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McHugh C, Petek B, Grant AJ, Gustus S, van Dyk N, Hind K, Wilson F, Wasfy M. ECG findings in professional rugby players using international screening recommendations. BMJ Open Sport Exerc Med 2024; 10:e001813. [PMID: 38562152 PMCID: PMC10982795 DOI: 10.1136/bmjsem-2023-001813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 04/04/2024] Open
Abstract
Background While World Rugby guidelines do not mandate the inclusion of an electrocardiogram (ECG) for all players, this is required for entry into international rugby competitions. We, therefore, sought to describe sport-specific normative ECG values and evaluate the performance of contemporary athlete ECG guidelines in male and female professional rugby players. Methods We retrospectively analysed professional rugby players' ECGs (n=356, male 79%) obtained during preparticipation screening (2010-2022), comparing by sex and playing position (forwards vs backs). ECGs were categorised as normal 'training-related', borderline and abnormal findings, as defined by the 2017 International Recommendations. Results 84% of players had one or more normal, 'training-related' findings, with males having a higher prevalence than females (91% vs 60%, p<0.001). Most ECG findings did not vary by position. No female player had borderline or abnormal ECG findings. Borderline findings were present in 3% (n=12/356) of players. Abnormal findings were present in 2% (n=7/356) of players. Overall, 2.2% of ECGs were 'positive' (n=8/356, including n=1 ECG with two borderline findings). Conclusions The application of contemporary ECG interpretation criteria resulted in a low positivity rate isolated to male players. These results help inform the logistic feasibility of ECG-inclusive screening, which is already required to enter major tournaments.
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Affiliation(s)
- Clíodhna McHugh
- Department of Physiotherapy, Trinity College Dublin, Dublin, Ireland
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bradley Petek
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Sports Cardiology Program, Oregon Health & Science University Knight Cardiovascular Institute, Portland, Oregon, USA
| | - Aubrey J Grant
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Cardiovascular Sport & Performance, MedStar Health, Columbia, Maryland, USA
| | - Sarah Gustus
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nicol van Dyk
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland
- Section Sports Medicine, Faculty of Health Science, University of Pretoria, Pretoria, South Africa
| | - Karen Hind
- Department of Sport and Exercise Science, Durham University, Durham, UK
| | - Fiona Wilson
- Department of Physiotherapy, Trinity College Dublin, Dublin, Ireland
| | - Meagan Wasfy
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Football Player Health Study, Harvard Medical School, Boston, Massachusetts, USA
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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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3
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Ekomy HM, Abogo JM, Begouabe H, Kinga A, Eboue BA, Ekouaghe LPA, Karmakar J, Obiang CS. Medical Checks for Professional Football Players in Franceville, Gabon. Niger Postgrad Med J 2024; 31:62-68. [PMID: 38321798 DOI: 10.4103/npmj.npmj_235_23] [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: 09/30/2023] [Accepted: 01/02/2024] [Indexed: 02/08/2024]
Abstract
THE AIM OF THE STUDY To describe the clinical and non-clinical characteristics of Gabon footballers in the Haut-Ogooue Polyclinic in Franceville, Gabon, during visits, to assess whether they are not contraceptive to sports. PATIENTS AND METHODS A descriptive and analytical cross-sectional study was conducted in the city of Franceville, Gabon, in May 2022. The first and second divisions of footballers were subjected to medical examinations to determine whether they had any contraindications for playing sports, including clinical examinations, rest electrocardiograms (ECG), rest cardiac ultrasounds, chest X-rays, Rick-Dickson and biological checks. RESULTS The average age of 88 footballers (22-25 years) was 23 years. Blood pressure (BP) is abnormal in 19% of players, and alcohol and tobacco consumption is reported in 70% and 30%, respectively. Exercise adaptation was also closely associated with age (P = 0.00137724; P = 0.008974301), football position (P = 0.009957548; P = 0.006646182) and alcohol consumption (P = 0.000531971). Electrical and biological changes were 16% and 86.79%, respectively. Sinus bradycardia and first-degree atrioventricular block are the most common ECG abnormalities. Metabolic, inflammatory, infectious, electrolyte and anaemia syndromes were found in 22.64%, 24.53%, 19.81%, 7.55% and 12.26%, respectively. Midfielders and defenders have shown the greatest changes in biological parameters. CONCLUSION Medical checks are essential to determine if sports are contraindicated, as they can help identify physiological and pathological conditions and improve the monitoring of athletes.
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Affiliation(s)
- Hervé Martial Ekomy
- Department of Occupational Health, Masuku University of Science and Technology, USTM, Franceville, Gabon
| | - Joefred Mbogho Abogo
- Department of Biology, Masuku University of Science and Technology, USTM, Franceville, Gabon
- Department of Laboratory of Research in Biochemistry, Masuku University of Science and Technology, USTM, Franceville, Gabon
| | - Herman Begouabe
- Department of Biology, Masuku University of Science and Technology, USTM, Franceville, Gabon
| | - Armel Kinga
- Department of Cardiologie, Polyclinic of Haut-Ogooue, Masuku University of Science and Technology, USTM, Franceville, Gabon
- Department of Medicine, Amissa Bongo University Hospital Centre, Franceville, Gabon
| | - Brice Angwe Eboue
- Department of Occupational Health, University of Health Sciences, Libreville, Gabon
| | | | - Jayanta Karmakar
- Department of Biology, Masuku University of Science and Technology, USTM, Franceville, Gabon
| | - Cedric Sima Obiang
- Department of Biology, Masuku University of Science and Technology, USTM, Franceville, Gabon
- Department of Laboratory of Research in Biochemistry, Masuku University of Science and Technology, USTM, Franceville, Gabon
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4
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Panhuyzen-Goedkoop NM, Verbeek ALM, Goedkoop RJ, Malekzadeh A, Wilde AAM, Peters RJG, Jørstad HT. Quality of athlete screening for high-risk cardiovascular conditions-A systematic review. Scand J Med Sci Sports 2023; 33:2094-2109. [PMID: 37449413 DOI: 10.1111/sms.14446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 04/21/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Sudden cardiac death (SCD) is the leading medical cause of death in athletes. To prevent SCD, screening for high-risk cardiovascular conditions (HRCC) is recommended. Screening strategies are based on a limited number of studies and expert consensus. However, evidence and efficacy of athlete HRCC screening is unclear. OBJECTIVE To determine methodological quality and quality of evidence of athlete screening, and screening efficacy to detect HRCC in a systematic review. METHODS We performed a systematic search of Medline, Embase, Scopus and Cochrane Library up to June 2021. We included articles containing original data of athlete cardiovascular screening, providing details of screening strategies, test results and HRCC detection. We assessed methodological quality of the included articles by QUADAS-2, quality of evidence of athlete HRCC screening by GRADE, and athlete HRCC screening efficacy by SWiM. RESULTS Of 2720 citations, we included 33 articles (1991-2018), comprising 82 417 athletes (26.7% elite, 73.4% competitive, 21.7% women, 75.2% aged ≤35). Methodological quality was 'very low' (33 articles), caused by absence of data blinding and inappropriate statistical analysis. Quality of evidence was 'very low' (33 articles), due to observational designs and population heterogeneity. Screening efficacy could not be reliably established. The prevalence of HRCC was 0.43% with false positive rate (FPR) 13.0%. CONCLUSIONS Methodological quality and quality of evidence on athlete screening are suboptimal. Efficacy could not be reliably established. The prevalence of screen detected HRCC was very low and FPR high. Given the limitations of the evidence, individual recommendations need to be prudent.
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Affiliation(s)
- Nicole M Panhuyzen-Goedkoop
- Department of Cardiology, Amsterdam University Medical Centers, Heart Centre, Amsterdam, The Netherlands
- Sports Medical Centre Papendal, Arnhem, The Netherlands
| | - André L M Verbeek
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Arjan Malekzadeh
- University Library, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam University Medical Centers, Heart Centre, Amsterdam, The Netherlands
| | - Ron J G Peters
- Department of Cardiology, Amsterdam University Medical Centers, Heart Centre, Amsterdam, The Netherlands
| | - Harald T Jørstad
- Department of Cardiology, Amsterdam University Medical Centers, Heart Centre, Amsterdam, The Netherlands
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5
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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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6
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Rimskaya EM, Mironova NA, Sokolov SF, Golitsyn SP. [Left bundle branch block - dilated cardiomyopathy - heart failure: common links in the closed pathogenetic chain]. KARDIOLOGIIA 2023; 63:68-76. [PMID: 36880146 DOI: 10.18087/cardio.2023.2.n1773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/23/2021] [Indexed: 03/08/2023]
Abstract
This review summarizes the available information on the epidemiology and prognosis of patients with left bundle branch block (LBBB), morphological alterations of the myocardium both resulting in and ensuing LBBB, cardiac biomechanics in LBBB, and possibilities of its correction.
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Affiliation(s)
- E M Rimskaya
- Chazov National Medical Research Center of Cardiology
| | - N A Mironova
- Chazov National Medical Research Center of Cardiology
| | - S F Sokolov
- Chazov National Medical Research Center of Cardiology
| | - S P Golitsyn
- Chazov National Medical Research Center of Cardiology
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7
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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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8
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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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9
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Pambo P, Adu-Adadey M, Agbodzakey H, Scharhag J. Electrocardiographic and Echocardiographic Findings in Elite Ghanaian Male Soccer Players. Clin J Sport Med 2021; 31:e373-e379. [PMID: 31876793 DOI: 10.1097/jsm.0000000000000801] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/22/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To analyze the athlete's heart of adult and adolescent elite male soccer players by electrocardiography (ECG) and echocardiography (ECHO) and to describe typical ECG and ECHO findings in this cohort (West African elite soccer players). DESIGN A cross-sectional study of ECGs and ECHOs conducted as part of precompetition medical assessment for national male soccer teams preparing for various Fédération Internationale de Football Association (FIFA) tournaments in 2016 and 2017. SETTING Ghana National Football Association. PARTICIPANTS One hundred fifty-nine players playing for the National male soccer teams preparing for tournaments in 2016 and 2017. INTERVENTIONS Precompetition medical assessment using ECGs and ECHOs. MAIN OUTCOME MEASURES Number of athletes with abnormal ECGs and ECHO findings. RESULTS Twenty-three percent of the players had abnormal ECGs. Nine percent of the participants had T-wave inversions in lateral leads (V5-V6). Sokolow-Lyon criteria for left ventricular hypertrophy were present in 64% of participants. Thirty-six (23%) players had left ventricular wall thickness (LVWT) ≥13 mm, with no player exceeding 16 mm. Four percent of players had left ventricular cavity dimension greater than 60 mm. Relative wall thickness >0.42 was present in 44% of the players. CONCLUSIONS Uncommon ECG changes seem to be more common in elite Ghanaian soccer players compared with previously reported results for Caucasians and even mixed populations of black athletes. Although ST elevation, T-wave inversions, and LVWT up to 15 mm are common, ST depression, deep T-waves in lateral leads, and LVWT ≥16 mm always warrant further clinical and scientific investigations.
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Affiliation(s)
- Prince Pambo
- University of Health and Allied Sciences, Ho, Ghana
- Civil Service/Stadium Clinic, School of Allied Sciences, Ghana Health Service
- Sports Medicine Department, Institute for Sports and Preventive Medicine, Saarland University, Saarbrucken, Germany
| | - Martin Adu-Adadey
- National Cardiothoracic Centre, Korle-Bu Teaching Hospital, Accra, Ghana ; and
| | - Hope Agbodzakey
- Civil Service/Stadium Clinic, School of Allied Sciences, Ghana Health Service
| | - Jürgen Scharhag
- Sports Medicine Department, Institute for Sports and Preventive Medicine, Saarland University, Saarbrucken, Germany
- Department of Sports Medicine, Exercise Physiology and Prevention, University of Vienna, Vienna, Austria
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10
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Morrison B, Mohammad A, Oxborough D, Somauroo J, Lindsay S, Drane AL, Shave R, George K. The 12-lead electrocardiogram of the elite female footballer as defined by different interpretation criteria across the competitive season. Eur J Sport Sci 2021; 22:1475-1483. [PMID: 34374331 DOI: 10.1080/17461391.2021.1966103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ABSTRACTPre-participation screening (PPS), using a 12-lead electrocardiogram (ECG), is recommended to identify athletes at risk of sudden cardiac death (SCD). ECG interpretation criteria have been developed to address the concern arising from high false-positives in athletes. There are limited ECG data in elite female footballers. The aims of this study were to (1) compare the ECG outcomes using three published ECG criteria (European Society of Cardiology [ESC], Seattle, International) in elite female footballers and (2) compare ECG data at three different stages of a competitive season. Eighty-one elite female footballers (21 ± 4 yr) completed a medical assessment, anthropometrics, resting blood pressure and a resting 12-lead ECG. Each 12-lead ECG was interpreted in accordance with (1) ESC; (2) Seattle; (3) International Criteria to determine training-related and non-training-related ECG changes. A subset of thirteen (26 ± 4 yr) footballers had repeated resting ECG tests at three time points across the competitive season. Eighty percent of females had training-related ECG patterns. Sinus bradycardia (65%) and early repolarization (42%) were the most common. Using the ESC Criteria 25% (20/81) of the athletes were considered to have an abnormal ECG, compared to 0% using the Seattle and International Criteria, mainly due to alterations in QT length criteria. There were no clinically significant differences in ECG data across a competitive season. The Seattle and International ECG Criteria significantly reduced the number of ECG false-positives in elite female footballers and the time point of PPS within a competitive season is unlikely to alter the PPS outcomes.Abbreviations: AMSSM: American Medical Society for Sports Medicine; ANOVA: Analysis of Variance; BSA: Body Surface Area; ECG: Electrocardiogram; ESC: European Society of Cardiology; FA: Football Association; FIFA: The Fédération Internationale de Football Association (FIFA); F-MARC: FIFA Medical Assessment and Research Centre; LAE: Left atrial enlargement; LVH: Left ventricular hypertrophy; PPS: Pre-participation screening; SCD: Sudden cardiac death.
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Affiliation(s)
- Barbara Morrison
- Sports Cardiology BC, University of British Columbia, Vancouver, Canada.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Aleah Mohammad
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - John Somauroo
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Sarah Lindsay
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Aimee L Drane
- Cardiff School of Sport and Health, Cardiff Metropolitan University, Cardiff, UK
| | - Rob Shave
- School of Health and Exercise Sciences, University of British Columbia, Okanagan, Canada
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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11
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Romagnoli S, Sbrollini A, Colaneri M, Marcantoni I, Morettini M, Zitti G, Brocchini M, Pozzi M, Burattini L. Initial Investigation of Athletes’ Electrocardiograms Acquired by Wearable Sensors during the Pre-exercise Phase. Open Biomed Eng J 2021. [DOI: 10.2174/1874120702115010037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Aim:
The aim of this study is to support large-scale prevention programs fighting sport-related sudden cardiac death by providing a set of electrocardiographic features representing a starting point in the development of normal reference values for the pre-exercise phase.
Background:
In people with underlying, often unknown, cardiovascular abnormalities, increased cardiovascular load during exercise can trigger sport-related sudden cardiac death. Prevention remains the only weapon to contrast sport-related sudden cardiac death. So far, no reference values have been proposed for electrocardiograms of athletes acquired with wearable sensors in the pre-exercise phase, consisting of the few minutes immediately before the beginning of the training session.
Objective:
To perform an initial investigation of athletes’ electrocardiograms acquired by wearable sensors during the pre-exercise phase.
Methods:
The analyzed electrocardiograms, acquired through BioHarness 3.0 by Zephyr, belong to 51 athletes (Sport Database and Cycling Database of the Cardiovascular Bioengineering Lab of the Università Politecnica delle Marche, Italy). Preliminary values consist of interquartile ranges of six electrocardiographic features which are heart rate, heart-rate variability, QRS duration, ST level, QT interval, and corrected QT interval.
Results:
For athletes 35 years old or younger, preliminary values were [72;91]bpm, [26;47]ms, [85;104]ms, [-0.08;0.08]mm, [326;364]ms and [378;422]ms, respectively. For athletes older than 35 years old, preliminary values were [71;94]bpm, [16;65]ms, [85;100]ms, [-0.11;0.07]mm, [330;368]ms and [394;414]ms, respectively.
Conclusion:
Availability of preliminary reference values could help identify those athletes who, due to electrocardiographic features out of normal ranges, are more likely to develop cardiac complications that may lead to sport-related sudden cardiac death.
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12
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For the Evaluation of Pacific Island Athletes, an ECG and Echocardiography Are Highly Recommended. HEARTS 2021. [DOI: 10.3390/hearts2020021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Physical exercise increases the relative risk of sudden cardiac death (SCD) in athletes when compared to a non-sporting population. Pre-participation evaluation (PPE) of athletes is thus of major importance. For Pacific Island athletes, medical guidelines recommend an echocardiography to complement a PPE including personal and family history, a physical examination and a resting twelve-lead electrocardiogram (ECG). Indeed, silent rheumatoid heart diseases found in up to 7.6% of adolescents give rise to severe valve lesions, which are the main causes of SCD in Pacific Island athletes. This short review examines the incidence rate of SCD in Pacific Island athletes and indicates how a questionnaire, physical examination, ECG and echocardiography can prevent it.
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13
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Electrocardiographic and Echocardiographic Findings in Black Athletes: A General Review. Clin J Sport Med 2021; 31:321-329. [PMID: 31233430 DOI: 10.1097/jsm.0000000000000754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/09/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Participation in regular physical activity produces electrophysiological and structural cardiac changes in electrocardiograms (ECGs) and echocardiographs (ECHOs) of athletes, and the term "athlete's heart" is used to describe these physiological cardiovascular adaptations. Extent and type of sporting discipline, age, sex, body dimensions, and ethnicity have an influence on cardiac remodeling. OBJECTIVE As the recent scientific literature increasingly reports on ethnicity-specific ECG and ECHO findings in black athletes, it is the aim of this review to provide an overview of ECG and ECHO findings among athletes of black African/Afro-Caribbean descent. DATA SOURCES A systematic search of PubMed and MEDLINE databases up to and including August 2017 was conducted using the following terms/phrases "black OR African OR Afro-Caribbean athlete heart," "black OR African OR Afro-Caribbean athlete electrocardiogram," and "black OR African OR Afro-Caribbean athlete echocardiogram." The search generated a total of 130 papers, out of which 16 original articles fitted our criteria and were selected for this review. MAIN RESULTS The various studies reviewed revealed that about 10% to 30% of black African/Afro-Caribbean athletes had abnormal ECG. R/S voltage criteria exceeding hypertrophic indices were found in about 60% to 89% of black African/Afro-Caribbean athletes. ST-segment elevation (17%-90%) and T-wave inversions were also common findings among this ethnicity. About 10% to 12% of black African/Afro-Caribbean athletes had a left ventricular wall thickness ranging from 13 to 15 mm. Cavity dimensions ranged from 40 to 66 mm in black African/Afro-Caribbean athletes with a relative wall thickness >0.44. CONCLUSIONS Updated ethnic-specific guidelines are required to discriminate physiological from pathologic hypertrophy and repolarization changes. Future studies should focus on homogeneous cohorts of African athletes.
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14
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Wen X, Huang YM, Shen TH, Gong YL, Dong RQ, Xia L, Xie TS. Prevalence of abnormal and borderline electrocardiogram changes in 13, 079 Chinese amateur marathon runners. BMC Sports Sci Med Rehabil 2021; 13:41. [PMID: 33879236 PMCID: PMC8056690 DOI: 10.1186/s13102-021-00268-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 04/12/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The 12-lead electrocardiogram (ECG) has been adopted as an important component of preparticipation cardiovascular screening. However, there are still controversies in the screening and few studies with a large sample size have reported the results of ECGs of marathon runners. Therefore, the purpose of this study was to assess the prevalence of normal, borderline, and abnormal ECG changes in marathon runners. METHODS The 12-lead ECG data of 13,079 amateur marathon runners between the ages of 18 and 35 years were included for analysis. The prevalence of ECG abnormalities among different gender groups was compared with chi-square tests. RESULTS In terms of training-related changes, sinus bradycardia, sinus arrhythmia, and left ventricular high voltage were found in approximately 15, 5, and 3.28% of the participants, respectively. The incidence of right axis deviation in the marathon runners was 1.78%, which was slightly higher than the incidence of left axis deviation (0.88%). No more than 0.1% of the amateur marathon runners exhibited ST-segment depression, T wave inversion (TWI), premature ventricular contraction, pathologic Q waves, and prolonged QT interval. CONCLUSIONS Training-related ECG changes, including sinus bradycardia, sinus arrhythmia, and left ventricular high voltage, were common in amateur marathon runners. Most abnormal ECG changes, including ST-segment depression, TWI, premature ventricular contraction, pathologic Q waves, and prolonged QT interval, were infrequently found in amateur marathon runners. The data also suggested Chinese amateur marathon runners may have a relatively lower prevalence of ECG abnormalities than black and white runners.
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Affiliation(s)
- Xu Wen
- Department of Sport Science, College of Education, Zhejiang University, Hangzhou, China
| | - Yu-min Huang
- Department of Sport Science, College of Education, Zhejiang University, Hangzhou, China
| | - Tong-Hui Shen
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, UK
| | - Ying-Lan Gong
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Rui-qing Dong
- Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China
| | - Ling Xia
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Tian-sheng Xie
- Zhejiang Sino-German Institute of Life science and Healthcare, School of Biological and Chemical Engineering, Zhejiang University of Science and Technology, Hangzhou, China
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15
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Sokunbi OJ, Okoromah CAN, Ekure EN, Olawale OA, Eke WS. Electrocardiographic pattern of apparently healthy African adolescent athletes in Nigeria. BMC Pediatr 2021; 21:97. [PMID: 33632178 PMCID: PMC7905616 DOI: 10.1186/s12887-021-02557-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 02/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background Strategies to prevent sudden cardiac death (SCD) among young athletes have become topical worldwide and unrecognized cardiac pathology has been identified as a leading cause. Black ethnicity has been reported as an independent predictor of abnormal electrocardiography (ECG) findings among athletes and the frequency and significance of training-related ECG findings versus findings suggestive of an underlying pathology in the young African athletes is crucial. Methods This cross sectional study aimed to determine the prevalence and distribution of ECG patterns in young athletes and controls. A total of 360 participants (180 athletes and 180 controls) were recruited from six secondary schools in Lagos, Nigeria between November 2014 and July 2015. Evaluation included interviewer-administered questionnaires for relevant history, physical examination and resting 12 - lead ECG for each participant. Results Abnormal ECG patterns were found in 48.3% of athletes and 35.6% of controls. Training-related ECG findings occurred in 33.3% of athletes and 18.3% of controls. Athletes and controls had 7.7% prevalence of training un-related ECG patterns respectively. Left ventricular hypertrophy was the most common ECG finding among the athletes and male athletes had a higher prevalence of ECG abnormalities compared to females. Conclusion Adolescent athletes in Nigeria have a high prevalence of training-related ECG patterns and athletes and non-athletes alike have similar proportions of ECG findings suggestive of underlying structural heart disease. Cardiovascular evaluation including ECG should be performed for young athletes prior to competition at any level and should also be considered as part of pre-school entry assessment for all children. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02557-8.
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Affiliation(s)
- Ogochukwu J Sokunbi
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Lagos / Lagos University Teaching Hospital, Lagos, Nigeria.
| | - Christy A N Okoromah
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Lagos / Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ekanem N Ekure
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medicine, University of Lagos / Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olajide A Olawale
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Lagos / Lagos University Teaching Hospital, Lagos, Nigeria
| | - Wuraola S Eke
- Department of Nursing Services, Lagos University Teaching Hospital, Lagos, Nigeria
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16
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Petek BJ, Baggish AL. Pre-participation Cardiovascular Screening in Young Competitive Athletes. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2021; 8:77-89. [PMID: 33552703 DOI: 10.1007/s40138-020-00214-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose of Review The purpose of this review was to highlight the current recommendations, data, and limitations for methods of cardiovascular screening in athletes. Recent Findings While the history and physical (H&P) alone remains the cornerstone for preparticipation cardiovascular screening (PPCS) in athletes, the advent of modern electrocardiographic (ECG) screening criteria has drastically increased sensitivity and decreased false positive rates for screening. Advanced imaging techniques remain an important component of secondary testing after an athlete has an abnormal initial screening exam, however, the use of imaging for universal screening has not been rigorously tested to date. Current disqualification guidelines have now begun to emphasize shared decision making between the provider and athlete in situations of clinical equipoise. Summary All major medical and sporting societies recommend PPCS using a focused medical history and physical examination for all competitive athletes, but there remains controversy about the role of ECG and advanced imaging in PPCS. Future research should focus on the creation of a randomized trial that is powered for mortality that can truly assess the utility of PPCS in athletes.
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Affiliation(s)
| | - Aaron L Baggish
- Massachusetts General Hospital Cardiovascular Performance Program
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17
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Mbakwem AC, Bauersachs J, Viljoen C, Hoevelmann J, van der Meer P, Petrie MC, Mebazaa A, Goland S, Karaye K, Laroche C, Sliwa K. Electrocardiographic features and their echocardiographic correlates in peripartum cardiomyopathy: results from the ESC EORP PPCM registry. ESC Heart Fail 2021; 8:879-889. [PMID: 33453082 PMCID: PMC8006717 DOI: 10.1002/ehf2.13172] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/06/2020] [Accepted: 12/03/2020] [Indexed: 12/17/2022] Open
Abstract
AIMS In peripartum cardiomyopathy (PPCM), electrocardiography (ECG) and its relationship to echocardiography have not yet been investigated in large multi-centre and multi-ethnic studies. We aimed to identify ECG abnormalities associated with PPCM, including regional and ethnic differences, and their correlation with echocardiographic features. METHODS AND RESULTS We studied 411 patients from the EURObservational PPCM registry. Baseline demographic, clinical, and echocardiographic data were collected. ECGs were analysed for rate, rhythm, QRS width and morphology, and QTc interval. The median age was 31 [interquartile range (IQR) 26-35] years. The ECG was abnormal in > 95% of PPCM patients. Sinus tachycardia (heart rate > 100 b.p.m.) was common (51%), but atrial fibrillation was rare (2.27%). Median QRS width was 82 ms [IQR 80-97]. Left bundle branch block (LBBB) was reported in 9.30%. Left ventricular (LV) hypertrophy (LVH), as per ECG criteria, was more prevalent amongst Africans (59.62%) and Asians (23.17%) than Caucasians (7.63%, P < 0.001) but did not correlate with LVH on echocardiography. Median LV end-diastolic diameter (LVEDD) was 60 mm [IQR 55-65] and LV ejection fraction (LVEF) 32.5% [IQR 25-39], with no significant regional or ethnic differences. Sinus tachycardia was associated with an LVEF < 35% (OR 1.85 [95% CI 1.20-2.85], P = 0.006). ECG features that predicted an LVEDD > 55 mm included a QRS complex > 120 ms (OR 11.32 [95% CI 1.52-84.84], P = 0.018), LBBB (OR 4.35 [95% CI 1.30-14.53], P = 0.017), and LVH (OR 2.03 [95% CI 1.13-3.64], P = 0.017). CONCLUSIONS PPCM patients often have ECG abnormalities. Sinus tachycardia predicted poor systolic function, whereas wide QRS, LBBB, and LVH were associated with LV dilatation.
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Affiliation(s)
- Amam C Mbakwem
- Department of Medicine, College of Medicine, University of Lagos, Idi Araba, Lagos, Nigeria
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Charle Viljoen
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa.,Hatter Institute for Cardiovascular Research in Africa and Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Julian Hoevelmann
- Hatter Institute for Cardiovascular Research in Africa and Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Hospital, Homburg/Saar, Germany
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mark C Petrie
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Alexandre Mebazaa
- UMR 942 Inserm - MASCOT; University of Paris; Department of Anesthesia-Burn-Critical Care, APHP Saint Louis Lariboisière University Hospitals, Paris, France
| | - Sorel Goland
- Department of Cardiology, Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Kamilu Karaye
- Department of Cardiology, Bayero University, Kano, Nigeria
| | - Cécile Laroche
- ESC, EURObservational Research Programme, Sophia-Antipolis, France
| | - Karen Sliwa
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa.,Hatter Institute for Cardiovascular Research in Africa and Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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18
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Hallak YO, Battistin U, Al-Masaeed AM. Cardiac Screening to Mitigate the Risk of Sudden Cardiac Death in Middle Eastern and African Competitive Athletes. A Systematic Review. J Saudi Heart Assoc 2020; 32:174-185. [PMID: 33154912 PMCID: PMC7640562 DOI: 10.37616/2212-5043.1047] [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: 03/10/2020] [Revised: 04/05/2020] [Accepted: 04/15/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The study aims to review the literature regarding abnormalities predisposing to Sudden Cardiac Death (SCD) in young Middle Eastern and African competitive athletes between the years 2009-2019 and aims to assess cardiac pre-participation screening methods. METHODS A PubMed search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search targeted articles that reported the prevalence of cardiac abnormalities found in Middle Eastern and African athletes, and it also focused on comparing cardiac screening methods for assessment of athletes. RESULTS our studies fell within the inclusion criteria and were included in the study. Results identified a shortage in the literature regarding prevalence rates of SCD in the Middle East and Africa. Additionally, there seems to be a lack of ethnicity-specific cardiac pre-participation screening programs in the region. Nevertheless, the prevalence of SCD-related abnormalities (HCM, ARVC, etc …) ranged from 0.47 to 4.29%. Included studies conveyed only male athletes with no reports on the female athletic population. CONCLUSION The present study highlights a need to develop an efficient cardiac pre-participation screening program specific to Arab and African athletes due to their high false-positive rates in contrast to Caucasian athletes. Significant evidence proves that an adequate cardiac screening program can prevent SCD in young competitive athletes. Therefore, it is imperative that future studies highlight the prevalence of abnormalities directly related to SCD in order to create a valid screening program that can be implemented in the region to mitigate the risk of shocking events.
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Affiliation(s)
- Yusuf Omar Hallak
- College of Medicine, Mohammad Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Umberto Battistin
- College of Medicine, Mohammad Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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19
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Demoulin R, Poyet R, Schmitt P, Sidibe S, Capilla E, Rohel G, Pons F, Jego C, Brocq FX, Druelle A, Cellarier GR. [Particularities of African descent patient's electrocardiogram]. Ann Cardiol Angeiol (Paris) 2020; 69:289-293. [PMID: 33039116 DOI: 10.1016/j.ancard.2020.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/03/2020] [Indexed: 06/11/2023]
Abstract
Particularities of African descent patient's electrocardiogram have been described for many years. Variations such as higher QRS voltage, early repolarization pattern, precordial T-wave inversion and anterior ST segment elevation associated with T-wave inversion are more frequently observed. Ignorance of these variations can lead to misdiagnosis or therapeutic negligence. We present the electrocardiographic particularities attributed to the patient of African origin.
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Affiliation(s)
- R Demoulin
- Service de cardiologie et maladies vasculaires, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France.
| | - R Poyet
- Service de cardiologie et maladies vasculaires, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - P Schmitt
- Service de cardiologie et maladies vasculaires, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - S Sidibe
- Service de cardiologie et maladies vasculaires, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France; Healthcare Department of the Malian Armed Forces, Mali
| | - E Capilla
- Service de cardiologie et maladies vasculaires, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - G Rohel
- Service de cardiologie et maladies vasculaires, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - F Pons
- Service de cardiologie et maladies vasculaires, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - C Jego
- Service de cardiologie et maladies vasculaires, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - F X Brocq
- Centre d'expertise médicale du personnel naviguant, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
| | - A Druelle
- Service de médecine hyperbare et expertise de la plongée, hôpital d'instruction des armées Sainte-Anne, Toulon, France
| | - G R Cellarier
- Service de cardiologie et maladies vasculaires, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France
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20
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Ozo U, Sharma S. The Impact of Ethnicity on Cardiac Adaptation. Eur Cardiol 2020; 15:e61. [PMID: 32944090 DOI: 10.15420/ecr.2020.01] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/22/2020] [Indexed: 01/15/2023] Open
Abstract
Regular intensive exercise is associated with a plethora of electrical, structural and functional adaptations within the heart to promote a prolonged and sustained increase in cardiac output. Bradycardia, increased cardiac dimensions, enhanced ventricular filling, augmentation of stroke volume and high peak oxygen consumption are recognised features of the athlete's heart. The type and magnitude of these adaptations to physical exercise are governed by age, sex, ethnicity, sporting discipline and intensity of sport. Some athletes, particularly those of African or Afro-Caribbean (black) origin reveal changes that overlap with diseases implicated in sudden cardiac death. In such instances, erroneous interpretation has potentially serious consequences ranging from unfair disqualification to false reassurance. This article focuses on ethnic variation in the physiological cardiac adaption to exercise.
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21
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Petek BJ, Baggish AL. Current controversies in pre-participation cardiovascular screening for young competitive athletes. Expert Rev Cardiovasc Ther 2020; 18:435-442. [PMID: 32594825 DOI: 10.1080/14779072.2020.1787154] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Pre-participation cardiovascular screening (PPCS) in athletes is recommended by numerous medical and sporting societies. While there is consensus that young athletes should be screened prior to participation in competitive sports, there are on-going debates regarding the true incidence of sudden cardiac death (SCD), the most frequent causes of SCD, and the optimal methods for PPCS. AREAS COVERED This review focuses on the current evidence for the incidence of SCD, causes of SCD, and the pros and cons of a history and physical exam (H&P) and electrocardiogram (ECG) in PPCS of young competitive athletes. EXPERT OPINION With significant controversy surrounding PPCS in athletes, a large-randomized trial powered for mortality is needed to assess the utility of PPCS and to define the optimal screening methods to detect cardiovascular diseases that may lead to SCD in competitive athletes. Until a trial of this caliber is created, controversy will remain and heterogeneity in care will exist. Future research should also define the optimal timing and frequency of PPCS given age-related penetrance of certain diseases, create evidence-based history questionnaires, continue to optimize ECG screening criteria, and create more learning modules for ECG interpretation in athletes.
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Affiliation(s)
- Bradley J Petek
- Department of Medicine, Massachusetts General Hospital , Boston, MA, USA
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital , Boston, MA, USA
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22
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Rejeb OB, Ghali H, Messaoudi Y, Gharbi A, Bouhlel I, Ernez S, Mahdhaoui A, Jeridi G. [Study of unexpectedly detected repolarization in a group of black athletes]. Pan Afr Med J 2019; 33:114. [PMID: 31489092 PMCID: PMC6711696 DOI: 10.11604/pamj.2019.33.114.14241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 05/02/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Sudden death that occurs during sporting activity affects patients with ignored heart disease. Black athlete's ECG has been little studied and the features of this ethnic group have been discussed. This study aims to study the epidemiological profile and the peculiarities of repolarization of black athletes. METHODS We conducted a descriptive study of black athletes selected among all the athletes followed in the sectoral Center of Sports Science and Medicine in Sousse over a period of 8 months from March to October 2014. Data were collected using a medical questionnaire. RESULTS Data on 35 athletes were collected, with a male predominance (94,28%), with an average age of 24,34 years. Four athletes had left ventricular hypertrophy on cardiac ultrasound. There were 8 athletes with atrioventricular block degree I and 8 athletes with electrical type of left ventricular hypertrophy (LVH). ST segment changes were more marked at the level of precordial leads. Five athletes (14.2%) had inverted T waves in V2 and V3. These were the same athletes who ST-segment depression in these same leads. Early repolarization was found in 3 athletes. All these cases had notch signaling. CONCLUSION Black athletes have quite specific electrical modifications which are important to know. However, our sample is not sufficiently large to certify these results. A comparative study of white athletes would be very interesting.
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Affiliation(s)
- Oussama Ben Rejeb
- Université de Sousse, Faculté de Médecine de Sousse, 4000, Sousse, Tunisie
- Hopital Farhat Hached Sousse, Service de Cardiologie, Sousse, Tunisie
- Faculté de Médecine de Sousse, Laboratoire de Recherche LR14ES05 «Interactions du Système Cardio-pulmonaire», Sousse, Tunisie
| | - Hela Ghali
- Université de Sousse, Faculté de Médecine de Sousse, 4000, Sousse, Tunisie
- Hôpital Sahloul Sousse, Service de Prévention et Sécurité de Soins, Tunisie
| | - Yosra Messaoudi
- Université de Sousse, Faculté de Médecine de Sousse, 4000, Sousse, Tunisie
- Faculté de Médecine de Sousse, Laboratoire de Recherche LR14ES05 «Interactions du Système Cardio-pulmonaire», Sousse, Tunisie
- Hopital Ibn El Jazzar Kairouan, Service de Cardiologie, Sousse, Tunisie
| | - Anissa Gharbi
- Université de Sousse, Faculté de Médecine de Sousse, 4000, Sousse, Tunisie
- Hopital Farhat Hached Sousse, Service de Cardiologie, Sousse, Tunisie
| | - Imen Bouhlel
- Université de Sousse, Faculté de Médecine de Sousse, 4000, Sousse, Tunisie
- Hopital Farhat Hached Sousse, Service de Cardiologie, Sousse, Tunisie
| | - Samia Ernez
- Université de Sousse, Faculté de Médecine de Sousse, 4000, Sousse, Tunisie
- Hopital Farhat Hached Sousse, Service de Cardiologie, Sousse, Tunisie
| | - Abdallah Mahdhaoui
- Université de Sousse, Faculté de Médecine de Sousse, 4000, Sousse, Tunisie
- Hopital Farhat Hached Sousse, Service de Cardiologie, Sousse, Tunisie
- Faculté de Médecine de Sousse, Laboratoire de Recherche LR14ES05 «Interactions du Système Cardio-pulmonaire», Sousse, Tunisie
| | - Gouider Jeridi
- Université de Sousse, Faculté de Médecine de Sousse, 4000, Sousse, Tunisie
- Hopital Farhat Hached Sousse, Service de Cardiologie, Sousse, Tunisie
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23
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Oladunjoye OO, Oladunjoye AO, Oladiran O, Callans DJ, Schaller RD, Licata A. Persistent Exertional Chest Pain in a Marathon Runner: Exercise-induced, Painful, Left Bundle Branch Block Syndrome Treated With His-Bundle Pacing. Mayo Clin Proc Innov Qual Outcomes 2019; 3:226-230. [PMID: 31193904 PMCID: PMC6543455 DOI: 10.1016/j.mayocpiqo.2019.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
A 49-year-old woman presented with exercise-induced chest discomfort during long-distance running that was occasionally present during rest. Significant coronary artery disease was excluded and a diagnosis of “painful left bundle branch block (LBBB) syndrome” was made after correlation of LBBB aberrancy with symptoms during Holter monitoring. The patient underwent confirmatory testing consisting of rapid atrial pacing below and above 130 beats per minute, the rate cut-off for LBBB manifestation. His bundle pacing implantation was performed resulting in both non-selective and selective morphologies depending on output, both of which manifested with a painless narrow QRS regardless of rate. She was rendered completely pain free during long-distance running and remains so 6-months later. Her pain at rest, now thought to be due to severe anxiety secondary to her painful LBBB, has also subsided. Exercise-induced, painful LBBB is a rare phenomenon that manifests as chest discomfort when LBBB is present. This disease is frequently misdiagnosed as coronary angina, has limited medical treatment options, and can be disabling. HBP is an attractive treatment for this syndrome in an effort to avoid electromechanical dyssynchrony, the presumed mechanism of discomfort. This case report adds to the growing literature of painful LBBB syndrome and its effective treatment with HBP, with the added caveat that it can present with persistent symptoms at rest, in the setting of enhanced anxiety. HBP should be considered early on in the treatment of such patients.
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Affiliation(s)
| | | | | | - David J Callans
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Robert D Schaller
- Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Anthony Licata
- Cardiovascular Division, Department of Medicine, Tower Health Medical Group, Reading Hospital, Reading, PA
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Chatard JC, Espinosa F, Donnadieu R, Grangeon JP, Sabot JM, Guivarch C, Dacquin R, Raby FX, Papouin G, Viali S, Braunstein C, Gerbay A, Roche F, Isaaz K, Barthélémy JC, Carré F. Pre-participation cardiovascular evaluation in Pacific Island athletes. Int J Cardiol 2019; 278:273-279. [PMID: 30579721 DOI: 10.1016/j.ijcard.2018.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/23/2018] [Accepted: 11/05/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Pre-participation cardiovascular evaluation (PPE) aims to detect cardiac disease with sudden cardiac death (SCD) risk. No study has focused on Pacific Island athletes. METHODS A total of 2281 Pacific Island athletes were studied with (i) a questionnaire on family, personal history and symptoms, (ii) a physical examination and (iii) a 12-lead ECG. RESULTS 85% presented a normal history and examination. A positive family history was 1.4-1.9 fold higher in Melanesians, Polynesians and Métis than in Caucasians, while a positive personal history, abnormal symptoms and abnormal examination was 1.3 fold higher in Melanesians and Métis than in others. Neither gender nor training level had a bearing on these results. Melanesians had higher T wave inversions (TWIs) in V2-V4 leads but had no CV abnormalities. Lateral or infero-lateral TWIs were found in 6 male and in 5 highly trained athletes and cardiomyopathies were diagnosed in 3/6 athletes. Overall, 3.9% athletes were found to have a CV abnormality and 0.8% had a risk of SCD. Polynesians and males were more at risk than the others while the level of training made no difference. In athletes at risk of SCD, the main detected CV diseases were cardiomyopathies, Wolff-Parkinson-White (WPW) and severe valve lesions of rheumatoid origin. CONCLUSIONS PPE revealed that 3.9% presented CV abnormalities. A risk of SCD was found in 0.8% with cardiomyopathies, WPW, and severe valve lesions of rheumatoid origin. Melanesians, Polynesians and male of high level of training were more at risk than others.
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Affiliation(s)
- Jean-Claude Chatard
- Inter-university Laboratory of Human Movement Science, Faculty of Medicine Jacques Lisfranc, University Lyon-Saint-Etienne, 42023 Saint-Etienne, France.
| | - Florian Espinosa
- Department of Cardiology, Faculty of Medicine Jacques Lisfranc, University Lyon-Saint-Etienne, 42023 Saint-Etienne, France
| | | | | | | | | | | | | | - Gérard Papouin
- Department of cardiology, Taone Hospital, Tahiti, French Polynesia
| | - Satu Viali
- Department of cardiology, Apia Hospital, Samoa
| | - Corinne Braunstein
- Department of cardiology, Gaston Bourret Hospital, Noumea, New Caledonia
| | - Antoine Gerbay
- Department of Cardiology, Faculty of Medicine Jacques Lisfranc, University Lyon-Saint-Etienne, 42023 Saint-Etienne, France
| | - Frédéric Roche
- Laboratory of Autonomous Nervous System, Faculty of Medicine Jacques Lisfranc, University Lyon-Saint-Etienne, 42023 Saint-Etienne, France
| | - Karl Isaaz
- Department of Cardiology, Faculty of Medicine Jacques Lisfranc, University Lyon-Saint-Etienne, 42023 Saint-Etienne, France
| | - Jean-Claude Barthélémy
- Laboratory of Autonomous Nervous System, Faculty of Medicine Jacques Lisfranc, University Lyon-Saint-Etienne, 42023 Saint-Etienne, France
| | - François Carré
- CHU Pontchaillou, University of Rennes 1, INSERM U1099, France
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[High performance athlete's heart: Results of a cross-sectional survey conducted in Bobo-Dioulasso, Burkina Faso]. Ann Cardiol Angeiol (Paris) 2019; 68:17-21. [PMID: 30685082 DOI: 10.1016/j.ancard.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 06/12/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE OF THE STUDY To describe the clinical, electrocardiographic and echocardiographic features of the athlete's heart. PATIENTS AND METHODS This was a cross-sectional study conducted from August 2015 to February 2016 in the city of Bobo-Dioulasso in Burkina Faso. Athletes of high level of training (at least 8hours of weekly training, for more than six months regardless of the type of sport) have benefited from: a clinical examination, an electrocardiography and a cardiac ultrasound rest to look for electrical, morphological and functional cardiac changes. RESULTS The 192 athletes with an athlete heart included had a median age of 24 years (IQI: 21-27). The median seniority in high performance sport was 6 years (IQI: 4-8) and 10hours weekly training sessions (IQI: 10-10). The consumption of tobacco, alcohol, tea/coffee, medicines and/or energy drinks was reported respectively in 4.2%, 7.3%, 99.0%, 53.4%. A history of exertional discomfort was reported by 4.7 athletes. Electrical modifications were present in 92.1%. Sinus bradycardia was the most common abnormality (75.0% of cases). The prevalence of left atrium dilatation and left ventricular dilation was 72.4 and 22.4%, respectively. That of left ventricular hypertrophy was 9.0%. CONCLUSION In the high-performance athlete, the prevalence of electrical, morphological and functional changes was high. These need to be known by practitioners to differentiate them from cardiac pathology.
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Prutkin JM, Wilson MG. Electrocardiography in athletes: normal and abnormal findings. Heart 2018; 104:1902-1909. [PMID: 30121634 DOI: 10.1136/heartjnl-2017-312901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/16/2018] [Accepted: 07/23/2018] [Indexed: 12/19/2022] Open
Abstract
Many sporting organisations recommend a pre-participation ECG to screen for disorders which predispose to sudden cardiac arrest (SCA). The ability of the ECG to perform accurately is dependent on the ECG criteria used and the experience of the operator. There have been several ECG criteria over the last decade, though these were recently superseded with the publication of the 'International Consensus Criteria for ECG Interpretation in Athletes'. These criteria use the latest evidence to improve specificity while maintaining sensitivity for ECG-detectable pathologies associated with SCA. Accordingly, this review describes the normal, borderline and abnormal ECG findings in an asymptomatic athlete aged 12-35 years.
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Affiliation(s)
- Jordan M Prutkin
- Department of Medicine/Cardiology, University of Washington, Seattle, Washington, USA
| | - Mathew G Wilson
- Sports Medicine Department, ASPETAR Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Athlete Health and Performance Research Centre, ASPETAR Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Beale AL, Julliard MV, Maziarski P, Ziltener JL, Burri H, Meyer P. Electrocardiographic findings in elite professional cyclists: The 2017 international recommendations in practice. J Sci Med Sport 2018; 22:380-384. [PMID: 30001949 DOI: 10.1016/j.jsams.2018.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 05/25/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To categorize ECG findings into normal, borderline or abnormal in a team of professional elite cyclists according to the 2017 international recommendations. DESIGN A cross-sectional study was performed. METHODS Twelve-lead ECGs collected between 2012 and 2015 as part of an annual routine examination for a team of professional elite cyclists were analysed, and findings classified as normal, borderline or abnormal according to the 2017 recommendations. Information on exercise capacity testing was also collected. RESULTS A total of 43 professional cyclists, all Caucasian males ranging between 21 and 38years of age, were included. Given most were followed up for multiple years, a total of 103 ECGs were collected. Normal variations were found in 43 (100%) athletes; borderline findings in 4 (9.3%), and 2 (4.7%) athletes had abnormal findings. No pathology was identified on further investigation of the four cyclists with two concurrent borderline or any abnormal ECG findings, reflecting a false positive rate of 9.3%. CONCLUSIONS In this team of professional cyclists, the prevalence of abnormal ECG findings requiring further investigation, and the false positive rate were low, despite a very high prevalence of normal variations expected in athletes. This may be as a result of heightened specificity of the new international recommendations for ECG interpretation in athletes.
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Affiliation(s)
- Anna L Beale
- Cardiology Service, Geneva University Hospitals, Switzerland; Monash University Central Clinical School, Australia.
| | | | | | - Jean-Luc Ziltener
- Centre for Sports Medicine and Exercise, Clinique la Colline, Switzerland
| | - Haran Burri
- Cardiology Service, Geneva University Hospitals, Switzerland
| | - Philippe Meyer
- Cardiology Service, Geneva University Hospitals, Switzerland
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28
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Oxborough D, Augustine D, Gati S, George K, Harkness A, Mathew T, Papadakis M, Ring L, Robinson S, Sandoval J, Sarwar R, Sharma S, Sharma V, Sheikh N, Somauroo J, Stout M, Willis J, Zaidi A. A guideline update for the practice of echocardiography in the cardiac screening of sports participants: a joint policy statement from the British Society of Echocardiography and Cardiac Risk in the Young. Echo Res Pract 2018; 5:G1-G10. [PMID: 29551755 PMCID: PMC5861331 DOI: 10.1530/erp-17-0075] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 02/02/2018] [Indexed: 12/19/2022] Open
Abstract
Sudden cardiac death (SCD) in an athlete is a rare but tragic event. In view of this, pre-participation cardiac screening is mandatory across many sporting disciplines to identify those athletes at risk. Echocardiography is a primary investigation utilized in the pre-participation setting and in 2013 the British Society of Echocardiography and Cardiac Risk in the Young produced a joint policy document providing guidance on the role of echocardiography in this setting. Recent developments in our understanding of the athlete’s heart and the application of echocardiography have prompted this 2018 update.
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Affiliation(s)
- David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | | | - Sabiha Gati
- Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Allan Harkness
- Colchester Hospital University NHS Foundation Trust, Colchester, UK
| | - Thomas Mathew
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Liam Ring
- West Suffolk Hospital NHS Foundation Trust, Bury St Edmonds, UK
| | | | | | - Rizwan Sarwar
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Vishal Sharma
- Royal Liverpool and Broadgreen University Hospitals, Liverpool, UK
| | | | - John Somauroo
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Martin Stout
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | - James Willis
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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29
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Bessem B, De Bruijn MC, Nieuwland W, Zwerver J, Van Den Berg M. The electrocardiographic manifestations of athlete’s heart and their association with exercise exposure. Eur J Sport Sci 2018. [DOI: 10.1080/17461391.2018.1441910] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Bram Bessem
- Department of Cardiology and Centre for Sports and Exercise Medicine, University of Groningen, University Medical Centre Groningen, Netherlands
| | - Matthijs C. De Bruijn
- Department of Cardiology and Centre for Sports and Exercise Medicine, University of Groningen, University Medical Centre Groningen, Netherlands
| | - Wybe Nieuwland
- Department of Cardiology and Centre for Sports and Exercise Medicine, University of Groningen, University Medical Centre Groningen, Netherlands
| | - Johannes Zwerver
- Department of Cardiology and Centre for Sports and Exercise Medicine, University of Groningen, University Medical Centre Groningen, Netherlands
| | - Maarten Van Den Berg
- Department of Cardiology and Centre for Sports and Exercise Medicine, University of Groningen, University Medical Centre Groningen, Netherlands
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30
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Johnson C, Forsythe L, Somauroo J, Papadakis M, George K, Oxborough D. Cardiac structure and function in elite Native Hawaiian and Pacific Islander Rugby Football League athletes: an exploratory study. Int J Cardiovasc Imaging 2017; 34:725-734. [PMID: 29189933 PMCID: PMC5889413 DOI: 10.1007/s10554-017-1285-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 11/22/2017] [Indexed: 11/09/2022]
Abstract
The aim of this exploratory study was to define the Athletes Heart (AH) phenotype in Native Hawaiian & Pacific Islander (NH&PI) Rugby Football League (RFL) athletes. Specifically, (1) to describe conventional echocardiographic indices of left ventricle (LV) and right ventricle (RV) structure and function in NH&PI RFL players and matched RFL Caucasian controls (CC) and (2) to demonstrate LV and RV mechanics in these populations. Ethnicity is a contributory factor to the phenotypical expression of the AH. There are no data describing the cardiac phenotype in NH&PI athletes. Twenty-one male elite NH&PI RFL athletes were evaluated using conventional echocardiography and myocardial speckle tracking, allowing the assessment of global longitudinal strain (ε) and strain rate (SR); and basal, mid and global radial and circumferential ε and SR. Basal and apical rotation and twist were also assessed. Results were compared with age-matched Caucasian counterparts (CC; n = 21). LV mass [42 ± 9 versus 37 ± 4 g/(m2.7)], mean LV wall thickness (MWT: 9.5 ± 0.7 and 8.7 ± 0.4 mm), relative wall thickness (RWT: 0.35 ± 0.04 and 0.31 ± 0.03) and RV wall thickness (5 ± 1 and 4 ± 1 mm, all p < 0.05) were greater in NH&PI compared with CC. LV and RV cavity dimensions and standard indices of LV and RV systolic and diastolic function were similar between groups. NH&PI demonstrated reduced peak LV mid circumferential ε and early diastolic SR, as well as reduced global radial ε. There was reduced basal rotation at 25–35% systole, reduced apical rotation at 25–40% and 60–100% systole and reduced twist at 85–95% systole in NH&PI athletes. There were no differences between the two groups in RV wall mechanics. When compared to Caucasian controls, NH&PI rugby players have a greater LV mass, MWT and RWT with concomitant reductions in circumferential and twist mechanics. This data acts to prompt further research in NH&PI athletes.
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Affiliation(s)
- Christopher Johnson
- Research Institute for Sport and Exercise Sciences, Tom Reilly Building, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Lynsey Forsythe
- Research Institute for Sport and Exercise Sciences, Tom Reilly Building, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - John Somauroo
- Research Institute for Sport and Exercise Sciences, Tom Reilly Building, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Michael Papadakis
- Cardiology Clinical Academic Group, St Georges, University of London, London, UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Tom Reilly Building, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Tom Reilly Building, Liverpool John Moores University, Liverpool, L3 3AF, UK.
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31
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Surkova E, Badano LP, Bellu R, Aruta P, Sambugaro F, Romeo G, Migliore F, Muraru D. Left bundle branch block: from cardiac mechanics to clinical and diagnostic challenges. Europace 2017; 19:1251-1271. [DOI: 10.1093/europace/eux061] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/14/2017] [Indexed: 12/15/2022] Open
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32
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Drezner JA, Sharma S, Baggish A, Papadakis M, Wilson MG, Prutkin JM, Gerche AL, Ackerman MJ, Borjesson M, Salerno JC, Asif IM, Owens DS, Chung EH, Emery MS, Froelicher VF, Heidbuchel H, Adamuz C, Asplund CA, Cohen G, Harmon KG, Marek JC, Molossi S, Niebauer J, Pelto HF, Perez MV, Riding NR, Saarel T, Schmied CM, Shipon DM, Stein R, Vetter VL, Pelliccia A, Corrado D. International criteria for electrocardiographic interpretation in athletes: Consensus statement. Br J Sports Med 2017; 51:704-731. [PMID: 28258178 DOI: 10.1136/bjsports-2016-097331] [Citation(s) in RCA: 226] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2017] [Indexed: 01/16/2023]
Abstract
Sudden cardiac death (SCD) is the leading cause of mortality in athletes during sport. A variety of mostly hereditary, structural or electrical cardiac disorders are associated with SCD in young athletes, the majority of which can be identified or suggested by abnormalities on a resting 12-lead electrocardiogram (ECG). Whether used for diagnostic or screening purposes, physicians responsible for the cardiovascular care of athletes should be knowledgeable and competent in ECG interpretation in athletes. However, in most countries a shortage of physician expertise limits wider application of the ECG in the care of the athlete. A critical need exists for physician education in modern ECG interpretation that distinguishes normal physiological adaptations in athletes from distinctly abnormal findings suggestive of underlying pathology. Since the original 2010 European Society of Cardiology recommendations for ECG interpretation in athletes, ECG standards have evolved quickly, advanced by a growing body of scientific data and investigations that both examine proposed criteria sets and establish new evidence to guide refinements. On 26-27 February 2015, an international group of experts in sports cardiology, inherited cardiac disease, and sports medicine convened in Seattle, Washington (USA), to update contemporary standards for ECG interpretation in athletes. The objective of the meeting was to define and revise ECG interpretation standards based on new and emerging research and to develop a clear guide to the proper evaluation of ECG abnormalities in athletes. This statement represents an international consensus for ECG interpretation in athletes and provides expert opinion-based recommendations linking specific ECG abnormalities and the secondary evaluation for conditions associated with SCD.
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Affiliation(s)
- Jonathan A Drezner
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St. George's, University of London, London, UK
| | - Aaron Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, US
| | - Michael Papadakis
- Cardiology Clinical Academic Group, St. George's, University of London, London, UK
| | - Mathew G Wilson
- Department of Sports Medicine, ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Jordan M Prutkin
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Andre La Gerche
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Michael J Ackerman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.,Department of Paediatric, Mayo Clinic, Rochester, Minnesota, USA.,Department of Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Molecular Pharmacology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Mats Borjesson
- Department of Neuroscience, Sahlgrenska University Hospital/Ostra Sahlgrenska Academy, Goteborg, Sweden.,Department of Physiology, Sahlgrenska University Hospital/Ostra Sahlgrenska Academy, Goteborg, Sweden
| | - Jack C Salerno
- Department of Pediatrics, University of Washington, Seattle, Washington, US
| | - Irfan M Asif
- Department of Family Medicine, University of South Carolina, Greenville, USA
| | - David S Owens
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Eugene H Chung
- Division of Cardiology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, USA
| | - Michael S Emery
- Center of Cardiovascular Care in Athletics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | | | - Carmen Adamuz
- Department of Sports Medicine, ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | - Gordon Cohen
- Division of Paediatric Surgery, University of California, San Francisco School of Medicine, San Francisco, California, USA.,Division of Cardiothoracic Surgery, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Kimberly G Harmon
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | | | - Silvana Molossi
- Division of Pediatric, Baylor College of Medicine, Houston, Texas, USA.,Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Josef Niebauer
- University Institute of Sports Medicine, Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
| | - Hank F Pelto
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Marco V Perez
- Center for Inherited Cardiovascular Disease, Stanford University, Stanford, California, USA
| | - Nathan R Riding
- Department of Sports Medicine, ASPETAR, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Tess Saarel
- Department of Pediatrics, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Cardiology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - David M Shipon
- Heart Centre of Philadelphia, Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Ricardo Stein
- Department of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Victoria L Vetter
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Domenico Corrado
- Department of Cardiac Science, University of Padua Medical School, Padua, Italy.,Department of Thoracic Sciences, University of Padua Medical School, Padua, Italy.,Department of Vascular Sciences, University of Padua Medical School, Padua, Italy
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McCorquodale A, Poulton R, Hendry J, Norrish G, Field E, Mead-Regan S, Lowe M, Kaski JP. High prevalence of early repolarization in the paediatric relatives of sudden arrhythmic death syndrome victims and in normal controls. Europace 2016; 19:1385-1391. [DOI: 10.1093/europace/euw248] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 07/13/2016] [Indexed: 01/28/2023] Open
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34
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Dores H, Malhotra A, Sheikh N, Millar L, Dhutia H, Narain R, Merghani A, Papadakis M, Sharma S. Abnormal electrocardiographic findings in athletes: Correlation with intensity of sport and level of competition. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2016.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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35
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Dores H, Malhotra A, Sheikh N, Millar L, Dhutia H, Narain R, Merghani A, Papadakis M, Sharma S. Abnormal electrocardiographic findings in athletes: Correlation with intensity of sport and level of competition. Rev Port Cardiol 2016; 35:593-600. [DOI: 10.1016/j.repc.2016.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/31/2016] [Accepted: 04/04/2016] [Indexed: 11/15/2022] Open
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Lohrmann GM, Peters F, Srivathsan K, Essop MR, Mookadam F. Electrocardiographic Abnormalities in Disease-Free Black South Africans and Correlations With Echocardiographic Indexes and Early Repolarization. Am J Cardiol 2016; 118:765-70. [PMID: 27381667 DOI: 10.1016/j.amjcard.2016.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 02/08/2023]
Abstract
Electrocardiographic abnormalities, and specifically early repolarization (ER) patterns, are increasingly found to be common variants in healthy populations free of heart disease or risk factors. Data are sparse in subjects of African descent, for which no increase in adverse cardiovascular outcomes have been demonstrated. A database of healthy disease-free adult volunteers of sub-Saharan African descent had 12 lead electrocardiograms (ECGs) and transthoracic echocardiograms performed. Statistical tests were then performed on the data to elicit associations; 396 volunteers (63.1% women) with a mean age of 37.4 years met the inclusion and exclusion criteria. An abnormal ECG was identified in 50.5% of volunteers, largely because of underlying ST elevation at the J point (ER), left ventricular hypertrophy (LVH) by voltage criteria, and T-wave inversion. Men were more likely to have abnormal ECGs (odds ratio [OR] 1.75; p <0.001), axes (OR 2.05; p = 0.023), display LVH by Sokolow-Lyon voltage criteria (OR 5.45; p <0.001), and have ER patterns (OR 11.61; p <0.001). Additionally, younger adults were also more likely to display LVH by voltage criteria and ER patterns. Volunteers with LVH by ECG had 5.7% higher LV mass indexes (p = 0.047). An abnormal ECG was not associated with a reduced left ventricular ejection fraction or diastolic dysfunction. ECG abnormalities, especially ER patterns, in black adults of Sub-Saharan descent are common, occurring in half of the normal adults.
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37
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Bessem B, de Bruijn MC, Nieuwland W. Gender differences in the electrocardiogram screening of athletes. J Sci Med Sport 2016; 20:213-217. [PMID: 27451270 DOI: 10.1016/j.jsams.2016.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 05/31/2016] [Accepted: 06/30/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Gender-related differences are frequently used in medicine. Electrocardiograms are also subject to such differences. This study evaluated gender differences in ECG parameters of young athletes, discussing the possible implications of these differences for ECG criteria used in the cardiovascular screening of young athletes. DESIGN Observational cross-sectional study. METHODS In 2013 and 2014 all the ECGs from the cardiovascular screenings performed at University Sports Medical Centre in Groningen of the student athletes who wanted to participate in a college sports program were collected. The ECG characteristics were scored using computer-based measurements and the Seattle ECG criteria. RESULTS The study population included 1436 athletes, of which 72% were male. Male athletes were older (19.3 years vs. 18.6 years), participated in sports more frequently (4.0/week vs. 3.8/week) and spent more hours per week practising sports (6.4h/week vs. 5.8h/week) than female athletes. Male athletes had significantly higher PR intervals (149ms vs. 141ms), lead voltages and QRS duration (98ms vs. 88ms). Female athletes had significantly higher resting heart rates (69/min vs. 64/min) and QTc intervals (407ms vs. 400ms). Male athletes also had significantly higher amounts of sinus bradycardia (38.3% vs. 23.0%), incomplete RBBB (15.0% vs. 3.7%), early repolarisation (4.5% vs. 1.0%) and isolated QRS voltage criteria for LVH (26.3% vs. 4.6%). All P-values were ≤0.001. CONCLUSIONS ECGs of young athletes demonstrate gender-related differences. These differences could be considered in their cardiovascular screening. For the Seattle ECG criteria we advise additional research into the clinical implications of using gender-based cut-off values for the QRS duration in the intraventricular conduction delay criterion.
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Affiliation(s)
- Bram Bessem
- University of Groningen, University Medical Centre Groningen, Department of Cardiology and Centre for Sports Medicine, The Netherlands.
| | - Matthijs C de Bruijn
- University of Groningen, University Medical Centre Groningen, Department of Cardiology and Centre for Sports Medicine, The Netherlands
| | - Wybe Nieuwland
- University of Groningen, University Medical Centre Groningen, Department of Cardiology and Centre for Sports Medicine, The Netherlands
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38
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Ghani S, Papadakis M, Kemp S, Zaidi A, Sheikh N, Gati S, Raju H, Smith A, Palmer C, Somauroo J, Sharma S. Results of a nationally implemented de novo cardiac screening programme in elite rugby players in England. Br J Sports Med 2016; 50:1338-1344. [PMID: 27340147 DOI: 10.1136/bjsports-2015-095902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIM Screening of young competitive athletes remains a contentious issue. In 2010, a nationwide cardiac screening for all elite rugby players was introduced in England. This provided a unique opportunity to prospectively assess the feasibility and cost-effectiveness of a de novo, ECG-based cardiac screening programme. METHODS Between 2010 and 2012, 1191 rugby players aged ≥14 years underwent cardiac screening with a health questionnaire, 12-lead ECG and a consultation with a cardiologist. The players with concerning findings on initial evaluation were offered on-site transthoracic echocardiogram (TTE). Athletes were referred for further investigations as deemed necessary. The overall cost of the screening programme was estimated. RESULTS After initial evaluation, 9.7% of athletes underwent on-site TTE; 8.2% underwent on-site TTE due to ECG anomalies and 1.4% underwent on-site TTE due to concerns on the questionnaire. After TTE, only 2.9% of the total cohort was referred for further evaluation. Two players were diagnosed with potentially serious conditions; one with Wolff-Parkinson-White, who resumed competition after catheter ablation, and one with hypertrophic cardiomyopathy, who withdrew from competition. During a mean follow-up of 52.8±5.5 months, none of the players who were reassured experienced any adverse cardiac events. The total cost of the screening programme was £59 875, which averaged to a cost of £50 per player or £29 938 per condition identified. Application of refined ECG criteria would reduce the ECG false-positive rate to 4.9%. CONCLUSIONS Preparticipation cardiac screening with 12-lead ECG is feasible. Refinement of the ECG criteria, the use of on-site TTE and expert setting can minimise the burden of unnecessary investigations and reduce costs.
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Affiliation(s)
- Saqib Ghani
- Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
| | - Michael Papadakis
- Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
| | | | - Abbas Zaidi
- Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
| | - Nabeel Sheikh
- Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
| | - Sabiha Gati
- Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
| | - Hariharan Raju
- Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
| | - Andy Smith
- Mid Yorkshire Hospital NHS Trust, Wakefield, UK.,RWC England 2015 Medical Advisory Group.,Premiership Rugby, Twickenham, UK
| | | | - John Somauroo
- Countess of Chester NHS Hospital Trust, UK.,Liverpool Heart and Chest NHS Hospital Trust, Liverpool, UK
| | - Sanjay Sharma
- Cardiovascular Sciences Research Centre, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK
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39
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Chatard JC, Mujika I, Goiriena JJ, Carré F. Screening young athletes for prevention of sudden cardiac death: Practical recommendations for sports physicians. Scand J Med Sci Sports 2015; 26:362-74. [PMID: 26432052 DOI: 10.1111/sms.12502] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 12/13/2022]
Abstract
Regular intensive exercise in athletes increases the relative risk of sudden cardiac death (SCD) compared with the relatively sedentary population. Most cases of SCD are due to silent cardiovascular diseases, and pre-participation screening of athletes at risk of SCD is thus of major importance. However, medical guidelines and recommendations differ widely between countries. In Italy, the National Health System recommends pre-participation screening for all competitive athletes including personal and family history, a physical examination, and a resting 12-lead electrocardiogram (ECG). In the United States, the American College of Cardiology and the American Heart Association recommend a pre-participation screening program limited to the use of specific questionnaires and a clinical examination. The value of a 12-lead ECG is debated based on issues surrounding cost-efficiency and feasibility. The aim of this review was to focus on (i) the incidence rate of cardiac diseases in relation to SCD; (ii) the value of conducting a questionnaire and a physical examination; (iii) the value of a 12-lead resting ECG; (iv) the importance of other cardiac evaluations in the prevention of SCD; and (v) the best practice for pre-participation screening.
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Affiliation(s)
- J-C Chatard
- Laboratory of Exercise Physiology, Faculty of Medicine Jacques Lisfranc, University of Lyon-Saint-Etienne, Saint-Etienne, France
| | - I Mujika
- Department of Physiology, Faculty of Medicine and Odontology, University of the Basque Country, Leioa, Basque Country, Spain.,School of Kinesiology and Health Research Center, Faculty of Medicine, Universidad Finis Terrae, Santiago, Chile
| | - J J Goiriena
- Department of Physiology, Faculty of Medicine and Odontology, University of the Basque Country, Leioa, Basque Country, Spain
| | - F Carré
- Laboratory of Exercise Physiology, Faculty of Medicine, University of Rennes, Rennes, France
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Kim JH, Baggish AL. Electrocardiographic right and left bundle branch block patterns in athletes: Prevalence, pathology, and clinical significance. J Electrocardiol 2015; 48:380-4. [DOI: 10.1016/j.jelectrocard.2015.03.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Indexed: 01/02/2023]
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41
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The effectiveness of screening history, physical exam, and ECG to detect potentially lethal cardiac disorders in athletes: A systematic review/meta-analysis. J Electrocardiol 2015; 48:329-38. [DOI: 10.1016/j.jelectrocard.2015.02.001] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Indexed: 11/22/2022]
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Abstract
Athletic intensive exercise is associated with repolarization changes affecting the ST-segment and T-wave morphology. The prevalence and distribution of these alterations are influenced by several demographic factors. One of the most challenging conundrums for both the cardiologist and the sports medicine physician is the correct interpretation of these repolarization changes to prevent an erroneous diagnosis with potentially serious consequences. A 12-lead electrocardiogram (ECG) demonstrating inverted T-waves may represent the first and only sign of such inherited heart muscle diseases, and may precede the detection of any structural changes in the heart, however, T-wave inversion in leads V1-V4 in black athletes may represent ethnic variation which is exaggerated by exercise.
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Affiliation(s)
- Ricardo Stein
- Universidade Federal do Rio Grande do Sul, Cardiology Division, and Exercise Cardiology Research Group (CardioEx), Vitta Centro de Bem Estar Físico, Porto Alegre, Brazil.
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Jacob D, Main ML, Gupta S, Gosch K, McCoy M, Magalski A. Prevalence and significance of isolated T wave inversion in 1755 consecutive American collegiate athletes. J Electrocardiol 2015; 48:407-14. [PMID: 25795567 DOI: 10.1016/j.jelectrocard.2015.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND We evaluated the prevalence of isolated T-wave inversions (TWI) in American athletes using contemporary ECG criteria. Ethnic and gender disparities including the association of isolated TWI with underlying abnormal cardiac structure are evaluated. METHODS From 2004 to 2014, 1755 collegiate athletes at a single American university underwent prospective collection of medical history, physical examination, 12-lead ECG, and 2-dimensional echocardiography. ECG analysis was performed to evaluate for isolated TWI as per contemporary ECG criteria. RESULTS The overall prevalence of isolated TWI is 1.3%. Ethnic and gender disparities are not observed in American athletes (black vs. white: 1.7% vs. 1.1%; p=0.41) (women vs. men: 1.5% vs. 1.1; p=0.52). No association was found with underlying cardiomyopathy. CONCLUSION A lower prevalence of isolated TWI in American athletes than previously reported. Isolated TWI was not associated with an abnormal echocardiogram. No ethnic or gender disparity is seen in American college athletes.
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Affiliation(s)
- Dany Jacob
- University of Missouri-Kansas City, 2301 Holmes St, Kansas City, MO, USA
| | - Michael L Main
- Saint Luke's Mid America Heart Institute, 4401 Wornwall Rd, Kansas City, MO, USA
| | - Sanjaya Gupta
- Saint Luke's Mid America Heart Institute, 4401 Wornwall Rd, Kansas City, MO, USA
| | - Kensey Gosch
- Saint Luke's Mid America Heart Institute, 4401 Wornwall Rd, Kansas City, MO, USA
| | - Marcia McCoy
- Saint Luke's Mid America Heart Institute, 4401 Wornwall Rd, Kansas City, MO, USA
| | - Anthony Magalski
- Saint Luke's Mid America Heart Institute, 4401 Wornwall Rd, Kansas City, MO, USA.
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Riding NR, Sheikh N, Adamuz C, Watt V, Farooq A, Whyte GP, George KP, Drezner JA, Sharma S, Wilson MG. Comparison of three current sets of electrocardiographic interpretation criteria for use in screening athletes. Heart 2015; 101:384-90. [PMID: 25502812 PMCID: PMC4345900 DOI: 10.1136/heartjnl-2014-306437] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/24/2014] [Accepted: 10/30/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND An increasing number of sporting bodies report unacceptably high levels of false-positive ECGs when undertaking pre-participation cardiac screening. To address this issue, modified ECG interpretation criteria have become available for use within athletes. OBJECTIVE This study assessed the accuracy of the new 2014 'Refined Criteria' against the 2013 Seattle Criteria and the 2010 European Society of Cardiology (ESC) recommendations in a cohort of Arabic, black and Caucasian athletes. METHODS 2491 male athletes (1367 Arabic, 748 black and 376 Caucasian) undertook pre-participation screening including a 12-lead ECG, with further investigation(s) upon indication. RESULTS Ten athletes (0.4%) were identified with cardiac pathology; seven with hypertrophic cardiomyopathy (HCM; five black and two Arabic) and three Arabs with Wolff-Parkinson-White syndrome (WPW). All three ECG criteria were 100% sensitive identifying all cases of HCM and WPW. The 2014 Refined Criteria reduced (p<0.0001) the prevalence of an abnormal ECG to 5.3% vs 11.6% (Seattle Criteria) and 22.3% (2010 ESC recommendations). The 2014 Refined Criteria significantly (p<0.0001) improved specificity (94.0%) across all ethnicities compared with the Seattle Criteria (87.5%) and ESC recommendations (76.6%). Black athletes continue to present a higher prevalence (p<0.0001) of abnormal ECGs compared with Arabic and Caucasian athletes (10% vs 3.6% and 2.1%). CONCLUSIONS The 2014 Refined Criteria for athlete ECG interpretation outperformed both the 2013 Seattle Criteria and the 2010 ESC recommendations by significantly reducing the number of false-positive ECGs in Arabic, black and Caucasian athletes while maintaining 100% sensitivity for serious cardiac pathologies.
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Affiliation(s)
- Nathan R Riding
- Athlete Health and Performance Research Centre, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Research Institute for Sport and Exercise Science, Liverpool John Moores University, UK
| | - Nabeel Sheikh
- Department of Cardiovascular Sciences, St Georges University of London, UK
| | - Carmen Adamuz
- Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Victoria Watt
- Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Abdulaziz Farooq
- Athlete Health and Performance Research Centre, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Gregory P Whyte
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, UK
| | - Keith P George
- Research Institute for Sport and Exercise Science, Liverpool John Moores University, UK
| | - Jonathan A Drezner
- Department of Family Medicine, University of Washington, Seattle, Washington USA
| | - Sanjay Sharma
- Department of Cardiovascular Sciences, St Georges University of London, UK
| | - Mathew G Wilson
- Athlete Health and Performance Research Centre, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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45
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Berge HM, Isern CB, Berge E. Blood pressure and hypertension in athletes: a systematic review. Br J Sports Med 2015; 49:716-23. [DOI: 10.1136/bjsports-2014-093976] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2014] [Indexed: 12/18/2022]
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46
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Modern standards of ECG interpretation in young athletes: yield and effectiveness. J Electrocardiol 2015; 48:292-7. [PMID: 25595717 DOI: 10.1016/j.jelectrocard.2014.12.017] [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: 10/27/2014] [Indexed: 10/24/2022]
Abstract
Although cardiovascular screening is recommended before participating in competitive sports, the role of the 12-lead electrocardiogram (ECG) has been debated. When added to the medical history and physical examination, an ECG used during the pre-participation screening (PPS) of young athletes can greatly enhance the ability to detect underlying cardiovascular pathology. Concerns over false positive rates, however, have posed an obstacle to large-scale implementation. The recent development of modern athlete-specific ECG interpretation criteria has dramatically reduced false positive rates to levels below other commonly used screening tests (e.g. breast cancer, prostate cancer) and subsequently improved cost effectiveness. There are also emerging data that certain sub-groups have a higher prevalence of ECG abnormalities, including males, athletes of Afro-Caribbean descent, basketball players, and endurance athletes. While false positive rates from a number of studies are reduced with the improved standards, there may be room for continued improvements. Future efforts should focus on refining criteria based on age, race, gender, ethnicity, and sport, while also clearly delineating the appropriate work-up strategies for those with abnormal findings, as this can lead to improved resource utilization.
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47
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Dores H, Freitas A, Malhotra A, Mendes M, Sharma S. The hearts of competitive athletes: An up-to-date overview of exercise-induced cardiac adaptations. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2014.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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48
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Dores H, Freitas A, Malhotra A, Mendes M, Sharma S. The hearts of competitive athletes: An up-to-date overview of exercise-induced cardiac adaptations. Rev Port Cardiol 2015; 34:51-64. [DOI: 10.1016/j.repc.2014.07.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 07/31/2014] [Indexed: 11/27/2022] Open
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49
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Calò L, Sperandii F, Martino A, Guerra E, Cavarretta E, Quaranta F, Ruvo ED, Sciarra L, Parisi A, Nigro A, Spataro A, Pigozzi F. Echocardiographic findings in 2261 peri-pubertal athletes with or without inverted T waves at electrocardiogram. Heart 2014; 101:193-200. [DOI: 10.1136/heartjnl-2014-306110] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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50
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Bessem B, de Bruijn MC, Nieuwland W. The ECG of high-level junior soccer players: comparing the ESC vs the Seattle criteria. Br J Sports Med 2014; 49:1000-6. [DOI: 10.1136/bjsports-2013-093245] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2014] [Indexed: 11/03/2022]
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