Follow-up results of three athletes presenting with an abnormal ECG on initial screening
| Athlete | Symptoms | FH of SCD (<35 year) | ECG abnormality | Echocardiogram | Exercise Stress Test and 24 h Holter ECG | CMR | Screened first-degree relatives | Diagnosis |
|---|---|---|---|---|---|---|---|---|
| (1) 19-year-old West-Asian footballer (1.99 m2 BSA) | No | No | RAE, profound voltage (77 mm), Q waves in II, III, aVF, T wave inversion in I, II, III, aVL, aVF and ST segment depression in II, III and aVF | Subaortic IVSd bulge of 20 mm, without obstruction of the outflow tract | No arrhythmia during exercise with appropriate BP response. Few monomorphic PVB on Holter monitoring | Asymmetric septal hypertrophy with a maximal septal wall thickness of 20 mm versus lateral wall of 11 mm without obstruction. No LGE, oedema or systolic dysfunction | Father's ECG and Echo confirmed HCM | Non-obstructive HCM |
| (2) 29-year-old Black African-American basketball player (2.35 m2 BSA) | No | No | Profound voltage in V3, deep T wave inversion in V6 | Normal apart from max wall thickness of 13.6 mm | No arrhythmia during exercise with appropriate BP response | Mild asymmetric hypertrophy of IVSd without obstruction (basal 8 mm, mid 15 mm, apical 9 mm), associated with significant mid-septum transmural fibrosis | Not available | Non-obstructive HCM |
| No arrhythmia on Holter | ||||||||
| (3) 27-year-old West-Asian Futsal player (1.75 m2 BSA) | No | No | Profound voltage in V4 (59 mm), T wave inversion in II, III, aVF, V2–V6 and ST segment depression in V4–V5 | Normal (max wall thickness 8.2 mm) | No arrhythmia during exercise with appropriate BP response | Apical segments are disproportionally thickened, increased basal and septal wall thickness. No LGE, oedema or systolic dysfunction | Not available | Mild variant of apical HCM |
| No arrhythmia on Holter |
BP, blood pressure; BSA, body surface area; CMR, cardiac magnetic resonance imaging; FH, family history; HCM, hypertrophic cardiomyopathy; IVSd, intraventricular septum in diastole; LGE, late gadolinium enhancement; PVB, premature ventricular beats; RAE, right atrial enlargement; SCD, sudden cardiac death.