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Electrical and structural adaptations of the paediatric athlete’s heart: a systematic review with meta-analysis
  1. Gavin McClean1,2,
  2. Nathan R Riding1,
  3. Clare L Ardern1,3,4,
  4. Abdulaziz Farooq1,
  5. Guido E Pieles5,6,
  6. Victoria Watt7,
  7. Carmen Adamuz7,
  8. Keith P George2,
  9. David Oxborough2,
  10. Mathew G Wilson1,2,8
  1. 1 Athlete Health and Performance Research Centre, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  2. 2 Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
  3. 3 Division of Physiotherapy, Linköping University, Linköping, Sweden
  4. 4 School of Allied Health, La Trobe University, Melbourne, Australia
  5. 5 National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit, Congenital Heart Unit, Bristol Royal Hospital for Children and Bristol Heart Institute, Bristol, UK
  6. 6 School of Clinical Sciences, University of Bristol, Bristol, UK
  7. 7 Department of Sports Medicine, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  8. 8 Research Institute of Sport and Exercise Sciences, University of Canberra, Australia
  1. Correspondence to Professor Mathew G Wilson, Athlete Health and Performance Research Centre, ASPETAR Qatar Orthopaedic and Sports Medicine Hospital, PO BOX 29222, Doha, Qatar; mathew.wilson{at}


Aim To describe the electrocardiographic (ECG) and echocardiographic manifestations of the paediatric athlete’s heart, and examine the impact of age, race and sex on cardiac remodelling responses to competitive sport.

Design Systematic review with meta-analysis.

Data sources Six electronic databases were searched to May 2016: MEDLINE, PubMed, EMBASE, Web of Science, CINAHL and SPORTDiscus.

Inclusion criteria (1) Male and/or female competitive athletes, (2) participants aged 6–18 years, (3) original research article published in English language.

Results Data from 14 278 athletes and 1668 non-athletes were included for qualitative (43 articles) and quantitative synthesis (40 articles). Paediatric athletes demonstrated a greater prevalence of training-related and training-unrelated ECG changes than non-athletes. Athletes ≥14 years were 15.8 times more likely to have inferolateral T-wave inversion than athletes <14 years. Paediatric black athletes had significantly more training-related and training-unrelated ECG changes than Caucasian athletes. Age was a positive predictor of left ventricular (LV) internal diameter during diastole, interventricular septum thickness during diastole, relative wall thickness and LV mass. When age was accounted for, these parameters remained significantly larger in athletes than non-athletes. Paediatric black athletes presented larger posterior wall thickness during diastole (PWTd) than Caucasian athletes. Paediatric male athletes also presented larger PWTd than females.

Conclusions The paediatric athlete’s heart undergoes significant remodelling both before and during ‘maturational years’. Paediatric athletes have a greater prevalence of training related and training-unrelated ECG changes than non-athletes, with age, race and sex mediating factors on cardiac electrical and LV structural remodelling.

  • Paediatrics
  • Athlete’s heart
  • Cardiology

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  • Contributors GM, NRR, CLA and MGW contributed to the conception and design of the review. GM applied the search strategy. GM, NRR and MGW applied the selection criteria. GM and NRR completed assessment of risk of bias. GM, CLA and AF analysed the data. All authors contributed to data interpretation. GM and MGW wrote the manuscript. NRR, CLA, AF, GEP, VW, CA, KPG and DO critically revised the manuscript for important intellectual content. GM and MGW are responsible for the overall content as guarantors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.