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Comparison of Frequency of Significant Electrocardiographic Abnormalities in Endurance Versus Nonendurance Athletes

https://doi.org/10.1016/j.amjcard.2014.01.438Get rights and content

Most data assessing the accuracy of electrocardiographic (ECG) screening in identifying cardiac pathology in athletes are derived from relatively unselected cohorts of subjects involved in competitive sports. We hypothesized that the prevalence of ECG abnormalities may be greater in athletes performing the greatest combination of exercise intensity and duration, namely professional endurance athletes. A total of 1,007 male and 254 female elite adult athletes underwent cardiovascular screening inclusive of an electrocardiogram, interpreted using the 2010 European Society of Cardiology guidelines. Training-related ECG changes (group 1) were more common in endurance athletes (EAs) than nonendurance athletes (NEAs; 90.8% vs 86.0%, p = 0.04), as were multiple (≥2) training-related changes (78.9% vs 53.5%, p <0.0001). Group 2 ECG changes (previously considered uncommon and training unrelated) were seen in 18.1% of subjects and were twice as prevalent in EAs compared with NEAs (29.9% vs 15.1%, p <0.0001). Right ventricular hypertrophy (4.4% EAs vs 1.5% NEAs, p <0.005) and deep right precordial T-wave inversion (14.3% EAs vs 4.7% NEAs, p <0.0001) were 3 times as common in EAs. Both group 1 and group 2 changes were similarly prevalent among elite male and female athletes and were more common in EAs regardless of gender. In conclusion, ECG abnormalities are very common in elite athletes and are more common in EAs than NEAs. Right ventricular hypertrophy and deep right precordial T-wave inversion are particularly common in EAs, possibly because of increased structural and/or electrical right ventricular remodeling in this subgroup. The predictive value of ECG screening and criteria for abnormal findings in elite EAs requires specific appraisal.

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Methods

In 2011, the investigators contacted a variety of Australian sporting organizations currently undertaking, or wishing to undertake, ECG screening and invited athletes to participate in this study. From June 2011 to June 2013, a total of 1,381 elite athletes underwent cardiovascular screening inclusive of a 12-lead electrocardiography at rest, clinical history and examination, and collection of morphometric and demographic data. Athletes aged from 16 to 35 years were included. In 23 athletes who

Results

All athletes were nationally or internationally competitive, with 62% having represented Australia at the Olympic Games, world championships, or other international events and 36% competing in Australian Rules football at the highest level. They competed in a variety of sporting disciplines, 251 (20%) classified as endurance and 1,010 (80%) as nonendurance (Figure 1). Of the 1,261 athletes, 254 (21.1%) were women. A total of 1,078 (85.5%) were Caucasian, 149 (11.8%) of indigenous Australian,

Discussion

In this, the first study to directly compare large numbers of truly elite endurance athletes and NEAs, we found that training-related ECG changes were significantly more common in EAs than NEAs, consistent with the hypothesis that more profound physiological cardiac adaptation (athlete's heart) in response to endurance exercise may be reflected on the electrocardiogram. Group 1 ECG changes were present in the vast majority of sportsmen and sportswomen and were both more prevalent and more

Acknowledgment

The authors thank the following people for their interest and invaluable organizational assistance during this study: Dr Anik Shawdon, MBBS, Dr Larissa Trease, MBBS, Dr Geoffrey Verrall, MBBS, and Dr David T. Martin, PhD.

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