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Orchard JJ, La Gerche A, Puranik R, Raju H, Davis AJ, Eggleton S, Driscoll T, Lorimer M, Doughty RN, Hamilton B, Drezner JA, Orchard JW. Rationale and Design of the Australasian Registry of Screening ECGs in National Athletes Project. J Am Heart Assoc 2024; 13:e035898. [PMID: 39158566 DOI: 10.1161/jaha.124.035898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/24/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Cardiac screening of elite athletes is widely recommended by Australasian sporting federations, but data are not structured to be shared. Data are lacking from underrepresented groups to inform ECG interpretation guidelines. The ARENA (Australasian Registry of Screening ECGs in National Athletes) project is a retrospective and prospective, multicenter, longitudinal, observational registry of athlete cardiac screening results and outcomes. The aim is to create a repository to improve our understanding of the diagnoses and outcomes of screening. METHODS Participating sports that conduct cardiac screening of athletes will contribute data. This includes an initial collection (retrospective data, waiver of consent) and future prospective data (opt-out consent). Data include sex, age, sport/event, screening date, ECG findings, cardiac test results, follow-up details, sport participation status, cardiac diagnoses, and major cardiovascular outcomes defined as sudden cardiac arrest/death, cardiac syncope or implanted cardioverter defibrillator shock, cardiac hospitalization, and arrhythmias requiring intervention. Comparisons will be made between diagnoses, outcomes, and ECG features and analyzed by sport and sex. The ARENA project was developed in collaboration with sporting bodies, team physicians, and players association representatives and endorsed by the Australasian College of Sport & Exercise Physicians and Sports Medicine Australia. CONCLUSIONS The ARENA project will provide a long-term international data repository to improve our understanding of ECG interpretation, cardiac screening and diagnoses, and the prevalence of cardiovascular outcomes in screened athletes. A unique aim is to address evidence gaps in underrepresented athlete groups, specifically female athletes and Indigenous populations. Results will inform screening policies and guidelines.
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Affiliation(s)
- Jessica J Orchard
- Sydney School of Public Health, Faculty of Medicine and Health The University of Sydney NSW Australia
| | - Andre La Gerche
- St Vincent's Institute for Medical Research Melbourne Victoria Australia
- National Centre for Sports Cardiology Melbourne Victoria Australia
| | - Rajesh Puranik
- Faculty of Medicine and Health The University of Sydney NSW Australia
| | | | - Angus J Davis
- Sydney School of Public Health, Faculty of Medicine and Health The University of Sydney NSW Australia
| | | | - Tim Driscoll
- Sydney School of Public Health, Faculty of Medicine and Health The University of Sydney NSW Australia
| | - Michelle Lorimer
- South Australian Health and Medical Research Institute Adelaide South Australia Australia
| | - Robert N Doughty
- University of Auckland New Zealand
- The Heart Group Auckland New Zealand
| | - Bruce Hamilton
- High Performance Sport Auckland New Zealand
- Sport Research Institute Auckland New Zealand
| | | | - John W Orchard
- Sydney School of Public Health, Faculty of Medicine and Health The University of Sydney NSW Australia
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Krishnan S, Guseh JS, Chukumerije M, Grant AJ, Dean PN, Hsu JJ, Husaini M, Phelan DM, Shah AB, Stewart K, Wasfy MM, Capers Q, Essien UR, Johnson AE, Levine BD, Kim JH. Racial Disparities in Sports Cardiology: A Review. JAMA Cardiol 2024:2820717. [PMID: 39018059 DOI: 10.1001/jamacardio.2024.1899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
Importance Racial disparities in cardiovascular health, including sudden cardiac death (SCD), exist among both the general and athlete populations. Among competitive athletes, disparities in health outcomes potentially influenced by social determinants of health (SDOH) and structural racism remain inadequately understood. This narrative review centers on race in sports cardiology, addressing racial disparities in SCD risk, false-positive cardiac screening rates among athletes, and the prevalence of left ventricular hypertrophy, and encourages a reexamination of race-based practices in sports cardiology, such as the interpretation of screening 12-lead electrocardiogram findings. Observations Drawing from an array of sources, including epidemiological data and broader medical literature, this narrative review discusses racial disparities in sports cardiology and calls for a paradigm shift in approach that encompasses 3 key principles: race-conscious awareness, clinical inclusivity, and research-driven refinement of clinical practice. These proposed principles call for a shift away from race-based assumptions towards individualized, health-focused care in sports cardiology. This shift would include fostering awareness of sociopolitical constructs, diversifying the medical team workforce, and conducting diverse, evidence-based research to better understand disparities and address inequities in sports cardiology care. Conclusions and Relevance In sports cardiology, inadequate consideration of the impact of structural racism and SDOH on racial disparities in health outcomes among athletes has resulted in potential biases in current normative standards and in the clinical approach to the cardiovascular care of athletes. An evidence-based approach to successfully address disparities requires pivoting from outdated race-based practices to a race-conscious framework to better understand and improve health care outcomes for diverse athletic populations.
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Affiliation(s)
- Sheela Krishnan
- Cardiovascular Services, Division of Cardiology, Maine Medical Center, Portland
| | - James Sawalla Guseh
- Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston
| | - Merije Chukumerije
- Sports and Exercise Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Cedars-Sinai Medical Group, Los Angeles, California
| | | | - Peter N Dean
- Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia, Charlottesville
| | - Jeffrey J Hsu
- Department of Medicine (Cardiology), David Geffen School of Medicine, University of California, Los Angeles
| | - Mustafa Husaini
- Division of Cardiovascular Medicine, Department of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Dermot M Phelan
- The Gragg Center for Cardiovascular Performance, Atrium Health Sanger Heart & Vascular Institute, Charlotte, North Carolina
| | - Ankit B Shah
- Sports & Performance Cardiology, Georgetown University School of Medicine, Chevy Chase, Maryland
| | - Katie Stewart
- Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston
| | - Meagan M Wasfy
- Division of Cardiology, Massachusetts General Hospital, Boston
| | - Quinn Capers
- Department of Medicine, The University of Texas Southwestern Medical Center, Dallas
| | - Utibe R Essien
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Amber E Johnson
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian, Dallas
- Department of Medicine and Cardiology, The University of Texas Southwestern Medical Center, Dallas
| | - Jonathan H Kim
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
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Ferrari F, da Silveira AD, Ziegelmann PK, Aleixo H, Dilda GD, Emed LGM, Magalhães FCO, Cardoso FB, da Silva HC, Guerra FEF, Soares LG, Bassan F, Braga F, Herdy AH, Froelicher V, Stein R. Imaging associations enhance the understanding of ECG abnormalities in male Brazilian football players: findings from the B-Pro Foot ECG study. Br J Sports Med 2024; 58:598-605. [PMID: 38621858 DOI: 10.1136/bjsports-2023-108053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES To evaluate the prevalence of abnormal ECG findings and their association with imaging results in male Brazilian football players. METHODS The 'B-Pro Foot ECG' is a multicentre observational study conducted in 82 Brazilian professional clubs. It analysed 6125 players aged 15-35 years (2496 white, 2004 mixed-race and 1625 black individuals) who underwent cardiovascular screening from 2002 to 2023. All ECGs were reviewed by two experienced cardiologists in the athlete's care. Those with abnormal findings underwent further investigations, including a transthoracic echocardiogram (TTE). Cardiac magnetic resonance (CMR) was subsequently performed based on TTE findings or clinical suspicion. RESULTS In total, 180 (3%) players had abnormal ECGs and 176 (98%) showed normal TTE results. Athletes aged 26-35 years had a higher prevalence of abnormal ECGs than younger athletes (15-25 years). Black players had a higher prevalence of T-wave inversion (TWI) in the inferior leads than white players (2.6% vs 1.4%; p=0.005), as well as in V5 (2.9%) and V6 (2.1%) compared with white (1.2% and 1.0%; p<0.001) and mixed-race (1.5% and 1.2%; p<0.05) players, respectively. TTE parameters were similar across ethnicities. However, four out of 75 players with inferolateral TWI showed abnormal TTEs and CMR findings consistent with cardiomyopathies. CMR also showed cardiomyopathies or myocarditis in four players with inferolateral TWI and normal TTEs. In total, nine (0.1%) athletes were diagnosed with cardiac diseases and were followed for 40±30 months, with no cardiac events documented. CONCLUSION This study found a 3% prevalence of abnormal ECGs in male Brazilian football players. Inferolateral TWI was associated with cardiac pathologies confirmed by CMR, even in athletes with a normal TTE.
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Affiliation(s)
- Filipe Ferrari
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Exercise Cardiology Research Group (CardioEx), Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Anderson D da Silveira
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Exercise Cardiology Research Group (CardioEx), Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Science, Health and Performance Department, Grêmio Foot-Ball Porto Alegrense, Porto Alegre, RS, Brazil
| | - Patrícia K Ziegelmann
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Graduate Program in Epidemiology, Department of Statistics, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Haroldo Aleixo
- Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Luiz G M Emed
- Instituto de Neurologia de Curitiba, Curitiba, PR, Brazil
| | | | | | | | | | - Luciano G Soares
- Clínica Biocorfit Reabilitação Cardíaca Pulmonar e Metabólica, Goiânia, GO, Brazil
| | - Fernando Bassan
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brazil
| | - Fabrício Braga
- Laboratorio de Performance Humana, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Artur H Herdy
- Instituto de Cardiologia de Santa Catarina, Florianópolis, SC, Brazil
| | - Victor Froelicher
- Department of Cardiovascular Medicine, Stanford University, Palo Alto, CA, USA
| | - Ricardo Stein
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Exercise Cardiology Research Group (CardioEx), Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Internal Medicine Department, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Janssen SLJE, de Vries F, Mingels AMA, Kleinnibbelink G, Hopman MTE, Mosterd A, Velthuis BK, Aengevaeren VL, Eijsvogels TMH. Exercise-induced cardiac troponin release in athletes with versus without coronary atherosclerosis. Am J Physiol Heart Circ Physiol 2024; 326:H1045-H1052. [PMID: 38363583 PMCID: PMC11279743 DOI: 10.1152/ajpheart.00021.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 02/17/2024]
Abstract
The magnitude of exercise-induced cardiac troponin (cTn) elevations is dependent on cardiovascular health status, and previous studies have shown that occult coronary atherosclerosis is highly prevalent among amateur athletes. We tested the hypothesis that middle-aged and older athletes with coronary atherosclerosis demonstrate greater cTn elevations following a controlled endurance exercise test compared with healthy peers. We included 59 male athletes from the Measuring Athletes' Risk of Cardiovascular events 2 (MARC-2) study and stratified them as controls [coronary artery calcium score (CACS) = 0, n = 20], high CACS [≥300 Agatston units or ≥75th Multi-Ethnic Study of Atherosclerosis (MESA) percentile, n = 20] or significant stenosis (≥50% in any coronary artery, n = 19). Participants performed a cycling test with incremental workload until volitional exhaustion. Serial high-sensitivity cTn (hs-cTn) T and I concentrations were measured (baseline, after 30-min warm-up, and 0, 30, 60, 120, and 180 min postexercise). There were 58 participants (61 [58-69] yr) who completed the exercise test (76 ± 14 min) with a peak heart rate of 97.7 [94.8-101.8]% of their estimated maximum. Exercise duration and workload did not differ across groups. High-sensitivity cardiac troponin T (Hs-cTnT) and high-sensitivity cardiac troponin I (hs-cTnI) concentrations significantly increased (1.55 [1.33-2.14]-fold and 2.76 [1.89-3.86]-fold, respectively) over time, but patterns of cTn changes and the incidence of concentrations >99th percentile did not differ across groups. Serial sampling of hs-cTnT and hs-cTnI concentrations during and following an exhaustive endurance exercise test did not reveal differences in exercise-induced cTn release between athletes with versus without coronary atherosclerosis. These findings suggest that a high CACS or a >50% stenosis in any coronary artery does not aggravate exercise-induced cTn release in middle-aged and older athletes.NEW & NOTEWORTHY Exercise-induced cardiac troponin (cTn) release is considered to be dependent on cardiovascular health status. We tested whether athletes with coronary atherosclerosis demonstrate greater exercise-induced cTn release compared with healthy peers. Athletes with coronary atherosclerosis did not differ in cTn release following exercise compared with healthy peers. Our findings suggest that a high CACS or a >50% stenosis in any coronary artery does not aggravate exercise-induced cTn release in middle-aged and older athletes.
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Affiliation(s)
- Sylvan L J E Janssen
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Femke de Vries
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alma M A Mingels
- Department of Clinical Chemistry, Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Geert Kleinnibbelink
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria T E Hopman
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arend Mosterd
- Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vincent L Aengevaeren
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thijs M H Eijsvogels
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Ilodibia TF, Riding N. Anterior T-wave inversion in black athletes: an African perspective. Br J Sports Med 2024; 58:295-296. [PMID: 38290797 DOI: 10.1136/bjsports-2023-107585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 02/01/2024]
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