young-adolescent) and required additional examinations. 0.27% of the total population were diagnosed with a previously unknown cardiac pathology only through the ECG. CONCLUSIONS This study provides valuable insights into the prevalence of normal, borderline, and abnormal electrocardiogram (ECG) findings in a large population of pediatric and young-adolescent athletes. These findings serve as guidance in detecting potentially serious cardiac alterations within this specific group, considering variations based on age and sex. The study confirms that ECG screening is a useful tool for identifying cardiac abnormalities in pediatric and young-adolescent athletes, even though the prevalence of significant findings in this population is relatively low. Furthermore, our findings support the utilization of the refined Seattle criteria as a sensitive and specific technique for screening pediatric and young-adolescent athletes, further enhancing the accuracy of ECG-based evaluations.
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Affiliation(s)
- Uxua Idiazabal-Ayesa
- Servicio de Cardiología y Medicina Interna, Hospital García Orcoyen, Estella, Navarra, Spain; Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - María Sanz-de la Garza
- Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain; CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
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16
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Korotkikh AV, Vakhnenko YV, Kashtanov MG. Some Topical Aspects of the "Sports Heart" Problem. Literature Review. Part 2. Curr Probl Cardiol 2023; 48:101921. [PMID: 37394208 DOI: 10.1016/j.cpcardiol.2023.101921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/04/2023]
Abstract
Electrocardiography occupies a special place among a significant list of other methods for diagnosing the pathology of the cardiovascular system of athletes. Often its results differ significantly from those in the general population, being a consequence of the adaptation of the heart to economical functioning at rest and super-intensive work in training and competitions. This review focuses on the features of the "athlete's electrocardiogram (ECG)." In particular, those changes that are not a reason for removing athletes from physical activity, but in combination with known factors can lead to more serious changes up to sudden cardiac death. Fatal rhythm disorders in athletes are described, possible in Wolff-Parkinson-White syndrome, syndrome of ion channel pathology, arrhythmogenic dysplasia of the right ventricle, etc. Particular attention is paid to arrhythmia due to connective tissue dysplasia syndrome. Knowledge of these issues is necessary to choose the right tactics for an athlete with changes to the electrocardiogram and in the protocol of daily Holter monitoring of the electrocardiogram, and a doctor related to sports medicine should be aware of the features of "electrophysiological remodeling" of the athlete's heart, normal and pathological "sports electrocardiogram," about conditions accompanied with the development of serious rhythm disorders and algorithms for examining the cardiovascular system of the athlete.
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Affiliation(s)
| | | | - Maksim Gennadievich Kashtanov
- Ural Federal University, Experimental Laboratory, Ekaterinburg, Russia; Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Catheterization Laboratory, Tomsk, Russia; Sverdlovsk Regional Hospital No.1, Catheterization Laboratory, Ekaterinburg, Russia
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17
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Kırık ABT, Yüksel O, Dursun H, Çöllüoğlu İT, Kocahan T, Kaya D. Visual or computer-based measurements: Which is important for the interpretation of an athlete's electrocardiography? REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230476. [PMID: 37909616 PMCID: PMC10610756 DOI: 10.1590/1806-9282.20230476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/22/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Preparticipation screening of athletes by electrocardiography is the most crucial step in determining sudden cardiac death risk factors. Several electrocardiography interpretation software programs have been developed for physicians practicing in this field. Our study aimed to assess cardiopoint sudden death screening module by comparing its findings with two cardiologists using Seattle and International criteria. METHODS A total of 303 licensed national athletes (37% females) were enrolled. electrocardiographies were examined by the cardiopoint sudden death screening module using Seattle criteria and cardiologists. The consistency between cardiologists and software was compared, and the confidence assessment of the module was tested. RESULTS With regard to Seattle criteria, moderate consistency was found between the cardiopoint sudden death screening module and the 1st (κ=0.41) and 2nd cardiologist (κ=0.59). Consistency between two cardiologists was moderate (κ=0.55). When we applied International criteria, there was moderate consistency between the module and the 1st cardiologist (κ=0.42), and good consistency between the module and the 2nd cardiologist (κ=0.63). Consistency between the two cardiologists was good (κ=0.62). CONCLUSION The cardiopoint sudden death screening module had similar agreement with cardiologists based on both criteria. However, the software needs to be updated according to International criteria. Using computer-based measurements for preparticipation screening will help to save time and provide standardization of electrocardiography interpretation.
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Affiliation(s)
| | - Oğuz Yüksel
- Dokuz Eylül University, Faculty of Medicine, Department of Sports Medicine – İzmir, Turkey
| | - Hüseyin Dursun
- Dokuz Eylül University, Faculty of Medicine, Department of Cardiology – İzmir, Turkey
| | - İnci Tuğçe Çöllüoğlu
- Karabük University Education and Research Hospital, Department of Cardiology – Karabük, Turkey
| | - Tuğba Kocahan
- University of Health Sciences Gülhane Training and Research Hospital, Department of Sports Medicine – Ankara, Turkey
| | - Dayimi Kaya
- Dokuz Eylül University, Faculty of Medicine, Department of Cardiology – İzmir, Turkey
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18
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Goff NK, Hutchinson A, Koek W, Kamat D. Meta-analysis on the Effectiveness of ECG Screening for Conditions Related to Sudden Cardiac Death in Young Athletes. Clin Pediatr (Phila) 2023; 62:1158-1168. [PMID: 36797841 PMCID: PMC10478328 DOI: 10.1177/00099228231152857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Controversy exists over the use of electrocardiograms (ECGs) in sports pre-participation screening. We performed a meta-analysis comparing the effectiveness of history and physical examination (H&P) with ECG at detecting both cardiac disease and sudden cardiac death-associated conditions (SCD-AC). Pre-participation studies published from 2015 to 2020 with athletes 10 to 35 years old were included. This yielded 28 011 athletes screened and 124 cardiac diagnoses, 103 of which were SCD-AC. A meta-analysis of log odds ratios (ORs) was conducted using a random-effects model. The ORs for the association between H&P and detecting both cardiac disease and SCD-AC were not statistically significant (OR = 3.4, P = .076; OR = 2.9, P = .078). The ORs for the association between ECG and detecting both cardiac disease and SCD-AC were statistically significant (60, P < .001; 148, P < .0001). In conclusion, the odds of detecting both cardiac disease and conditions related to SCD with ECG are greater than with H&P during sports pre-participation screening.
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Affiliation(s)
- Nicolas K. Goff
- Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | | | - Wouter Koek
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Deepak Kamat
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Corrado D, Trovato D, Zorzi A. Long QT Syndrome: A Preventable Cause of Exercise-Induced Sudden Cardiac Death. JACC Case Rep 2023; 22:101991. [PMID: 37790770 PMCID: PMC10544427 DOI: 10.1016/j.jaccas.2023.101991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Affiliation(s)
- Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | | | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
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20
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Malik A, Hanson J, Han J, Dolezal B, Bradfield JS, Boyle NG, Hsu JJ. Sudden cardiac arrest in athletes and strategies to optimize preparedness. Clin Cardiol 2023; 46:1059-1071. [PMID: 37493125 PMCID: PMC10540019 DOI: 10.1002/clc.24095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/07/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023] Open
Abstract
Sudden cardiac arrest (SCA) is the leading cause of death in young athletes. Despite efforts to improve preparedness for cardiac emergencies, the incidence of out-of-hospital cardiac arrests in athletes remains high, and bystander awareness and readiness for SCA support are inadequate. Initiatives such as designing an emergency action plan (EAP) and mandating training in cardiopulmonary resuscitation (CPR) and automated external defibrillator use (AED) for team members and personnel can contribute to improved survival rates in SCA cases. This review provides an overview of SCA in athletes, focusing on identifying populations at the highest risk and evaluating the effectiveness of different screening practices in detecting conditions that may lead to SCA. We summarize current practices and recommendations for improving the response to SCA events, and we highlight the need for ongoing efforts to optimize preparedness through the implementation of EAPs and the training of individuals in CPR and AED use. Additionally, we propose a call to action to increase awareness and training in EAP development, CPR, and AED use for team members and personnel. To improve outcomes of SCA cases in athletes, it is crucial to enhance bystander awareness and preparedness for cardiac emergencies. Implementing EAPs and providing training in CPR and AED use for team members and personnel are essential steps toward improving survival rates in SCA cases.
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Affiliation(s)
- Aneeq Malik
- Department of MedicineOlive View‐UCLA Medical CenterLos AngelesCaliforniaUSA
| | - Justin Hanson
- Department of Medicine, Division of CardiologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Janet Han
- Department of Medicine, Division of CardiologyVeterans Affairs Greater Los Angeles Healthcare System and UCLALos AngelesCaliforniaUSA
| | - Brett Dolezal
- Exercise Physiology Research Laboratory, Departments of Medicine and PhysiologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Jason S. Bradfield
- UCLA Cardiac Arrhythmia CenterDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Noel G. Boyle
- UCLA Cardiac Arrhythmia CenterDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Jeffrey J. Hsu
- Department of Medicine, Division of CardiologyDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
- Department of Medicine, Division of CardiologyVeterans Affairs Greater Los Angeles Healthcare System and UCLALos AngelesCaliforniaUSA
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Kurtoğlu A, Kurtoğlu E, Akgümüş A, Çar B, Eken Ö, Sârbu I, Ciongradi CI, Alexe DI, Candussi IL. Evaluation of electrocardiographic parameters in amputee football players. Front Psychol 2023; 14:1189712. [PMID: 37554132 PMCID: PMC10405824 DOI: 10.3389/fpsyg.2023.1189712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/17/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE The present study aimed to compare electrocardiographic (ECG) parameters of amputee football players (AF) with football players without disability (FP) and sedentary individuals without disability (SI). METHODS A total of 32 participants (AF = 9, FP = 11, SI = 12) were included in the study. ECG parameters including P-wave amplitude, P-wave duration, PR interval, QRS duration, RR interval, QT interval, corrected-QT interval (QTc), ST segment duration, Tp-e duration, Tp-e/QT and Tp-e/QTc ratios were assessed in all the study participants by using a 12-lead ECG device. OneWay ANOVA Test was used for statistical analysis. RESULTS Of all ECG parameters, P-wave amplitude and QTc were significantly higher in the AF group in comparison to FP and SI groups. QRS duration was found to be lower in the AF group when compared to FP and SI groups. Myocardial repolarization parameters including Tp-e duration, Tp-e/QT and Tp-e/QTc ratios were similar between groups, as were other parameters such as P-wave duration, PR interval, RR interval, QRS duration and QT interval. CONCLUSION It was found that some ECG parameters of amputee football players differ from those with non-disabled players and non-disabled sedentary individuals. These different parameters were within normal limits.
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Affiliation(s)
- Ahmet Kurtoğlu
- Department of Coaching Education, Faculty of Sport Science, Bandirma Onyedi Eylul University, Balikesir, Türkiye
| | - Ertuğrul Kurtoğlu
- Department of Cardiology, Medical Faculty, Malatya Turgut Ozal University, Malatya, Türkiye
| | - Alkame Akgümüş
- Department of Cardiology, Medical Faculty, Bandirma Onyedi Eylul University, Balikesir, Türkiye
| | - Bekir Çar
- Department of Physical Education and Sport Teaching, Faculty of Sport Sciences, Bandirma Onyedi Eylul University, Balikesir, Türkiye
| | - Özgür Eken
- Department of Physical Education and Sport Teaching, Faculty of Sport Sciences, Inonu University, Malatya, Türkiye
| | - Ioan Sârbu
- Second Department of Surgery—Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, Iași, Romania
| | - Carmen Iulia Ciongradi
- Second Department of Surgery—Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy Iasi, Iași, Romania
| | - Dan Iulian Alexe
- Department of Physical and Occupational Therapy, Faculty of Movement, Sports and Health, Sciences, “Vasile Alecsandri” University of Bacau, Bacau, Romania
| | - Iuliana Laura Candussi
- Clinical Surgery Department, Faculty of Medicine and Pharmacy, “Dunărea de Jos” University, Galați, Romania
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22
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Major Z, Medvegy Z, Tulit TT, Simonyi G, Pavlik G, Medvegy M. [Analysis of sudden cardiac death in competitive athletes, possibilities for reducing cases]. Orv Hetil 2023; 164:1155-1163. [PMID: 37481770 DOI: 10.1556/650.2023.32806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/02/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Sudden cardiac death in athletes is rare (0.5 to 1 per 100 000 athlete years), but sudden cardiac death in known athletes causes general shock. OBJECTIVE Our research aim was to collect and study as many sudden cardiac death cases as possible, judge the role of stress and look for ways to reduce fatal tragedies. METHOD From registers and newspaper articles found on the Internet, we collected 360 (including 14 women) athletes' sudden cardiac death cases where the sport, age and place of death (during training/competition/after) could be determined. From these, a single database has been prepared in order of the year of death. The cases were grouped and analyzed by sports. Based on our results and literature data, we made recommendations to reduce fatalities. RESULTS AND CONCLUSION There were more sudden cardiac deaths in competitions than in trainings (239 vs. 99), but tragedies also happened during warm-ups and chess without physical exertion, furthermore, there was no sudden cardiac death in the stakeless training of marathon/half marathon/triathlon athletes; all these prove the role of stress, so we recommend a psychological conversation before a high-stakes race. There were also a lot of sudden cardiac deaths (79/360) during team sports trainings, so we recommend reanimation readiness there as well. After training/competition, sudden cardiac death happened mainly in sports requiring high static effort, where post-competition monitoring is also recommended. Those who died in training were younger than those who died during the race (p<0.01), so young people should be monitored more closely for medical and (under)fitness. Marathon runners and triathletes were older than team athletes (p<0.005) and only died in competition, so for them a basic examination and an ECG within 1 month before competition are recommended. Conclusions drawn from literature data: sports medicine examination should be standardized and documented in an accessible way; since resuscitation started earlier and professionally is more effective, all competitors should receive reanimation training. Orv Hetil. 2023; 164(29): 1155-1163.
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Affiliation(s)
| | - Zoltán Medvegy
- 2 Magyar Testnevelési és Sporttudományi Egyetem Budapest Magyarország
| | - Tímea Terézia Tulit
- 3 Kistarcsai Flór Ferenc Kórház, Kardiológiai Osztály Kistarcsa Magyarország
| | - Gábor Simonyi
- 4 Dél-budai Centrumkórház - Szent Imre Egyetemi Oktatókórház, Anyagcsere Központ Budapest Magyarország
| | - Gábor Pavlik
- 2 Magyar Testnevelési és Sporttudományi Egyetem Budapest Magyarország
| | - Mihály Medvegy
- 3 Kistarcsai Flór Ferenc Kórház, Kardiológiai Osztály Kistarcsa Magyarország
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23
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Cuenza L, Cheong AP, Yeo TJ. Improving electrocardiogram interpretation in Asian athletes: A call to action. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:225-227. [PMID: 38904518 DOI: 10.47102/annals-acadmedsg.2023110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Affiliation(s)
- Lucky Cuenza
- ManilaMed Sports and Exercise Medicine Centre, Manila, Philippines
- Cardinal Santos Medical Center Sports Medicine Institute: The MVP Clinic, Manila, Philippines
| | | | - Tee Joo Yeo
- Department of Cardiology, National University Heart Centre, Singapore
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24
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Lim B, Lim B, Hamzah F, Lim AT, Ng CS, Tan B, Tong KL. Comparison of four electrocardiographic criteria for the detection of cardiac abnormalities in Singapore athletes. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:230-238. [PMID: 38904520 DOI: 10.47102/annals-acadmedsg.2022191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Introduction Sudden cardiac death in athletes is a rare occurrence, the most common cause being hypertrophic cardiomyopathy, which increases the risk of sustained ventricular tachycardia or ventricular fibrillation. Most of these young athletes are asymptomatic prior to the cardiac arrest. Several electrocardiogram criteria such as the European Society of Cardiology group 2 Criteria changes, Seattle Criteria, Refined Criteria, and most recently the 2017 International Criteria, have sought to improve the accuracy of identifying these at-risk athletes during pre-participation screening while minimising unnecessary investigations for the majority of athletes at low risk.We aimed to compare the above four criteria in our Singapore athlete population to identify which criterion performed the best in detecting cardiac abnormalities on echocardiography. Method Out of 1,515 athletes included in Changi General Hospital, Singapore registry between June 2007 and June 2014, the electrocardiograms of 270 athletes with further cardiac investigations were analysed. We compared the above four electrocardiographic criteria to evaluate which performed best for detecting cardiac abnormalities on echocardiography in our Southeast Asian athlete population. Results The European Society of Cardiology, Seattle, Refined and 2017 International Criteria had a sensitivity of 20%, 0%, 20% and 5%, respectively; a specificity of 64%, 93%, 84% and 97%, respectively; a positive predictive value of 4%, 0%, 9% and 11%, respectively; and a negative predictive value of 91%, 92%, 93% and 93%, respectively for detecting abnormalities on echocardiography. Conclusion The latest 2017 International Criteria performed the best as it had the highest specificity and positive predictive value, joint highest negative predictive value, and lowest false positive rate.
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Affiliation(s)
- Benji Lim
- Department of Cardiology, Changi General Hospital, Singapore
| | - Baoying Lim
- Department of Sport and Exercise Medicine, Changi General Hospital, Singapore
| | - Fadzil Hamzah
- Department of Sport and Exercise Medicine, Changi General Hospital, Singapore
| | - Ang Tee Lim
- Department of Sport and Exercise Medicine, Changi General Hospital, Singapore
| | - Chung Sien Ng
- Department of Sport and Exercise Medicine, Changi General Hospital, Singapore
| | - Benedict Tan
- Department of Sport and Exercise Medicine, Changi General Hospital, Singapore
| | - Khim Leng Tong
- Department of Cardiology, Changi General Hospital, Singapore
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25
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Stein R, Ferrari F, da Silveira AD. Electrocardiogram of Brazilian Elite Football Players: Filling a Gap. Arq Bras Cardiol 2023; 120:e20230090. [PMID: 37132672 PMCID: PMC10263416 DOI: 10.36660/abc.20230090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Affiliation(s)
- Ricardo Stein
- Programa de Pós-Graduação em Cardiologia e Ciências CardiovascularesUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasilPrograma de Pós-Graduação em Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS – Brasil
- Grupo de Pesquisa em Cardiologia do ExercícioHospital de Clínicas de Porto AlegrePorto AlegreRSBrasilGrupo de Pesquisa em Cardiologia do Exercício do Hospital de Clínicas de Porto Alegre (CardioEx-HCPA), Porto Alegre, RS – Brasil
- Departamento de Clínica MédicaUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasilDepartamento de Clínica Médica da Universidade Federal do Rio Grande do Sul, Porto Alegre, RS – Brasil
| | - Filipe Ferrari
- Programa de Pós-Graduação em Cardiologia e Ciências CardiovascularesUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasilPrograma de Pós-Graduação em Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS – Brasil
- Grupo de Pesquisa em Cardiologia do ExercícioHospital de Clínicas de Porto AlegrePorto AlegreRSBrasilGrupo de Pesquisa em Cardiologia do Exercício do Hospital de Clínicas de Porto Alegre (CardioEx-HCPA), Porto Alegre, RS – Brasil
| | - Anderson Donelli da Silveira
- Programa de Pós-Graduação em Cardiologia e Ciências CardiovascularesUniversidade Federal do Rio Grande do SulPorto AlegreRSBrasilPrograma de Pós-Graduação em Cardiologia e Ciências Cardiovasculares, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS – Brasil
- Grupo de Pesquisa em Cardiologia do ExercícioHospital de Clínicas de Porto AlegrePorto AlegreRSBrasilGrupo de Pesquisa em Cardiologia do Exercício do Hospital de Clínicas de Porto Alegre (CardioEx-HCPA), Porto Alegre, RS – Brasil
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26
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Sarto P, Zorzi A, Merlo L, Vessella T, Pegoraro C, Giorgiano F, Graziano F, Basso C, Drezner JA, Corrado D. Value of screening for the risk of sudden cardiac death in young competitive athletes. Eur Heart J 2023; 44:1084-1092. [PMID: 36760222 PMCID: PMC10027466 DOI: 10.1093/eurheartj/ehad017] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 11/17/2022] [Accepted: 01/05/2023] [Indexed: 02/11/2023] Open
Abstract
AIMS This study aimed to report the long-term findings of the Italian programme of cardiovascular preparticipation screening (PPS) in young, competitive athletes. METHODS AND RESULTS The study assessed the diagnostic yield for diseases at risk of sudden cardiac death (SCD), the costs of serial evaluations, and the long-term outcomes of PPS in a large population of Italian children (age range, 7-18 years). The PPS was repeated annually and included medical history, physical examination, resting electrocardiogram, and stress testing; additional tests were reserved for athletes with abnormal findings. Over an 11-year study period, 22 324 consecutive children [62% males; mean age, 12 (interquartile range, 10-14) years at first screening] underwent a total of 65 397 annual evaluations (median 2.9/child). Cardiovascular diseases at risk of SCD were identified in 69 children (0.3%) and included congenital heart diseases (n = 17), channelopathies (n = 14), cardiomyopathies (n = 15), non-ischaemic left ventricular scar with ventricular arrhythmias (n = 18), and others (n = 5). At-risk cardiovascular diseases were identified over the entire age range and more frequently in children ≥12 years old (n = 63, 91%) and on repeat evaluation (n = 44, 64%). The estimated cost per diagnosis was 73 312€. During a follow-up of 7.5 ± 3.7 years, one child with normal PPS findings experienced an episode of resuscitated cardiac arrest during sports activity (event rate of 0.6/100.000 athletes/year). CONCLUSION The PPS programme led to the identification of cardiovascular diseases at risk of SCD over the whole study age range of children and more often on repeat evaluations. Among screened children, the incidence of sport-related cardiac arrest during long-term follow-up was low.
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Affiliation(s)
- Patrizio Sarto
- Sports Medicine Unit regional referral center for exercise prescription in young patients with heart diseases, AULSS 2, Via Castellana, 2, 31100 Treviso, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via n. Giustiniani 2, 35121 Padova, Italy
| | - Laura Merlo
- Sports Medicine Unit regional referral center for exercise prescription in young patients with heart diseases, AULSS 2, Via Castellana, 2, 31100 Treviso, Italy
| | - Teresina Vessella
- Sports Medicine Unit regional referral center for exercise prescription in young patients with heart diseases, AULSS 2, Via Castellana, 2, 31100 Treviso, Italy
| | - Cinzia Pegoraro
- Sports Medicine Unit regional referral center for exercise prescription in young patients with heart diseases, AULSS 2, Via Castellana, 2, 31100 Treviso, Italy
| | - Flaviano Giorgiano
- Sports Medicine Unit regional referral center for exercise prescription in young patients with heart diseases, AULSS 2, Via Castellana, 2, 31100 Treviso, Italy
| | - Francesca Graziano
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via n. Giustiniani 2, 35121 Padova, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via n. Giustiniani 2, 35121 Padova, Italy
| | - Jonathan A Drezner
- Center for Sports Cardiology, University of Washington, 3800 Montlake Blvd NE, Box 354060, Seattle, WA 98195, USA
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via n. Giustiniani 2, 35121 Padova, Italy
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27
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Petek BJ, Drezner JA, Churchill TW. The International Criteria for Electrocardiogram Interpretation in Athletes: Common Pitfalls and Future Directions. Cardiol Clin 2023; 41:35-49. [PMID: 36368810 PMCID: PMC10292923 DOI: 10.1016/j.ccl.2022.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Preparticipation cardiovascular screening (PPCS) in young athletes is performed to detect conditions associated with sudden cardiac death. Many medical societies and sports governing bodies support the addition of a 12-lead electrocardiogram (ECG) to the history and physical to improve PPCS sensitivity. The current standard for ECG interpretation in athletes, the International Criteria, was developed to distinguish physiologic from pathologic ECG findings in athletes. Although application of the International Criteria has reduced the PPCS false-positive rate, interpretative challenges and potential areas of improvement remain. This review provides an overview of common pitfalls and future directions for ECG interpretation in athletes.
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Affiliation(s)
- Bradley J Petek
- Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA
| | - Jonathan A Drezner
- University of Washington Medical Center for Sports Cardiology, Massachusetts General Hospital, 3800 Montlake Boulevard Northeast, Box 354060, Seattle, WA 98195, USA
| | - Timothy W Churchill
- Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Yawkey Suite 5B, 55 Fruit Street, Boston, MA 02114, USA.
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28
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Corrado D, Zorzi A. Sports cardiology: An emerging discipline and research field. Int J Cardiol 2023; 370:472-475. [PMID: 36216091 DOI: 10.1016/j.ijcard.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Science and Public Health, University of Padua, Italy.
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Science and Public Health, University of Padua, Italy
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29
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Ujeyl A, Niederseer D. [The athlete's ECG : What is normal or abnormal?]. Herzschrittmacherther Elektrophysiol 2023; 34:10-18. [PMID: 36670183 PMCID: PMC9950162 DOI: 10.1007/s00399-022-00917-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/12/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND The electrocardiogram (ECG) has become a mobile and cost-effective routine assessment tool to risk stratify leisure-time and professional athletes during preparticipation screening. A central goal is the reduction of sudden cardiac death in sports through early recognition of the most prevalent underlying cardiac pathologies, e.g., hereditary cardiomyopathies or primary arrhythmias. METHODS Continuous evolution of the first ECG criteria for athletes, presented in 2010 by the European Society of Cardiology (ESC), has helped to improve the specificity of the criteria to both detect cardiac pathologies in early stages and differentiate from physiologic adaptation of the athlete's heart. Thus, the risk of false-positive findings and erroneous stigmatizations of athletes has been successfully reduced. CONCLUSION This review article intends to trace back the changes of the ECG criteria in the light of a growing body of scientific evidence over the last 15 years, to present the key messages of the current International ECG criteria from 2017 and to identify some of the remaining challenges that wait to be answered by physicians in the field of sports medicine and sports cardiology.
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Affiliation(s)
- Amaar Ujeyl
- Praxis LANS Cardio, Hamburg, Deutschland ,grid.264200.20000 0000 8546 682XMSc Sports Cardiology, St. George’s University of London, London, Großbritannien
| | - David Niederseer
- Klinik für Kardiologie, Universitäres Herzzentrum Zürich, Universitätsspital Zürich, Universität Zürich, Rämistrasse 100, Zürich, 8091, Schweiz.
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30
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Lim DYZ, Ho WHH, Wang L, Ang WK, Thiagarajan N, Sng GGR, Wang H, Loo WTW, Yang LH, Chow W, Chua TJ, Yeo TJ, Lim P, Chong TTD. Wolff-Parkinson-White Presenting as QRS Alternans and Other Differential Diagnoses in a Large Pre-Participation ECG Screening Cohort. Arq Bras Cardiol 2022; 119:940-945. [PMID: 36417617 PMCID: PMC9814817 DOI: 10.36660/abc.20220081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Wolff-Parkinson-White (WPW) syndrome is a proarrhythmic condition that may require restriction from strenuous activities and is characterized by ECG signs, including delta waves. We observed cases of intermittent WPW patterns presenting as QRS alternans ('WPW alternans') in a large pre-participation ECG screening cohort of young men reporting for military conscription. OBJECTIVES We aimed to determine the WPW alternans pattern, case characteristics, and the prevalence of other relevant differential diagnoses presenting as QRS alternans in a pre-participation setting. METHODS One hundred twenty-five thousand one hundred fifty-eight prospective male military recruits were reviewed from January 2016 to December 2019. A review of electronic medical records identified cases of WPW alternans and WPW patterns or syndrome. Reviewing electronic medical records identified cases of relevant differential diagnoses that might cause QRS alternans. RESULTS Four individuals (2.2%) had WPW alternans out of 184 individuals with a final diagnosis of WPW pattern or syndrome. Two of these individuals manifested symptoms or ECG findings consistent with supraventricular tachycardia. The overall prevalence of WPW alternans was 0.003%, and the prevalence of WPW was 0.147%. WPW alternans represented 8.7% of individuals presenting with QRS alternans, and QRS alternans had a prevalence of 0.037% in the entire population. CONCLUSIONS WPW alternans is a variant of intermittent WPW, which comprised 2.2% of WPW cases in our pre-participation screening cohort. It does not necessarily indicate a low risk for supraventricular tachycardia. It must be recognized at ECG screening and distinguished from other pathologies that also present with QRS alternans.
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Affiliation(s)
- Daniel Y. Z. Lim
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura
| | - Wilbert H. H. Ho
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura
| | - Luokai Wang
- HQ Medical CorpsSingapore Armed ForcesCingapuraHQ Medical Corps, Singapore Armed Forces, Cingapura,Department of CardiologyNational Heart Centre SingaporeCingapuraDepartment of Cardiology, National Heart Centre Singapore, Cingapura
| | - Wee Kiat Ang
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura
| | - Nishanth Thiagarajan
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura
| | - Gerald GR Sng
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura
| | - Hankun Wang
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura
| | - Wesley TW Loo
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura
| | - Lim Huai Yang
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura
| | - Weien Chow
- HQ Medical CorpsSingapore Armed ForcesCingapuraHQ Medical Corps, Singapore Armed Forces, Cingapura
| | - Terrance J Chua
- Department of CardiologyNational Heart Centre SingaporeCingapuraDepartment of Cardiology, National Heart Centre Singapore, Cingapura
| | - Tee Joo Yeo
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura,Department of CardiologyNational University Heart Centre SingaporeCingapuraDepartment of Cardiology, National University Heart Centre Singapore, Cingapura,University Medicine ClusterNational University Health SystemCingapuraUniversity Medicine Cluster, National University Health System, Cingapura
| | - Paul Lim
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura,Department of CardiologyNational Heart Centre SingaporeCingapuraDepartment of Cardiology, National Heart Centre Singapore, Cingapura
| | - Thuan Tee Daniel Chong
- Medical Classification CentreCentral Manpower BaseSingapore Armed ForcesCingapuraMedical Classification Centre, Central Manpower Base, Singapore Armed Forces, Cingapura,Department of CardiologyNational Heart Centre SingaporeCingapuraDepartment of Cardiology, National Heart Centre Singapore, Cingapura
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Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 749] [Impact Index Per Article: 374.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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32
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La Gerche A, Wasfy MM, Brosnan MJ, Claessen G, Fatkin D, Heidbuchel H, Baggish AL, Kovacic JC. The Athlete's Heart-Challenges and Controversies: JACC Focus Seminar 4/4. J Am Coll Cardiol 2022; 80:1346-1362. [PMID: 36075838 DOI: 10.1016/j.jacc.2022.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 12/11/2022]
Abstract
Regular exercise promotes structural, functional, and electrical remodeling of the heart, often referred to as the "athlete's heart," with intense endurance sports being associated with the greatest degree of cardiac remodeling. However, the extremes of exercise-induced cardiac remodeling are potentially associated with uncommon side effects. Atrial fibrillation is more common among endurance athletes and there is speculation that other arrhythmias may also be more prevalent. It is yet to be determined whether this arrhythmic susceptibility is a result of extreme exercise remodeling, genetic predisposition, or other factors. Gender may have the greatest influence on the cardiac response to exercise, but there has been far too little research directed at understanding differences in the sportsman's vs sportswoman's heart. Here in part 4 of a 4-part seminar series, the controversies and ambiguities regarding the athlete's heart, and in particular, its arrhythmic predisposition, genetic, and gender influences are reviewed in depth.
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Affiliation(s)
- Andre La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; National Centre for Sports Cardiology, Fitzroy, Victoria, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
| | - Meagan M Wasfy
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Maria J Brosnan
- National Centre for Sports Cardiology, Fitzroy, Victoria, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Guido Claessen
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Diane Fatkin
- Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, New South Wales, Australia; Cardiology Department, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Hein Heidbuchel
- Antwerp University Hospital, Department of Cardiology, Antwerp, Belgium; Cardiovascular Sciences, Antwerp University, Antwerp, Belgium
| | - Aaron L Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jason C Kovacic
- Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, New South Wales, Australia; Cardiology Department, St Vincent's Hospital, Darlinghurst, New South Wales, Australia; Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Samesima N, God EG, Kruse JCL, Leal MG, Pinho C, França FFDAC, Pimenta J, Cardoso AF, Paixão A, Fonseca A, Pérez-Riera AR, Ribeiro ALP, Madaloso BA, Luna Filho B, Oliveira CARD, Grupi CJ, Moreira DAR, Kaiser E, Paixão GMDM, Feitosa Filho G, Pereira Filho HG, Grindler J, Aziz JL, Molina MS, Facin M, Tobias NMMDO, Oliveira PAD, Sanches PCR, Teixeira RA, Atanes SM, Pastore CA. Brazilian Society of Cardiology Guidelines on the Analysis and Issuance of Electrocardiographic Reports - 2022. Arq Bras Cardiol 2022; 119:638-680. [PMID: 36287420 PMCID: PMC9563889 DOI: 10.36660/abc.20220623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Nelson Samesima
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo , SP - Brasil
| | | | | | | | - Claudio Pinho
- Pontifícia Universidade Católida (PUC), Campinas , SP - Brasil
- Clínica Pinho , Valinhos , SP - Brasil
| | | | - João Pimenta
- Hospital do Servidor Público Estadual , São Paulo , SP - Brasil
| | - Acácio Fernandes Cardoso
- Serviço de Eletrocardiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo , SP - Brasil
| | - Adail Paixão
- Hospital Unimec , Vitória Da Conquista , BA - Brasil
| | - Alfredo Fonseca
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo , SP - Brasil
| | | | | | - Bruna Affonso Madaloso
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo , SP - Brasil
| | - Bráulio Luna Filho
- Hospital São Paulo , Universidade Federal de São Paulo (UNIFESP), São Paulo , SP - Brasil
| | | | - César José Grupi
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo , SP - Brasil
| | | | - Elisabeth Kaiser
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo , SP - Brasil
| | | | | | - Horacio Gomes Pereira Filho
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo , SP - Brasil
| | - José Grindler
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo , SP - Brasil
| | - José Luiz Aziz
- Faculdade de Medicina do ABC , Santo André , SP - Brasil
| | | | - Mirella Facin
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo , SP - Brasil
| | - Nancy M M de Oliveira Tobias
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo , SP - Brasil
| | - Patricia Alves de Oliveira
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo , SP - Brasil
| | | | - Ricardo Alkmin Teixeira
- Hospital Renascentista , Pouso Alegre , MG - Brasil
- Faculdade de Medicina da Universidade do Vale do Sapucaí (UNIVÁS), Pouso Alegre , MG - Brasil
| | | | - Carlos Alberto Pastore
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo , SP - Brasil
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Modesti PA, Casolo G, Olivotto I, Pellegrino A. Sudden death in young athletes: Is it preventable? Eur J Intern Med 2022; 104:13-20. [PMID: 35718646 DOI: 10.1016/j.ejim.2022.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 01/09/2023]
Abstract
Sudden death in young athletes is a rare but always dramatic condition. Unlike all other rare diseases, the estimate of its real incidence is made complex not only because of the uncertain number of correctly identified cases (numerator) but also because of the uncertain estimation of the real number of the reference population, the athletes (denominator). New elements of complexity are also emerging with regard to prevention. The current two pillars of prevention are pre-participation screening (proactive strategy) and promoting use / access to the automated external defibrillator (reactive strategy). The standardization of procedures implemented over the past two decades for pre-participation screening can now allow us to assess the impact of this approach. The result is complex to evaluate. While screening may allow the identification of conditions potentially associated with SDA, and therefore the adoption of specific treatments, in about 0.4% of screened subjects, a single study investigated the yield in terms of mortality showing a positive predictive value of 4.7% with 25% sensitivity. Conversely, the reactive strategy appears considerably effective, due to the widespread use of the automated external defibrillators in sports facilities, calling for a homogeneous implementation worldwide. On a broader perspective, the vast attention devoted to SDA prevention in the world of sports represents a major driver for transfer of a reactive prevention strategy to the general population.
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Affiliation(s)
- Pietro Amedeo Modesti
- Sport Medicine Unit, Careggi University Hospital, University of Florence, Largo Brambilla 3, Florence 50134, Italy.
| | - Giancarlo Casolo
- Cardiology Department, Ospedale Versilia, Lido di Camaiore, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, University of Florence, Florence, Italy
| | - Alessio Pellegrino
- Sport Medicine Unit, Careggi University Hospital, University of Florence, Largo Brambilla 3, Florence 50134, Italy
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Raman KS, Vyselaar JR. Electrocardiographic Findings in Professional Male Athletes. Clin J Sport Med 2022; 32:e513-e520. [PMID: 36083337 DOI: 10.1097/jsm.0000000000001006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/25/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To generate granular normative electrocardiogram (ECG) data and characterize the variation by ethnicity and sport played. DESIGN Cross-sectional study; ECGs were collected from preseason screening programs from 2012 to 2019 and interpreted in accordance with athlete-specific guidelines. SETTING Of the professional athletes based in Vancouver, the North Shore Heart Centre performs the annual preparticipation ECG screening. PARTICIPANTS Seven hundred fifty-three professional male athletes competing in hockey, football, lacrosse, skiing, and snowboarding. INTERVENTIONS Independent variables include commonly transcribed electrocardiographic findings, for example, those indicating benign and pathologic findings. MAIN OUTCOME MEASURES Prevalence of and variance in electrocardiographic findings by sport played and ethnicity. RESULTS Of the 753 athletes, 171 (22.3%) were National Hockey League, 358 (47.5%) were Canadian Football League, 163 (21.6%) were Major League Soccer and/or the Canadian National Soccer team, and 61 (8%) others. The most common finding, sinus bradycardia, was more likely in both soccer (P < 0.001) and hockey (P < 0.001) versus football players. Early repolarization (ER) was more likely in soccer players versus both hockey (P < 0.001) and football players (P = 0.001). Within football, Black athletes (BA) were more likely than White athletes to display ER (P = 0.009), left ventricular hypertrophy (P = 0.004), and nonspecific ST changes (P = 0.027). CONCLUSION Our study contributes to the generation of normative data for ECG findings while accounting for ethnic and sport-specific variation. The expected clinical presentation of endurance athletes, including soccer players, and the possible predisposition of BA to develop distinct adaptations can augment clinical care by delineating physiology from pathologic changes.
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Affiliation(s)
- Karanvir S Raman
- Karanvir S. Raman: Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia
| | - John R Vyselaar
- Division of Cardiology, The University of British Columbia, Vancouver, British Columbia; and
- Vancouver Coastal Health, Vancouver, British Columbia
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Orchard JJ, Orchard JW, Raju H, La Gerche A, Puranik R, Davis A, Drezner JA, Semsarian C. Analysis of athlete QT intervals by age: Fridericia and Hodges heart rate corrections outperform Bazett for athlete ECG screening. J Electrocardiol 2022; 74:59-64. [PMID: 36027674 DOI: 10.1016/j.jelectrocard.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/27/2022] [Accepted: 08/11/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cardiac screening of elite athletes including a 12‑lead electrocardiogram (ECG) is recommended by numerous international bodies. Current athlete ECG interpretation guidelines recommend the Bazett method to correct the QT interval (QTc). OBJECTIVE This study sought to investigate normative QTc changes by age using athlete screening ECGs and different QT correction methods in a population of elite cricketers. METHODS Initial cardiac screening ECGs from an existing database of elite Australian cricketers aged 14-35 years were examined. Average QT interval, QTcB (corrected QT-Bazett), QTcF (Fridericia), QTcH (Hodges), and heart rate (HR) were analyzed by age and sex. RESULTS A total of 1310 athletes (66% male, 34% female) were included with mean age 19.1 years and mean heart rate 66.9 bpm (range 38-121 bpm). With increasing age, HR decreased and absolute QT increased. The pattern of QTc change with age differed depending on the method of correction: Bazett correction (QTcB) demonstrated a "dish-shaped" or broad U-shaped appearance; while Fridericia and Hodges corrections showed a linear increase in QTc from young to older age. The Bazett method had a stronger correlation of HR with QTc (R2 = 0.32) than either Fridericia (R2 = 0.0007) or Hodges (R2 = 0.009) methods. CONCLUSIONS The Bazett method is not the most accurate QT correction in athletes, especially during adolescence. In elite cricketers, QTcB revealed a drop in QTc from adolescence to early adulthood due to mis-correction of the QT interval. The Fridericia method has the smoothest correction of HR and least QT variation by age and may be preferred for athlete screening.
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Affiliation(s)
- Jessica J Orchard
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - John W Orchard
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Andre La Gerche
- Sports Cardiology Lab, Baker Heart and Diabetes Institute, Melbourne, Australia; National Centre for Sports Cardiology, St Vincent's Hospital, Melbourne, Fitzroy, Australia
| | - Rajesh Puranik
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Angus Davis
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Chris Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
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Cavarretta E, Pingitore A, Della Porta S, Capitani R, Bernardi M, Sciarra L, Saglietto A, Versaci F, Autore C, Perroni F, Biondi-Zoccai G, Frati G, Peruzzi M. Accuracy of the "International Criteria" for ECG screening in athletes in comparison with previous published criteria: rationale and design of a diagnostic meta-analysis. Minerva Cardiol Angiol 2022; 70:484-490. [PMID: 32996310 DOI: 10.23736/s2724-5683.20.05347-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
INTRODUCTION The impact of the International Criteria for ECG interpretation in athletes has further improved the diagnostic accuracy of the 12-lead ECG use for preparticipation screening (PPS); moreover, these criteria have been evaluated in different populations of athletes and settings proving good results. EVIDENCE ACQUISITION We aimed to perform a comprehensive review of the use of the International Criteria for ECG interpretation in athletes, stemming from a systematic review to diagnostic meta-analysis, limiting our inclusion only to observational studies to determine the diagnostic accuracy of ECG for detecting cardiac anomalies related to sudden cardiac death in athletes. EVIDENCE SYNTHESIS This meta-analysis is expected to include several important studies related to PPS on different populations of athletes comparing different ECG criteria and detail important data on the diagnostic accuracy of ECG in PPS. Furthermore, we intend to highlight the advantage of using ECG in PPS. CONCLUSIONS The present diagnostic meta-analysis results will aid sports medicine physicians and cardiologist in adhering to the most accurate criteria for ECG evaluation in athletes and it may help to solve controversies aroused regarding the excess cost of ECG in PPS related to the amount of false positive cases.
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Affiliation(s)
- Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy -
- Mediterranea Cardiocentro, Naples, Italy -
| | | | | | - Riccardo Capitani
- Department of Physiology and Pharmacology, Sapienza University, Rome, Italy
| | - Marco Bernardi
- Department of Physiology and Pharmacology, Sapienza University, Rome, Italy
| | - Luigi Sciarra
- Division of Cardiology, Casilino Polyclinic, Rome, Italy
| | - Andrea Saglietto
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | | - Camillo Autore
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Fabrizio Perroni
- Section of Exercise and Health Sciences, Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
- Department of Angio-Cardio-Neurology, IRCCS NeuroMed, Pozzilli, Isernia, Italy
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Risk Factors for Sudden Death in Athletes, Is There a Role for Screening? CURRENT CARDIOVASCULAR RISK REPORTS 2022; 16:97-109. [PMID: 35813032 PMCID: PMC9251040 DOI: 10.1007/s12170-022-00697-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/15/2022]
Abstract
Purpose of Review Sudden cardiac death (SCD) in a young athlete is an infrequent yet devastating event often associated with substantial media attention. Screening athletes for conditions associated with SCD is a controversial topic with debate surrounding virtually each component including the ideal subject, method, and performer/interpreter of such screens. In fact, major medical societies such as the American College of Cardiology/American Heart Association and the European Society of Cardiology have discrepant recommendations on the matter, and major sporting associations have enacted a wide range of screening policies, highlighting the confusion on this subject. This review seeks to summarize the literature in this area to address the complex and disputed subject of screening young athletes for SCD. Recent Findings The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause myocarditis, which is one acquired cardiac disease associated with SCD. The coronavirus 2019 (COVID-19) pandemic has therefore resulted in an increased incidence of an otherwise less common condition, providing an expanded dataset for further study of this condition. Recent findings indicate that cardiac complications of athletes with myocardial involvement of SARS-CoV-2 infection are rare. Other contemporary work in SCD screening has been focused on the implementation of various screening protocols and measuring their effectiveness. Summary No universal consensus exists for athlete screening for conditions associated with SCD with varying guidelines and protocols across cardiology and sport-specific organizations. No screening program will prevent all SCD; however, small programs managed by physicians familiar with the examination of an athlete that carefully personalize screening to the individual may maximize detection of dangerous cardiac conditions while minimizing false positives.
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Kashou AH, Adedinsewo DA, Siontis KC, Noseworthy PA. Artificial Intelligence-Enabled ECG: Physiologic and Pathophysiologic Insights and Implications. Compr Physiol 2022; 12:3417-3424. [PMID: 35766831 PMCID: PMC9795459 DOI: 10.1002/cphy.c210001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Advancements in machine learning and computing methods have given new life and great excitement to one of the most essential diagnostic tools to date-the electrocardiogram (ECG). The application of artificial intelligence-enabled ECG (AI-ECG) has resulted in the ability to identify electrocardiographic signatures of conventional and unique variables and pathologies, giving way to tremendous clinical potential. However, what these AI-ECG models are detecting that the human eye is missing remains unclear. In this article, we highlight some of the recent developments in the field and their potential clinical implications, while also attempting to shed light on the physiologic and pathophysiologic features that enable these models to have such high diagnostic yield. © 2022 American Physiological Society. Compr Physiol 12:3417-3424, 2022.
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Affiliation(s)
- Anthony H Kashou
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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The Impact of Ethnicity on Athlete ECG Interpretation: A Systematic Review. J Cardiovasc Dev Dis 2022; 9:jcdd9060183. [PMID: 35735812 PMCID: PMC9225578 DOI: 10.3390/jcdd9060183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 11/30/2022] Open
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. 0–5.0%) and anterior TWI (3.7–14.3% vs. 0.6–2.0%). 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.
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Evaluation of a Preparticipation Cardiovascular Screening Program Among 1,686 National Collegiate Athletic Association Division I Athletes: Comparison of the Seattle, Refined, and International Electrocardiogram Screening Criteria. Clin J Sport Med 2022; 32:306-312. [PMID: 32487874 DOI: 10.1097/jsm.0000000000000858] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 04/06/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To: (1) analyze the results of 5 years of preparticipation cardiac screening including 12-lead electrocardiogram (ECG) of National Collegiate Athletic Association (NCAA) Division I athletes; and (2) assess the rates of ECG screening abnormalities and false-positive rates among 3 ECG screening criteria. DESIGN Retrospective chart review. SETTING National Collegiate Athletic Association Division I University. PARTICIPANTS One thousand six hundred eighty-six first-year athletes presenting for their preparticipation examination including 12-lead resting ECG. INTERVENTIONS At the completion of the study period, all ECGs were retrospectively reviewed using the Seattle, Refined, and International Criteria. MAIN OUTCOME MEASURES (1) Prevalence of pathologic cardiac conditions identified by screening; and (2) number of ECG screening abnormalities by criteria. RESULTS Three athletes (0.2%) were found to have conditions that are associated with sudden cardiac death. Retrospective review of ECGs using Seattle, Refined, and International criteria revealed an abnormal ECG rate of 3.0%, 2.1%, and 1.8%, respectively. International criteria [odds ratios (OR), 0.58; P = 0.02] demonstrated a lower false-positive rate compared with the Seattle criteria. There was no significant difference in false-positive rates between the Seattle and Refined (OR, 0.68; P = 0.09) or the International and Refined criteria (OR, 0.85; P = 0.5). CONCLUSIONS There was a low rate of significant cardiac pathology in this population, and no athletes were permanently restricted from play as a result of screening. Our results suggest that the International criteria have the lowest false-positive rate of athlete-specific ECG criteria, and thus, it is the preferred method for preparticipation ECG screening in NCAA athletes.
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Nguyen Nguyen N, Assad JG, Femia G, Schuster A, Otton J, Nguyen TL. Role of cardiac magnetic resonance imaging in troponinemia syndromes. World J Cardiol 2022; 14:190-205. [PMID: 35582465 PMCID: PMC9048277 DOI: 10.4330/wjc.v14.i4.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 11/13/2021] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
Cardiac magnetic resonance imaging (MRI) is an evolving technology, proving to be a highly accurate tool for quantitative assessment. Most recently, it has been increasingly used in the diagnostic and prognostic evaluation of conditions involving an elevation in troponin or troponinemia. Although an elevation in troponin is a nonspecific marker of myocardial tissue damage, it is a frequently ordered investigation leaving many patients without a specific diagnosis. Fortunately, the advent of newer cardiac MRI protocols can provide additional information. In this review, we discuss several conditions associated with an elevation in troponin such as myocardial infarction, myocarditis, Takotsubo cardiomyopathy, coronavirus disease 2019 related cardiac dysfunction and athlete’s heart syndrome.
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Affiliation(s)
- Nhung Nguyen Nguyen
- Department of Cardiology, Liverpool Hospital, Liverpool 2170, NSW, Australia
| | - Joseph George Assad
- Department of Cardiology, Liverpool Hospital, Liverpool 2170, NSW, Australia
| | - Giuseppe Femia
- Department of Cardiology, Campbelltown Hospital, Campbelltown 2560, NSW, Australia
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center, Göttingen 37075, Germany
| | - James Otton
- Department of Cardiology, Liverpool Hospital, Liverpool 2170, NSW, Australia
| | - Tuan Le Nguyen
- Department of Cardiology, Liverpool Hospital, Liverpool 2170, NSW, Australia
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Gupta A, Bansal N, Jour LS, Clark BC. Utility of Exercise Stress Testing in Pediatric Patients with T-Wave Inversions. Pediatr Cardiol 2022; 43:713-718. [PMID: 34820701 DOI: 10.1007/s00246-021-02776-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/08/2021] [Indexed: 11/24/2022]
Abstract
T-wave inversions (TWI) in inferolateral electrocardiogram (ECG) leads (II, III, aVF, V5-V6) are often suggestive of cardiac pathology in adult patients. They are a common reason of additional testing in pediatric patients. The goal of the study is to determine correlation of exercise stress test T-wave response with diagnosis of cardiac pathology. This is a retrospective review of pediatric patients < 21 years with the finding of baseline TWI in inferior (II, III, avF) and/or lateral (V5-V6) leads on 12-lead ECG. All patients underwent treadmill exercise stress test (EST) and an echocardiogram within 1 year of each other. Demographics, baseline ECG findings, echocardiogram results, and EST data were recorded. T-wave reversion was considered complete if T waves demonstrated normalization during exercise, partial if there was minimal improvement, and no response if there was no change or worsening of inversions. In our cohort of 72 patients with a mean age 14.6 (± 2.9) years and 61% males, 59 (82%) had a structurally normal heart. Thirteen patients had evidence of structural or functional heart disease. Of the 59 patients, 83% had either complete or partial T-wave response. Among the 13 patients with heart disease, two patients had genetic testing consistent with risk for hypertrophic cardiomyopathy and had complete and partial response on EST. Exercise stress testing for TWI in pediatric patients has low sensitivity and specificity for the diagnosis of cardiac disease and routine use in this patient population may not be indicated.
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Affiliation(s)
- Aditi Gupta
- Department of Pediatrics, Lincoln Medical Center, Bronx, NY, USA
| | - Neha Bansal
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Bronx, NY, USA.,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Leslie Saint Jour
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Bradley C Clark
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Bronx, NY, USA. .,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY, USA.
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Corrado D, Zorzi A, Basso C, Thiene G. 800 years of research at the University of Padua (1222-2022): contemporary insights into Sports Cardiology. Eur Heart J 2022; 43:1787-1791. [PMID: 35567556 DOI: 10.1093/eurheartj/ehac043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Domenico Corrado
- Inherited Cardiomyopathy and Sports Cardiology Unit and Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padova Medical School, Via Giustiniani 2, 35128, Padova, Italy
| | - Alessandro Zorzi
- Inherited Cardiomyopathy and Sports Cardiology Unit and Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padova Medical School, Via Giustiniani 2, 35128, Padova, Italy
| | - Cristina Basso
- Inherited Cardiomyopathy and Sports Cardiology Unit and Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padova Medical School, Via Giustiniani 2, 35128, Padova, Italy
| | - Gaetano Thiene
- Inherited Cardiomyopathy and Sports Cardiology Unit and Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padova Medical School, Via Giustiniani 2, 35128, Padova, Italy
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Mancone M, Maestrini V, Fusto A, Adamo F, Scarparo P, D’Ambrosi A, Cinque A, Gatto MC, Salvi N, Agnes G, Pucci M, Birtolo LI, Marruncheddu L, Genuini I, De Lazzari C, Severino P, Giunta G, Lavalle C, Fegatelli DA, Vestri A, Fedele F. ECG evaluation in 11 949 Italian teenagers: results of screening in secondary school. J Cardiovasc Med (Hagerstown) 2022; 23:98-105. [PMID: 34570036 PMCID: PMC8855949 DOI: 10.2459/jcm.0000000000001259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/04/2021] [Accepted: 08/29/2021] [Indexed: 01/02/2023]
Abstract
AIM There is lack of evidence regarding the screening role of ECG for sudden cardiac death (SCD) prevention. Our aim was to evaluate the prevalence of ECG abnormalities among teenagers according to sport participation and competitive status. METHODS Eleven thousand nine hundred and forty-nine Italian pupils from 179 secondary schools (13-19 years) were consecutively enrolled. ECG abnormalities were divided into minor and major. Medical history, clinical examination and sport activity information were acquired. Further evaluations were suggested in case of major ECG abnormalities. Follow-up was performed at 2 years. RESULTS N = 1945 (16%) pupils had ECG abnormalities. Major ECG abnormalities were detected in 13% of the cohort, minor in 34%. ECG abnormalities were more common in nonathletes compared with athletes. A diagnosis of cardiac disease was reached in 25 (1.6%) of the pupils with major ECG abnormalities. CONCLUSION ECG abnormalities are common among young populations and more prevalent in nonathletes. Among pupils with major ECG abnormalities 1.6% had a cardiac disease diagnosis. Our results are in line with the data supporting ECG screening in the general young population.
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Affiliation(s)
- Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Antonio Fusto
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Francesco Adamo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Paola Scarparo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Alessandra D’Ambrosi
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Alessandra Cinque
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Maria Chiara Gatto
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Nicolò Salvi
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Gianluca Agnes
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Mariateresa Pucci
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Lucia Ilaria Birtolo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Laura Marruncheddu
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Igino Genuini
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | | | - Paolo Severino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Giuseppe Giunta
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
| | - Danilo Alunni Fegatelli
- Department of Public Health and Infections Disease, Sapienza University of Rome, Rome, Italy
| | - Annarita Vestri
- Department of Public Health and Infections Disease, Sapienza University of Rome, Rome, Italy
| | - Francesco Fedele
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome
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Yeo TJ, Wang M, Grignani R, McKinney J, Koh LP, Tan FHY, Chan GCT, Tay N, Chan SP, Lee CH, Oxborough D, Malhotra A, Sharma S, Richards AM. Electrocardiographic and Echocardiographic Insights From a Prospective Registry of Asian Elite Athletes. Front Cardiovasc Med 2022; 8:799129. [PMID: 35047579 PMCID: PMC8761771 DOI: 10.3389/fcvm.2021.799129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/29/2021] [Indexed: 01/31/2023] Open
Abstract
Background: Asian representation in sport is increasing, yet there remains a lack of reference values for the Asian athlete's heart. Consequently, current guidelines for cardiovascular screening recommend using Caucasian athletes' norms to evaluate Asian athletes. This study aims to outline electrocardiographic and echocardiographic characteristics of the Asian athlete's heart using a Singaporean prospective registry of Southeast (SE) Asian athletes. Methods and Results: One hundred and fifty elite athletes, mean age of 26.1 ± 5.7 years (50% males, 88% Chinese), were evaluated using a questionnaire, 12-lead electrocardiogram (ECG) and transthoracic echocardiogram. All ECGs were analyzed using the 2017 International Recommendations. Echocardiographic data were presented by gender and sporting discipline. The prevalence of abnormal ECGs among SE Asian athletes was 6.7%—higher than reported figures for Caucasian athletes. The abnormal ECGs comprised mainly anterior T wave inversions (ATWI) beyond lead V2, predominantly in female athletes from mixed/endurance sport (9.3% prevalence amongst females). None had echocardiographic structural abnormalities. Male athletes had reduced global longitudinal strain compared to females (−18.7 ± 1.6 vs. −20.7 ± 2.1%, p < 0.001). Overall, SE Asian athletes had smaller left ventricular cavity sizes and wall thickness compared to non-Asian athletes. Conclusion: SE Asian athletes have higher abnormal ECG rates compared to Caucasian athletes, and also demonstrate structural differences that should be accounted for when interpreting their echocardiograms compared to athletes of other ethnicities.
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Affiliation(s)
- Tee Joo Yeo
- Cardiac Department, National University Heart Centre Singapore, Singapore, Singapore.,Cardiovascular Research Institute, National University Heart Centre Singapore, Singapore, Singapore
| | - Mingchang Wang
- National University Hospital Sports Centre, National University Hospital, Singapore, Singapore
| | - Robert Grignani
- Department of Paediatrics, National University Hospital, Singapore, Singapore
| | - James McKinney
- SportsCardiologyBC, University of British Columbia, Vancouver, BC, Canada
| | - Lay Pheng Koh
- Cardiac Department, National University Heart Centre Singapore, Singapore, Singapore
| | - Frankie Hun Yau Tan
- Sport Science and Medicine Centre, Singapore Sport Institute, Sport Singapore, Singapore, Singapore.,Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gregory Chung Tsing Chan
- Sport Science and Medicine Centre, Singapore Sport Institute, Sport Singapore, Singapore, Singapore
| | - Nigel Tay
- Family Medicine Department, Cavendish Doctors, Auckland, New Zealand
| | - Siew-Pang Chan
- Cardiac Department, National University Heart Centre Singapore, Singapore, Singapore.,Cardiovascular Research Institute, National University Heart Centre Singapore, Singapore, Singapore
| | - Chi-Hang Lee
- Cardiac Department, National University Heart Centre Singapore, Singapore, Singapore.,Cardiovascular Research Institute, National University Heart Centre Singapore, Singapore, Singapore
| | - David Oxborough
- Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Aneil Malhotra
- Division of Cardiovascular Sciences, University of Manchester, Manchester NHS Foundation Trust, Manchester, United Kingdom.,Manchester Institute of Health and Performance, Manchester, United Kingdom
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St George's University of London, London, United Kingdom
| | - Arthur Mark Richards
- Cardiac Department, National University Heart Centre Singapore, Singapore, Singapore.,Cardiovascular Research Institute, National University Heart Centre Singapore, Singapore, Singapore
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47
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Brunetti G, Cipriani A, Perazzolo Marra M, De Lazzari M, Bauce B, Calore C, Rigato I, Graziano F, Vio R, Corrado D, Zorzi A. Role of Cardiac Magnetic Resonance Imaging in the Evaluation of Athletes with Premature Ventricular Beats. J Clin Med 2022; 11:jcm11020426. [PMID: 35054118 PMCID: PMC8781801 DOI: 10.3390/jcm11020426] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/18/2021] [Accepted: 01/06/2022] [Indexed: 12/19/2022] Open
Abstract
Premature ventricular beats (PVBs) in athletes are not rare. The risk of PVBs depends on the presence of an underlying pathological myocardial substrate predisposing the subject to sudden cardiac death. The standard diagnostic work-up of athletes with PVBs includes an examination of family and personal history, resting electrocardiogram (ECG), 24 h ambulatory ECG (possibly with a 12-lead configuration and including a training session), maximal exercise testing and echocardiography. Despite its fundamental role in the diagnostic assessment of athletes with PVBs, echocardiography has very limited sensitivity in detecting the presence of non-ischemic left ventricular scars, which can be revealed only through more in-depth studies, particularly with the use of contrast-enhanced cardiac magnetic resonance (CMR) imaging. The morphology, complexity and exercise inducibility of PVBs can help estimate the probability of an underlying heart disease. Based on these features, CMR imaging may be indicated even when echocardiography is normal. This review focuses on interpreting PVBs, and on the indication and role of CMR imaging in the diagnostic evaluation of athletes, with a special focus on non-ischemic left ventricular scars that are an emerging substrate of cardiac arrest during sport.
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48
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Powell AW, Urbina EM, Orr WB, Hansen JE, Baskar S. EKG Abnormalities in a Youth Athlete Following COVID-19: It's Not Always Myocarditis! Pediatr Cardiol 2022; 43:1922-1925. [PMID: 35622085 PMCID: PMC9136195 DOI: 10.1007/s00246-022-02935-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/13/2022] [Indexed: 11/24/2022]
Abstract
COVID-19 associated myocarditis following mild infections is rare while incidental findings may be more common. A young athlete fully recovered from a mild COVID-19 infection presented with inferolateral T-wave inversions and left ventricular hypertrophy on imaging. Exercise testing aided in correctly diagnosing the patient with masked systolic hypertension.
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Affiliation(s)
- Adam W. Powell
- grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnett Avenue, MLC 2003, Cincinnati, OH 45229-3026 USA ,grid.239573.90000 0000 9025 8099The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Elaine M. Urbina
- grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnett Avenue, MLC 2003, Cincinnati, OH 45229-3026 USA ,grid.239573.90000 0000 9025 8099The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - William B. Orr
- grid.4367.60000 0001 2355 7002Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, USA
| | - Jesse E. Hansen
- grid.413177.70000 0001 0386 2261Division of Pediatric Cardiology, Department of Pediatrics, C.S. Mott Children’s Hospital, Ann Arbor, MI USA
| | - Shankar Baskar
- grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnett Avenue, MLC 2003, Cincinnati, OH 45229-3026 USA ,grid.239573.90000 0000 9025 8099The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
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49
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Pathology of sudden death, cardiac arrhythmias, and conduction system. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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50
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Valvular Heart Disease. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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